Hemorrhagic fever with renal syndrome

Hemorrhagic fever with the presence of renal syndrome is an acute zoonotic viral natural focal disease, accompanied by a strong fever and kidney failure. RNA viruses cause it, distributed mainly in the East, as well as in the western regions of Europe. This virus is the most dangerous, and the mortality rate for the incidence of this pathology is approximately 20%.

Causes and pathogenesis

Hemorrhagic fever viruses enter the body from vector rodents, which can be domestic and field rats, mice, jerboas. They, as a rule, become infected from each other by airborne droplets and transmit the infection in a latent form. There are several ways of infection with this human infectious disease:

1. Contact, for example, in direct contact with rodents or their excrement.
2. Air-dust - when breathing in air, in which there are tiny particles of dried rodent stool.
3. Fecal-oral - by swallowing a dirty write, which contains particles of excrement of these types of rodents.

Description of the disease

A person is susceptible to the causative agent of this pathology in 100% of cases. The most affected by this disease, accompanied by renal syndrome, men from 20 to 60 years.

Hemorrhagic fever of this kind is characterized by seasonality and the presence of specific endemic territories. The peak incidence is observed from the beginning of summer to the end of autumn. In Russia, the highest incidence rate of this viral infectious pathology with renal syndrome has been recorded in such regions as Tatarstan, Udmurtia, Bashkortostan, Samara and Ulyanovsk Regions.

Frequent cases of the disease are also recorded in the Volga region and in broad-leaved zones of the Urals. To a slightly lesser extent, cases of pathology were recorded in Eastern Siberia.

Once carried over hemorrhagic fever accompanied by renal syndrome gives stable immunity until the end of life.

The virus that causes this disease in the human body settles on the mucous membranes of the respiratory and digestive systems, where it begins to multiply actively and penetrate the blood. During this period, the patient has a pronounced intoxication syndrome, which is due to the penetration of this type of infection into the bloodstream. In the future, this virus is localized on the inner walls of the vessels and violates their integrity. The patient develops acute hemorrhagic syndrome. Viruses are eliminated from the body through the urinary system, so the following clinical picture develops:

1. Damage to the renal vessels.
2. The inflammatory process and swelling of the kidney tissue.
3. The development of acute renal failure.

This period of the pathological process is the most dangerous and is characterized, as a rule, by a fatal outcome. In more favorable cases, the reverse process begins to form in the form of resorption of hemorrhages, restoration of excretory function of the kidneys. The duration of this recovery period with hemorrhagic fever can be, as a rule, from one year to three years.

Varieties of the pathological process

To date, there is no single classification of hemorrhagic fever with renal syndrome. However, depending on the territories in which the outbreak of the disease is registered, the following forms are distinguished:

1. Yaroslavskaya
2. Transcarpathian.
3. Ural.
4. Tula.
5. Far Eastern.
6. Korean uniform.

Crimea-Congo

Congo-Crimean hemorrhagic fever is an acute focal infectious disease. The causative agent of this pathology is RNA neurovirus. Pathogenic microorganisms are localized in the cytoplasm. Until the end, pathogenesis has not yet been studied.

The virus in the Congo-Crimean hemorrhagic fever affects the human body very selectively. That is, it accumulates in the cells of various organs, leading to increased blood supply, which provokes hemorrhages of varying degrees, the appearance of blood clots and impaired blood circulation. A subsequent massive attack damages the hypothalamus of the brain and adrenal cortex.

Crimean hemorrhagic fever is difficult to recognize in the early stages. This is fraught with death. That is why infectious disease specialists around the world pay maximum attention to the detection of the disease.

The clinical classification of the Crimean hemorrhagic fever has not been developed, therefore, the stages are conditionally divided into:

• First stage;
• hemorrhagic period;
• convalescence (when a person recovers on his own, but dysfunction of some systems is detected in him).

In addition, there are no symptoms in the incubation period of the disease.

Omsk hemorrhagic fever is a natural focal transmissible viral infection characterized by hemorrhagic reactions with a primary lesion of the respiratory system and central nervous system. It occurs with high fever, severe pain in the head, myalgia, bleeding, bronchitis, pneumonia, cerebral and meningeal phenomena.

