Hemorrhagic fever with renal syndrome

Hemorrhagic fever with presence of renal syndrome is an acute, zoonotic viral natural focal disease, accompanied by severe fever and renal failure. Call it RNA viruses distributed mainly in the East and in the Western regions of Europe. These virus is most dangerous, and the mortality in the incidence of this pathology is approximately 20 %.

Causes and pathogenesis

The hemorrhagic fever Viruses enter the body from rodents vectors, which can be domestic and field rats, mice, gerbils. They usually become infected from each other by airborne droplets way and carry the infection in a latent form. Tract infection according to infectious human disease there are several:

1. Contact, e.g. in direct contact with rodents or their excrement.
2. Air-dust - inhalation of air containing tiny particles of dried rodent excreta.
3. Fecal-oral-ingestion through dirty write, which contains particles of feces of these rodents.

Description of the disease

A Person susceptible to the causative agent of this disease in 100% of cases. Most are suffering from this disease accompanied by renal syndrome, men from 20 to 60 years.

For hemorrhagic fever such type is characterized by seasonality and availability of specific endemic areas. The peak incidence is noted from early summer to late autumn. In Russia the highest incidence of this viral infectious pathology with renal syndrome were recorded in regions such as Tatarstan, Udmurtia, Bashkortostan, Samara and Ulyanovsk region.

There are Frequent cases of disease are registered in the Volga region and in the deciduous zones of the Urals. In a slightly lesser degree the pathologies recorded in Eastern Siberia.

Once Migrated hemorrhagic fever accompanied by renal syndrome gives strong immunity to the end of life.

The Virus that causes this disease in the human body is deposited in the mucous membranes of the respiratory and digestive systems, where it begins to proliferate actively and to enter the blood stream. During this period the patient has a pronounced intoxication syndrome, which is caused by the penetration into the bloodstream this type of infection. Further, the virus is localized in the inner walls of blood vessels and disrupts their integrity. The patient develops acute hemorrhagic syndrome. The viruses are excreted through the urinary system, therefore, is the development of the following clinical picture:

1. Renal vessels.
2. Inflammation and edema of the tissues of the kidneys.
3. The Development of acute renal failure.

This period the pathological process is characterized by the most dangerous and usually fatal. In more favourable cases, begins to form a reverse process in the form of resorption of hemorrhage, restoration of renal excretory function. The duration of this recovery period in hemorrhagic fever may range generally from one year to three years.

Varieties of the pathological process

Today there is no uniform classification of hemorrhagic fever with renal syndrome. However, depending on which territories an outbreak of this disease, there are the following forms:

1. Jaroslavl.
2. Zakarpattia.
3. The Urals.
4. Tul.
5. Far East.
6. Korean form.

Crimean-Congo

Crimean-Congo hemorrhagic fever is an acute natural focal infectious disease. The causative agent of this disease RNA nairovirus. Pathogenic microorganisms are localized in the cytoplasm. Until the end of the pathogenesis yet to be studied.

The Virus, Congo-Crimean hemorrhagic fever on the human body acts very selectively. That is, it accumulates in the cells of various organs, leads to increased blood supply, which causes hemorrhages of varying degrees, the appearance of blood clots and impaired blood circulation. The subsequent massive attack damaged the hypothalamus of the brain and the adrenal cortex.

Crimean haemorrhagic fever is difficult to recognize in the early stages. It is fraught with death. That is why infectious diseases around the world focus maximum attention on the detection of the disease.

Clinical classification of Crimean hemorrhagic fever has not been developed, so the stage is conventionally divided into:

• The initial step;
• Hemorrhagic period;
• Convalescence (when a person is self recovering, but he has found dysfunction of some systems).

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

Omsk hemorrhagic fever called natural focal vector-borne viral infection characterised by haemorrhagic reactions, mainly affecting the respiratory system and Central nervous system. It occurs with high fever, severe painin my head, myalgia, bleeding, bronchitis, pneumonia, cerebral and meningeal phenomena.

Depending on the species of RNA virus, which caused the development of the disease, there are:

1. The Western type of hemorrhagic fever which caused by virus surroundings, and is accompanied by severe, oligoanuria and hemorrhagic syndrome in 10% of cases. Mortality is about 1-2 %.
2. Eastern type of the disease caused by the Hantaan virus. In 40-45 % of cases there is a very severe disease, accompanied by acute renal failure, and hemorrhagic symptoms. Mortality is about 8% of cases of the disease.
3. Hemorrhagic fever caused by the serotype of Seoul virus. The disease is relatively easy in almost half of cases and is accompanied by development of hepatitis and disorders of the organs of the respiratory system.

