Signs of hemorrhagic fever with renal syndrome. Clinical signs of the disease

Initially, the diagnosis of HFRS is established on the basis of the clinical picture of the infection with a set of specific symptoms of the early (first week) stage of the disease: acute onset, fever, general toxicosis syndrome and hemodynamic disorders, then pain in the abdomen and lumbar region. The peak stage of the disease is characterized by the dominance of hemorrhagic syndrome and manifestations of acute renal failure (ARF). At the same time, the polymorphism and variability of symptoms, the lack of standardized characteristics of the leading syndromes do not allow the primary diagnosis of HFRS to be established clinically with reliable accuracy.
The clinical picture of HFRS, described by numerous authors from different regions of the world and associated with different hantaviruses, demonstrates the similarity of the main manifestations of the disease. The generalized nature of the infection with the involvement of various organs and systems in the pathological process determines the polymorphism of symptoms, regardless of the etiological agent (hantavirus serotype).
The disease is characterized by a cyclic course and a variety of clinical variants from abortive febrile forms to severe forms with massive hemorrhagic syndrome and persistent renal failure.
Distinguish the following periods of the disease. Incubation (from 1 to 5 weeks, on average 2-3 weeks), febrile (initial, general toxic), lasting an average of 3 to 7 days; oliguric (average 6-12 days), polyuric (average 6-14 days), convalescence period (early - up to 2 months and late - up to 2-3 years).
In the clinical picture of the disease, 6-7 main clinical and pathogenetic syndromes are distinguished:
1) general toxic;
2) hemodynamic (central and microcirculatory disorders);
3) renal;
4) hemorrhagic;
5) abdominal;
6) neuroendocrine;
7) respiratory syndrome.
A different combination of these syndromes characterizes each of the four periods of the disease. Symptoms of dysfunction of various organs involved in the infectious process are observed during all periods of the disease.
 Incubation period lasts from 4 to 49 days (most often from 14 to 21 days), while any clinical manifestations no. During this period, the HFRS virus is introduced into the body through the epithelium. respiratory tract, gastrointestinal tract, as well as through damaged skin. Further, the virus reproduces in the cells of the macrophage system. It causes the activation of factors of specific and non-specific protection, the adequacy of which, as well as the infectious dose, pathogenicity and virulence of the pathogen, determine both the fate of the virus itself and the severity of pathological changes in the patient's body.
1,3,1 Initial (feverish) period of HFRS.
The pathogenetic basis of the initial (feverish) period of HFRS is viremia, intoxication, activation of hormonal and immune systems, production of pro-inflammatory cytokines, massive vasopathy (associated with the tropism of hantavirus to the endothelium of microcirculation vessels), coagulopathy, microcirculation disorders, tissue destruction, the formation of autoantigens with the formation of autoantibodies (in severe HFRS).
In most patients with HFRS, the onset is acute. Chills, headache, pain in muscles, joints, dry mouth, thirst, sometimes a slight cough, severe general weakness appear. In a small proportion of patients, the appearance pronounced signs the disease is preceded by a prodromal period: general malaise, fatigue, subfebrile temperature.
Fever in most patients on the first day of illness reaches high numbers, lasts from 5-6 to 10-11 days, an average of 6-7 days. The temperature curve does not have a definite pattern, in most cases it decreases lytically over two to three days. In a mild form of the disease, there is a slight short-term fever, which is often seen by the patient.
An objective examination reveals pronounced hyperemia of the skin of the face, neck, upper half of the body, associated with autonomic disorders at the level of the centers of the cervical and thoracic spinal cord. Especially noticeable is the injection of the vessels of the sclera and conjunctiva, hyperemia of the oropharyngeal mucosa, the appearance of a spotted enanthema of the upper palate. It is possible to develop a hemorrhagic syndrome in the form of a petechial rash in the area of ​​the inner surfaces of both shoulders, the lateral surfaces of the body, on the chest (the symptom of "scourge, whip"), ecchymosis at the injection sites, and short nosebleeds. Positive endothelial symptoms (cuffs, "pinch, tourniquet") are determined. Arterial pressure is normal or with a tendency to hypotension, relative bradycardia is characteristic. Some patients note a feeling of heaviness in the lower back.
At the end of the initial period, the frequency of urination and a slight decrease in urine output decrease. Laboratory changes are characterized by a slight increase in serum levels of creatinine, urea, a decrease in the relative density (OD) of urine and the appearance of single fresh erythrocytes and proteinuria in its sediment. A blood test in most patients is characterized by moderate leukopenia and less often by slight leukocytosis and a stab shift to the left, signs of blood clotting against the background of plasmorrhea and hypovolemia in the form of an increase in the number of erythrocytes and hemoglobin. The pathognomonic symptom of HFRS in the early period is thrombocytopenia, caused by the damaging effect of the virus, the development of immunopathological reactions, an increase in the adhesive properties of platelets and the formation of cell aggregates with their retention in the microcirculation vessels, a violation of the rheological properties of the blood.