Depending on the type of RNA virus that caused the development of the disease, there are:

1. The western type of hemorrhagic fever, which is provoked by the Puumala virus and is accompanied by severe course, oligoanuria and hemorrhagic syndrome in 10% of cases. Mortality is approximately 1-2%.
2. The eastern type of the disease is usually caused by the Hantaan virus. In 40-45% of cases, a very severe course of the disease is observed, accompanied by acute renal failure and hemorrhagic symptoms. Mortality is about 8% of cases of the disease.
3. Hemorrhagic fever caused by a serotype of the Seoul virus. The course of the disease is relatively mild in almost half the cases and is accompanied by the development of hepatitis and disorders of the respiratory system.

Infection methods

There are six methods of infection with hemorrhagic fever, but they are united by human contact with a virus that enters the environment from saliva and rodent feces:

1. Forest type - during the collection of mushrooms or berries in contact with infected dried feces of sick rodents.
2. Household type - when using household items.
3. Production type - when carrying out work in the forest zone, at oil pipelines in taiga regions, at drilling rigs, etc.
4. Cottage type - when cultivating land in gardens and cottages.
5. Camp type - in camps, on vacation in tents, etc. (mainly children are infected this way).
6. Agricultural - people become infected in the fields, the peak of activity is autumn / winter.

Symptoms and stages of the disease

The symptomatic nature of hemorrhagic fever with renal syndrome varies depending on what stage it is at. There are only four such stages, and each of them is characterized by alternating cycles. In other words, after a certain time after the fourth stage, the first one can begin again, etc.

Only a disease caused by the Seoul serotype can be characterized by acyclicity. The incubation periods for this infectious pathology with renal syndrome have a duration of about 2 weeks. Symptoms of hemorrhagic fever in this period are not significantly manifested.

The febrile, or initial, period of the disease lasts no more than 7 days, and most often about three days. The disease begins acutely and is characterized by an increase in the patient's body temperature to 39-40 degrees. The patient feels severe headaches, muscle and back pains, general malaise, thirst and dry mouth, flickering flies in front of the eyes and blurred vision. During this period, minor hemorrhages on the mucous membrane of the palate and sclera can be noted.

The oliguric stage of fever lasts about a week. The temperature decreases, but the condition begins to gradually deteriorate. There are nosebleeds, bruising on the body, sclera. In the chest area, as well as in the armpits and on the legs, a pronounced red rash forms, which is caused by numerous capillary ruptures. There is also an increase in patient complaints of acute pain in the back and abdomen. Daily urine volume is reduced. In some cases, there is an increase in liver in size.

The polyuric period of hemorrhagic fever symptoms begins on the 10th day. Urine volume increases dramatically and can reach 6 liters in 24 hours. Its low density is also found, which is the main sign of acute kidney failure.

The reconvalescence period of viral hemorrhagic fever is the longest, and it begins on the 20th day, and lasts six months. This stage is characterized by an improvement in the patient's condition and normalization of renal function. Recovery in mild disease is observed in some cases after a month, and with moderate severity after 6 months. In patients who have suffered severe stages of hemorrhagic fever, asthenic syndrome can remain for life.

Acute kidney failure

Symptoms of various manifestations of hemorrhagic fever affect the urinary system and seriously impair its activity.

The three main syndromes of this disease have a different degree of manifestation, depending on how severe the disease is. They are considered:

• intoxication;
• renal;
• hemorrhagic.

This infectious disease with the presence of mild renal syndrome manifests itself in the form of the following disorders:

1. By raising the temperature to 38 degrees (three days).
2. Headache.
3. Temporary agnosia.
4. Decreased urine output.
5. Spot hemorrhages.
6. In laboratory tests of urine, an increase in the level of proteins and urea is detected.
7. Agnosia.

The average degree of hemorrhagic fever is characterized by:

1. An increase in body temperature to 39 degrees (five days).
2. Pretty strong cephalalgia.
3. Hemorrhages on the skin and mucous membranes, which are usually multiple in nature.
4. Periodic bouts of vomiting, in which blood impurities are observed.
5. An increase in heart rate, which is the initial stage of an infectious toxic shock.
6. Oliguria, which lasts 3-5 days.
7. In laboratory tests of urine, an increase in the level of proteins, creatinine and urea is noted.

Severe hemorrhagic fever is accompanied by:

1. By raising the temperature to 40-41 degrees (eight days).
2. Repeated attacks of vomiting with blood.
3. Systemic hemorrhages of the skin and mucous membranes.

Signs of infectious intoxication of the body with hemorrhagic fever with renal syndrome are:

• digestive disorders;
• signs of weakness;
• insomnia;
• proteinuria;
• hematuria;
• oliguria;
• increased levels of urea and creatinine.