Methods of infection

Infections with hemorrhagic fever six, but they are United by the contact of a person with the virus entering the environment from saliva and feces of rodents:

1. Forest type – during the gathering of mushrooms and berries by contact with infected dried rodent feces patients.
2. Household type – in the use of everyday items.
3. Production type-when performing works in the forest area, on oil pipelines in the boreal areas, rigs, etc.
4. Country style – when the cultivation of the land for the gardens and cottages.
5. Camp type – in the camps, camping, etc. (mainly because infected children).
6. Agricultural – people get in the fields, the peak of activity – fall/winter.

Symptoms and stages of disease

Symptomatic specificity of hemorrhagic fever with renal syndrome varies depending on what stage it is in. A total of four such stages, and for each of them is characterized by alternation of cycles. In other words, after a certain time after the fourth stage again to attack the first, etc.

Acyclically can be characterized only disease caused by a serotype of Seoul. The incubation periods of the infectious disease with renal syndrome have a duration of about 2 weeks. Symptoms of hemorrhagic fever at this period does not significantly manifest.

A Frenetic first period of the disease lasts no more than 7 days, and most often about three days. Disease begins acutely and is characterized by an elevation of body temperature of the patient to 39-40 degrees. The patient feels severe headache, muscle and spinal pain, malaise, thirst, and dryness of the mouth, the flashes before the eyes of flies and blurred vision. In this period may experience slight bleeding of the mucous membrane of the sky and the sclera.

Oliguric stage of fever lasts about a week. While the temperature is lowered, however, the condition begins gradually to deteriorate. Appear nasal bleeding, bruises on the body, the sclera. In the chest and in the armpits and on the legs formed a severe red rash, which is caused by numerous ruptures of the capillaries. There is also the stress of patient complaints acute back pain and abdomen. The daily urine volume is reduced. In some cases, liver enlargement is in size.

Politicheskii period symptoms of hemorrhagic fever starts about 10 days. Urine volume increases dramatically and can reach 6 liters in 24 hours. Found also its low density, which is the main sign of acute kidney failure.

Reconvalescent period of viral hemorrhagic fever is the longest, and it starts about 20 days, and lasts six months. This stage is characterized by improvement of the patient's condition and normalization of renal function. Recovery in mild disease is observed in some cases in a month, and with an average severity – 6 months. In patients who suffered severe stage of hemorrhagic fever, asthenic syndrome may remain for a lifetime.

Acute renal failure

Symptoms of the various manifestations of hemorrhagic fever affects the urinary system and seriously disrupts its activities.

The Three main syndrome of this disease have different degrees of manifestation depending on how hard the disease. They are:

• Intoxication;
• Kidney;
• Hemorrhagic.

The infectious disease with the presence of a renal syndrome of a mild degree manifested in the form of the following violations:

1. Fever up to 38 degrees (three days).
2. Headache.
3. Temporary agnosia.
4. Decreased urine output.
5. Petechial haemorrhages.
6. Laboratory testing of the urine revealed an increase in the level of proteins and urea.
7. Agnosia.

The Average degree of hemorrhagic fever is characterized by:

1. Increased body temperature to 39 degrees (five days).
2. Pretty strong cephalalgia.
3. Hemorrhages in the skin and mucous membranes, which are usually multiple in nature.
4. Periodic bouts of vomiting, in which there are impurities in the blood.
5. Increaseintensity of heart contractions, what is the initial stage of infectious toxic shock.
6. Oliguria that lasts 3-5 days.
7. In lab tests of urine show increased levels of protein, creatinine and urea.

Severe hemorrhagic fever is accompanied by:

1. Rise in temperature to 40-41 degrees (eight days).
2. Multiple bouts of vomiting with blood.
3. Systemic hemorrhages of the skin and mucous membranes.

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

• Indigestion;
• Signs of weakness;
• Insomnia,
• Proteinuria;
• Hematuria;
• Oliguria;
• Increased levels of urea and creatinine.

The Disease affected people of all ages, even infants. For pathology is characterised 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 important to consider history from the patient, and the presence of certain clinical manifestations of the disease and serological data and laboratory research. Where necessary you may need an ultrasound, EGD, CT scan or x-ray studies.