1,3,2 Oligouric period of HFRS.
During the oligouric period of HFRS (the height of the disease), systemic circulatory disorders, hypovolemia and hemoconcentration, hypoperfusion and hypoxia of organs, tissue acidosis and damage to vital body systems continue. The hypocoagulation phase of DIC predominates. Edema, hemorrhage, dystrophic and necrobiotic changes occur in the pituitary gland, adrenal glands, kidneys, myocardium and other parenchymal organs.
The greatest changes are observed in the kidneys, which is accompanied by a decrease in glomerular filtration, a violation of tubular reabsorption. Acute renal failure in HFRS is caused by damage to the renal parenchyma, acute interstitial nephritis. On the one hand, impaired microcirculation, increased permeability of the vascular wall contribute to plasmorrhea and serous hemorrhagic edema of the interstitium of the kidneys, mainly pyramids, followed by compression of the tubules and collecting ducts, leading to dystrophy, desquamation of the tubular epithelium, sweating of protein and fibrin with obstruction of the tubules and collecting ducts. tubes with fibrin clots and impaired reverse reabsorption of urine. On the other hand, the immunopathological factor is the fixation of immune complexes on the glomerular basement membrane, which reduces glomerular filtration. Interstitial edema enhances the violation of the microcirculation of the kidneys, up to ischemia, in some cases to necrosis of the renal tubules, contributes to a further decrease in glomerular filtration and tubular reabsorption. Tubular cells are especially sensitive to hypoxia, the lack of energy material that occurs during ischemia. Autoantibodies to damaged tissue structures may also be involved in the pathological process. Disorders in central hemodynamics (hypovolemia, decreased cardiac output, blood pressure) exacerbate renal blood flow disorders.
The oligouric period is the most striking period when unfolds clinical picture inherent in HFRS. Body temperature drops to normal, sometimes rising again to subfebrile numbers - a "two-humped" curve. However, the decrease in temperature is not accompanied by an improvement in the patient's condition, as a rule, it worsens. General toxic phenomena reach a maximum, signs of hemodynamic disturbances, renal failure, and hemorrhagic diathesis increase. The most constant sign of the transition to the oliguric period is the appearance of pain in the lower back of varying intensity: from unpleasant sensations of heaviness to sharp, painful, nausea, vomiting, not associated with food or medication, in severe cases, hiccups. Growing asthenia and adynamia. Many patients have pain in the abdomen, mainly in the umbilical and epigastric region. The face is hyperemic, with increasing renal failure, the blush is replaced by pallor, hemorrhagic manifestations intensify, mainly in severe cases of the disease - hemorrhages in the sclera, ecchymosis, nasal bleeding and gross hematuria, hematomas at the injection sites, less often - intestinal bleeding, blood in the vomit, hemoptysis. It is important in making a diagnosis to identify visual impairment (decrease in visual acuity, "flying flies", a feeling of fog before the eyes), due to a violation of microcirculation in the retina, appears on days 2-7 of illness and lasts for 2-4 days.
In most patients, at the beginning of the oliguric period, blood pressure is within the normal range, and in severe cases arterial hypotension develops, reaching the degree of severe collapse or infectious-toxic shock. In the second half of this period, in 1/3 of patients, arterial pressure (BP) increases, the duration of hypertension rarely exceeds 5 days. Absolute or relative bradycardia is characteristic. Vesicular hard breathing is heard over the lungs, single dry rales, wet rales can be determined, in especially severe cases, a picture of pulmonary edema or distress syndrome is observed.
On the 2-5th day of illness, 10-15% of patients develop diarrhea. Tongue dry, coated with gray or brown coating. The abdomen is moderately swollen, there is pain on palpation in the epigastric and umbilical regions, especially in the projection of the kidneys and sometimes diffuse. There may be signs of peritonism. The liver is enlarged and painful in 20-25% of patients. In isolated cases, signs of meningism may appear. Most of the specific complications of HFRS develop during this period.
Renal syndrome is one of the leading. Pasternatsky's symptom is positive or sharply positive, so check given symptom it is necessary to carry out with the utmost care, by light pressure in the region of the costovertebral points in order to avoid tearing the cortical substance of the kidneys. A detailed picture of acute renal failure is characterized by progressive oligoanuria, increasing uremic intoxication, impaired water and electrolyte balance, and increasing metabolic acidosis.