The disease affects people of all ages, even infants. The course of the pathology is characterized by an acute onset, which may not be preceded by a variety of symptoms.

Diagnosis of hemorrhagic fever

To determine the exact diagnosis, it is extremely important to take into account the patient's history, as well as the presence of certain clinical manifestations of the disease and the data of serological and laboratory studies. If necessary, it may be necessary to conduct an ultrasound scan, CT scan, computed tomography, or X-ray examination.

If symptoms of this disease with the accompanying renal failure occur, the patient determines the probability of contact with field mice and other rodents that are carriers of this disease. The clinical picture of hemorrhagic fever is characterized by fever, redness of the skin of the neck, face and head. In addition, hemorrhagic syndrome and signs of renal failure after lowering body temperature can be observed.

Diagnosis of this pathological process is carried out through the following laboratory and serological studies:

1. General tests of urine and blood.
2. Indirect immunofluorescence reactions.
3. Radioimmune analysis.
4. Passive hemagglutination reactions.

In the blood of a person with hemorrhagic fever, there is a marked decrease in the number of leukocytes (at the initial stage), which is accompanied by a sharp increase in temperature. In the subsequent stages of infectious pathology, an increase in ESR, thrombocytopenia and neutrophilic leukocytosis, as well as the appearance of plasma in the patient’s blood, is noted. His development of antibodies to the virus can be diagnosed on the 7th day, and their maximum is observed on about the 14th day.

Hemorrhagic fever accompanied by renal syndrome is similar in course to other diseases characterized by fever, such as typhoid fever, encephalitis, tick-borne rickettsioses, leptospirosis, and ordinary flu. This means that in identifying a pathology, differential diagnostic methods are very important.

Hemorrhagic fever treatment

Therapy is carried out exclusively in the hospital ward of the infectious diseases hospital. The patient is required to bed rest, especially in the acute period of the disease, characterized by hyperthermia. In addition, food containing a large amount of carbohydrates with the exception of fish and meat is shown. Treatment, which is aimed at eliminating the root cause of the pathological process, can have a positive effect already in the first five days of the disease.

As a rule, medication is prescribed with medications that can inhibit RNA synthesis. In addition, the patient is treated with human immunoglobulin, alpha-interferons are prescribed rectally and orally, which stimulate the production of natural interferons.

Interferon

This infectious disease is characterized by a variety of pathogenic changes in internal organs. This means that the main therapeutic measures are aimed at eliminating these pathogenic changes, which are usually caused by severe intoxication syndrome in the body and kidney failure and hemorrhagic syndrome. Patients in such cases are assigned:

1. Glucose and some polyionic solutions.
2. Calcium and Vitamin C.
3. "Papaverine".
4. "Eufillin."
5. "Heparin."
6. Diuretic drugs, etc.

Papaverine

In addition to the above therapeutic agents, patients with hemorrhagic fever syndrome are prescribed treatment, which is aimed at lowering the body's sensitivity to a specific type of virus that caused this disease. Symptomatic therapy includes the elimination of attacks of vomiting, pain, as well as the restoration of the activity of the heart and blood vessels.

In severe illness, patients are shown hemodialysis and some other ways to normalize hemodynamics and blood clotting disorders.

During the recovery period after the disease, patients need a restorative treatment, good nutrition and maintaining immunity. They can also be prescribed physiotherapy, physiotherapy exercises and massage. What is the prevention of hemorrhagic fever?

Disease Forecast and Prevention

If the patient is given adequate therapy in a timely manner, even at the stage of the onset of febrile syndrome, then recovery usually occurs very quickly. Nevertheless, in most cases, after hemorrhagic fever accompanied by renal syndrome, residual effects are noted for some time. These manifestations include:

1. Asthenic symptoms that manifest in the form of weakness, fatigue, etc.
2. Painful disorders of the kidneys, characterized by swelling of the face, dry mouth, lumbar pain, polyuria.
3. Violations of the functions of the endocrine and nervous systems in the form of pleurisy, pituitary cachexia, etc.
4. The development of cardiomyopathy after an infectious disease in the form of shortness of breath, heart pain, tachycardia, etc.
5. In rare cases, the development of chronic pyelonephritis occurs.

Chronic kidney inflammation

People who have had hemorrhagic fever need constant monitoring by a nephrologist, infectious disease specialist and an ophthalmologist, which avoids many serious consequences from some body systems.

The severe course of such a pathological process is dangerous because there is a risk of complications, which in almost 10% of cases lead to death.

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