If you experience symptoms of this disease accompanied by renal failure in a patient specified probability of contacts with field mice and other rodents that are vectors 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, there may be a hemorrhagic syndrome and signs of renal failure after lowering the body temperature.

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

1. General urine and blood samples.
2. The reaction of indirect immunofluorescence.
3. Radioimmunoassay analysis.
4. The reaction of passive hemagglutination.

In the blood of a person sick with hemorrhagic fever, there is a marked reduction in the number of leukocytes (initially), accompanied by a sharp rise in temperature. At later stages of infectious disease marked increase in erythrocyte sedimentation rate, thrombocytopenia and leukocytosis, and the appearance of plasma in the blood of the patient. He development of antibodies to the virus can be diagnosed on the 7th day, and the maximum is observed approximately 14 days.

Hemorrhagic fever accompanied by renal syndrome similar for other diseases characterized by fever, such as typhoid fever, encephalitis, tick-borne ricketsiosis, leptospirosis and the flu. This means that the detection of pathology is a very important differential diagnostic methods.

Treatment of hemorrhagic fever

The Therapy is done exclusively in the Department of a hospital infectious diseases hospital. The patient required bed rest, especially in the acute phase of the disease characterized by hyperthermia. Furthermore, it is shown food containing large amounts of carbohydrates with the exception of fish and meat. Treatment, which is aimed at addressing the root causes of the pathological process, can have a positive effect already on the first five days of illness.

Granted, as a rule, medication medicines, which are able to inhibit RNA synthesis. In addition, the patient is therapy with human immunoglobulin, rectal and oral are assigned to alpha interferons, which stimulate the production of natural interferons.

Interferon

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

1. Glucose and some poligonnye solutions.
2. Calcium and vitamin C.
3. “Papaverine”.
4. “Aminophylline”.
5. “Heparin".
6. Diuretic drugs, etc.

Papaverine

In addition to the above therapeutic agents, patients with the syndrome of hemorrhagic fever treatment, which is aimed at the reduction of sensitivity of an organism to a particular type of virus that caused the disease. Symptomatic therapy includes elimination of vomiting, pain, and recovery activities of the heart and blood vessels.

In severe disease, patients are shown hemodialysis and some other ways of normalization of hemodynamics and blood coagulation disorders.

In the period of recovery after disease, patients require restorative treatment, good nutrition and immune support. They can also be assigned physiotherapy, therapeutic physical exercises and massage. What is the prevention of hemorrhagic fever?

Prognosis and prevention

Ifthe patient in a timely manner, at the stage of emergence of feverish syndrome, is adequate therapy, the recovery occurs, as a rule, very quickly. However, in most cases with hemorrhagic fever accompanied by renal syndrome marked residual effects for some time. Such manifestations include:

1. Asthenic symptoms that manifest as weakness, fatigue, etc.
2. Painful disorders of the kidneys, characterized by swelling of the face, dry mouth, lumbar pain, polyuria.
3. Disorders of the endocrine and nervous systems in the form of pleurisy, pituitary cachexia, etc.
4. Development of cardiomyopathy after infectious diseases in the form of shortness of breath, cardiac pain, tachycardia, etc.
5. In rare cases, there is the development of chronic pyelonephritis.

Chronic inflammation of the kidneys

People who have been ill with hemorrhagic fever, in need of constant follow-up by a nephrologist, infectious disease specialist and an ophthalmologist, which allows to avoid many serious consequences by some systems of the body.

Heavy for such pathological process is dangerous because the risk of complications in almost 10% of cases lead to death.

Prevention of this infectious disease with the development of acute renal syndrome is in compliance with the rules of hygiene, especially for who live in the territories-endemic. Also should pay attention to hygiene procedures after visiting the forest, stay on the fields and garden plots, it is necessary to wash hands thoroughly and disinfect clothes. Food should be stored in special airtight containers.

To avoid infection with viruses that cause hemorrhagic fever accompanied by renal failure, you should drink only boiled water.

When performing works in a dusty environment, for example in the fields, in barns, etc., you need to wear a special protective mask or respirator to prevent infection by air.

You should Not take in hand or to pet rodents, and the feral parts of the need to conduct timely disinfestation and thorough cleaning of premises.

We reviewed the symptoms and treatment of hemorrhagic fevers. I hope this information was useful for you. Not get sick!