Violations of the activity of the central nervous system are observed in almost all patients and as manifestations of cerebral symptoms associated with intoxication, and as a result of focal lesions. It is possible to develop symptoms of meningism, encephalitic reactions with the appearance of shell symptoms (stiff neck, symptoms of Kernig, Brudzinsky), focal symptoms (corresponding to areas of brain damage), and mental disorders are observed (from sleep disturbance to various disorders of consciousness).
The hemogram naturally reveals neutrophilic leukocytosis (up to 15-30×109/l of blood), plasmacytosis, and thrombocytopenia. In severe cases, the blood picture is characterized by a leukemoid reaction. Due to thickening of the blood, the level of hemoglobin and red blood cells may increase, but with bleeding, these figures decrease. ESR is gradually accelerating. An increase in the level of residual nitrogen, urea, creatinine, as well as hyperkalemia, hypermagnesemia, hyponatremia and signs of metabolic acidosis are characteristic. IN general analysis urine there is massive proteinuria (up to 33-66 g / l), the intensity of which changes during the day (“protein shot”), hematuria, cylindruria, the appearance of renal epithelial cells (so-called Dunayevsky cells). From the second half of the oligouric period, hypostenuria develops.
Significant changes occur in the state of the blood coagulation system. While in one part of the patients hypercoagulation persists, in severe cases of the disease, hypocoagulation develops. It is caused by the consumption of plasma coagulation factors due to the formation of microthrombi in small vessels. It is in the oliguric period of HFRS that hemorrhagic manifestations reach their climax and often become the cause of death.
1,3,3 Polyuric period of the disease.
The period of polyuria begins on the 9th-13th and lasts until the 21st-24th day of illness. As a result of the formation of specific immunity, elimination of the pathogen, immune complexes, pathological changes in the kidneys and other organs regress, and there are trends towards the normalization of their functions. In the stage of polyuria, glomerular filtration is the first to increase. In conditions of damaged tubular apparatus, even a slight increase in filtration contributes to an increase in diuresis. Polyuria is due to osmotic diuresis. Nitrogen slags accumulated in the body during oliguria, with the restoration of the functional ability of the kidneys, show their osmodiuretic effect, and the amount of urine excreted does not depend on the state of hydration of the body, excessive loss of fluid in the urine with insufficient replenishment can lead to dehydration, hypovolemia and the re-development of oliguria . The slow recovery of the reabsorption function of the tubules leads to the loss of potassium, sodium, chlorine.
Vomiting stops, pain in the lower back and abdomen gradually disappears, sleep and appetite normalize, the daily amount of urine increases (up to 3-10 liters), nocturia is characteristic. Against the background of hypokalemia, weakness, muscle hypotension, intestinal paresis, atony persist. Bladder, tachycardia, arrhythmia, dry mouth, thirst. The duration of polyuria and isohypostenuria, depending on the severity of the clinical course of the disease, can vary from several days to several weeks. However, the pace of improvement does not always run parallel to the increase in diuresis. Sometimes in the first days of polyuria, azotemia still increases, dehydration, hyponatremia, hypokalemia may develop, hypocoagulation persists, so this stage is often called the stage of "uncertain prognosis".
Laboratory changes in this period consist in some decrease in the number of erythrocytes, hemoglobin, and an increase in the number of platelets. The erythrocyte sedimentation rate (ESR) is somewhat accelerated. The indicators of urea and serum creatinine gradually decrease, hypokalemia often develops.
Changes in the urine (Zimnitsky test) are characterized by an extremely low relative density, not exceeding 1001-1005. In the urine sediment, a small amount of protein is determined, moderate hematuria and cylindruria, sometimes leukocyturia, renal epithelial cells in a small amount.
1,3,4 The period of convalescence.
The recovery period is pathogenetically characterized by the formation of stable post-infectious immunity with a high level of specific IgG, restoration of hemostasis, microcirculation, glomerular filtration of urine, but with long-term preservation of tubular disorders (tubular insufficiency). There is a noticeable improvement general condition, restoration of daily diuresis, normalization of urea and creatinine. In convalescents, asthenic syndrome is revealed: general weakness, fatigue, decreased performance, emotional lability. Along with this, there is also a vegetative-vascular syndrome in the form of hypotension, muffled heart tones, shortness of breath with slight physical activity, tremor of the fingers, excessive sweating, insomnia. During this period, there may be heaviness in the lower back, a positive symptom of Pasternatsky, nocturia, and isohyposthenuria persists for a long time (up to 1 year or more). It is possible to attach a secondary bacterial infection with the development of pyelonephritis, most often observed in those who have undergone acute renal failure.

hemorrhagic fever with renal syndrome(HFRS) is a rare severe disease that spreads mainly in the European part of Russia and in the Far Eastern regions. It affects not only blood vessels, but also internal organs, mainly the kidneys, which can lead to severe consequences in the form of renal failure and death.

The causative agent is the Hantaan virus, localized mainly in the lungs of rodents and is characterized by the fact that it affects the inner lining of blood vessels. Allocate eastern and western types of the disease. The eastern type is the most toxic, is able to change, and carries the highest percentage of death.

Ways of infection

The source of infection is the habitat of small rodents (mainly field mice). There are several routes of infection with the virus:

• when inhaling air, which contains dust from dried rodent excrement;
• when using dirty products that contain particles of field mice feces;
• during contact with hay, straw, feed or infected rodents.

A person can only become infected from an animal, the virus does not pass from person to person. People are very susceptible to the causative agent of HFRS, infection mainly occurs in autumn or winter. In urban environments, the virus can be carried by rats. The risk group includes people who:

• periodically visit the forest in order to collect berries, mushrooms;
• living in forest areas or near a forest belt;
• gardeners and gardeners;

• working on drilling rigs, deforestation and oil pipelines;
• vacationers in the bosom of nature, in rest houses and sanatoriums, especially those located in the forest;
• agricultural workers.

Children and the elderly are most susceptible to infection, this is due to weak immunity, among patients - mostly men. If a person has been ill with HFRS once, he develops strong immunity and cannot get sick again.

Symptoms

The syndrome virus enters the human body through the mucous membrane of the respiratory system or the oral cavity, entering the esophagus.

Often, when good immunity the virus dies. But in a weakened organism, it begins to multiply, the incubation period lasts 5–35 days, it can pass latently and manifest itself in acute form when a large-scale intoxication of the body has already occurred.

Getting into the blood, the Hantaan virus affects the vessels from the inside, which causes hemorrhagic fever, then it enters the kidneys with urine. Develops within 7-9 days kidney failure, and it is this period of the disease that can become critical.

Then, a positive dynamics of the syndrome can be observed, blood clots resolve, swelling of the kidneys decreases and urine outflow is restored. A person can fully recover only after 1-3 years.

Hemorrhagic fever with renal syndrome has a cyclic course:

• the latent period (incubation) of the disease can last from 5 to 35 days, depending on the age and body of the person;
• the febrile (initial) period of the syndrome is characterized by a sharp rise in temperature up to 40 0 ​​C, which is accompanied by a severe headache, chills, weakness, aching joints and the whole body, usually lasts no more than three days;
• the oligoanuric period of the disease is manifested by some relief of symptoms, the temperature decreases, but the patient continues to feel unwell. In parallel, there is a sharp pain in the kidney area, this period lasts up to 10 days from the onset of the disease;
• the polyuric period is a period of regression of the disease, urine begins to drain, the patient becomes better, lasts mainly up to a month from the onset of the disease;
• recovery period - lasts up to three years.

In hemorrhagic fever with renal syndrome, the symptoms depend on the period of illness and the presence of chronic diseases.

It often happens that before the initial period of the disease, weakness, fatigue, discomfort in the larynx, pain in the joints may appear, this lasts three days. The symptoms are very similar to SARS, so not everyone attaches importance to them. The peculiarity of the reproduction of the virus in the human body is a violation of the system that is responsible for blood clotting.

Fever period

It is characterized by a high temperature throughout the week, differs from other diseases in that the maximum increase occurs in the morning or afternoon. In parallel, signs of general intoxication of the body appear:

• loss of appetite;
• constant feeling of thirst;
• sleep disturbance;
• lethargy, headache, spreading throughout the head;

• reaction to light, as in migraine;
• visual impairment in the form of a veil;
• swelling of the face and neck, redness of the skin;
• bursting vessels of the eyes;
• white coating on the tongue.

With severe intoxication, vomiting appears, a decrease in the pulse rate, a sharp decrease in blood pressure and loss of consciousness.

Oliguric period

During this period of HFRS, pains appear in the kidney area, they can be sharp or debilitating. In a severe course of the disease, vomiting and pain in the abdominal region occur, as in case of poisoning.

Then comes oliguria (violation of the outflow of urine), laboratory tests in the urine reveal the presence of protein, erythrocytes, and the level of urea in the blood increases, as in diabetes. A hemorrhagic rash spreads on the chest, armpits and shoulders. Some may develop nosebleeds, as well as internal gastrointestinal bleeding.

Characteristic for this period of the disease is a significant change in the work of the cardiovascular system:

• decrease in heart rate;
• lowering blood pressure followed by an increase to a hypertensive crisis;
• the tone of heart contractions becomes muffled;
• tachycardia or bradycardia develops.

Such a patient needs close attention, this period of the disease is the most dangerous, and in one day pressure surges can be very significant.

Severe nausea and vomiting that does not bring relief can be triggered by a small sip of liquid. severe pain in the intestines and diarrhea with blood indicate a serious intoxication of the body.

Become vivid symptoms that indicate damage to the central nervous system:

• intense diffuse headache that does not affect only the eye area;
• loss of consciousness, in this case it is safe to say that the vessels of the brain burst and blood enters the medulla;

• the patient is in a state as if he had been stunned;
• feverish delirium, hallucinations may appear.

It is during this period of the disease that renal failure can develop.

Early convalescence

Early convalescence (polyuric period) is a period of regression of HFRS, in which the patient begins to experience relief, the symptoms of the disease gradually recede. Urination normalizes, first 10 liters per day, then a normal amount of urine is reached.

Urine and blood tests show an improved result, renal function returns to normal. The patient's condition returns to normal after a month from the onset of the disease, but general weakness persists.

body recovery period

Hemorrhagic fever with renal syndrome is a serious disease in which the human body is exposed to large-scale intoxication. For the restoration of all organs, especially the kidneys, a long time period is required, at least 2-3 years. During this time, some symptoms may still persist:

• low efficiency, rapid fatigue;
• poor appetite;
• increased sweating;
• itching of the skin;

• decrease in sexual desire;
• pain in the kidney area;
• increased urination, especially at night;
• constant feeling of thirst.

Symptoms can persist for six months, gradually receding. Full recovery of the body from such a serious illness requires a lot of effort and patience.

Childhood

Children can get sick, regardless of age, there have been cases of infection in infants. The disease begins suddenly, acutely, without any precursors.

The fever lasts for a week, accompanied by a severe headache, drowsiness. The child involuntarily tries to stay in bed, complains of pain in the lower back.

For a child, calling an ambulance should not be delayed for a minute if there is a high temperature.

The general list of warning signs for adults and children is:

• redness and swelling of the face and neck;
• headache;
• pain syndrome of muscles and limbs;
• general weakness;
• heat;

• hemorrhagic rash of the skin;
• pain in the kidney area;
• urinary retention;
• bursting vessels of the sclera;
• confusion.

In the presence of such symptoms, urgent hospitalization is necessary. If the patient does not receive timely adequate treatment, hemorrhagic fever with renal syndrome can cause serious complications, which in turn will lead to death.

Treatment

This disease can be treated only in a clinic with a specialized inpatient department. Therapeutic actions are primarily aimed at cleansing the body of toxins and stopping kidney failure.

The patient needs to observe bed rest for 2-4 weeks and control the amount of fluid he drinks, as well as the amount of fluid released.

As a drug therapy for hemorrhagic fever with renal syndrome, use:

• antibiotic treatment (penicillin group);
• drip inject a solution of glucose with insulin;
• taking prednisolone;
• as part of drugs to eliminate intoxication, ascorbic acid, calcium gluconate are used;
• dopamine is prescribed to improve urine output;
• eufillin, chimes;
• hemodialysis is used for severe intoxication;
• medicines to lower the temperature;
• antispasmodics;
• specific antiviral drugs and immunomodulators - amixin, immunoglobulin, virazole.

The drugs are used in a complex, intensive therapy lasts 5-7 days, then the doctor can cancel selectively medicines when the desired effect is achieved and the patient's condition is alleviated.

In hemorrhagic fever with renal syndrome, treatment should be accompanied by proper nutrition. The diet must be divided into 5-6 doses and limited to portions of no more than 300 grams. Food should not be heavy or coarse, it is better to cook soups and mashed potatoes.

If an infectious-toxic shock has developed, antispasmodics and gemodez are not prescribed. First, intoxication is reduced by washing the stomach, as well as the intestines. In case of illness, it is necessary to take absorbents.

With the development of a convulsive syndrome during the illness, Relanium or chlorpromazine is prescribed. When the patient begins to recover, he is prescribed fortifying agents and vitamins.

Preventive measures

Prevention of hemorrhagic fever with renal syndrome is an important measure. Such a serious disease is much easier to prevent than to cure. Preventive actions are as follows:

• compliance with the rules of personal hygiene, especially while being in the bosom of nature or in the countryside;
• water from any natural source must be boiled;
• you can not pick up rodents, especially for children;
• all products intended for outdoor consumption must be hermetically sealed;
• Wash hands thoroughly with soap and water before drinking or eating.

• if accidental contact with an animal occurs, measures must be taken to disinfect skin and clothing;
• if you have to work in the hayloft, in the barn or in the field, you must use a respirator;
• it is necessary to conduct preventive conversations with children and monitor their behavior in the forest and rural areas, to prevent eating berries, fruits and vegetables in an unwashed form.

In children, hemorrhagic fever with renal syndrome is much more severe than in adults. Infection of a pregnant woman can have terrible consequences of the disease, the danger to the fetus is obvious. If a woman falls ill during breastfeeding, the baby is urgently transferred to artificial nutrition to reduce the risk of infection.

With timely intensive treatment, the prognosis may be favorable, as a consequence of the illness, chronic pyelonephritis and hypertension may develop. Lethal cases of the disease make up no more than 8% of sick people.

The content of the article

Historical data on hemorrhagic fever

Etiology of hemorrhagic fever

Epidemiology of hemorrhagic fever

Pathogenesis and pathomorphology of hemorrhagic fever

Clinic of hemorrhagic fever

Initial (feverish) stage

Oliguric stage

Polyuric stage

Complications of hemorrhagic fever

Diagnosis of hemorrhagic fever

Specific diagnosis of hemorrhagic fever

Differential diagnosis of hemorrhagic fever

Treatment of hemorrhagic fever

Prevention of hemorrhagic fever

Hemorrhagic fever with renal syndrome is a viral disease that is characterized by an aggressive onset of symptoms. The pathology is characterized by lesions of the vascular and urinary systems, severe intoxication of the body. This is a fairly rare disease that is very difficult to tolerate by humans and causes a lot of complications. The hemorrhagic fever virus with renal syndrome was first detected in the lungs of rodents.

Causes and ways of transmission

Among the main carriers this disease mice and rats are isolated.

In the presence of a disease in an animal, no symptoms appear. The main sources through which the virus is transmitted are fecal saliva and urine. However, it should be noted that infection is possible only in rare cases. As a rule, patients with a fever do not spread the virus..

Transmission of hemorrhagic fever is possible in several ways, the main of which are:

• food;
• airborne;
• contact.

Human infection is possible with:

• the use of meat affected by the virus;
• direct contact with animal feces;
• bite;
• contact with animal saliva.

In most cases, the spread of HFRS occurs in the spring and summer. It is then that the risk of the likelihood of interaction with secretions infected with the virus increases significantly.

Even through contact with an animal that is a carrier of the infection, if hands were not washed after, you can get the causative agent of the disease. The saliva of a rodent that has fallen into a wound or abrasion also causes the transmission of the virus.

In winter, infection is possible by aspiration contact. The risk group includes people engaged in farming, owners living in private homes (if there are rats or mice in the room). Among other things, ticks located on the body of an animal may also be carriers of the causative agent of pathology, but, as a rule, they do not pass to humans.

Untimely access to a doctor leads to rather unpleasant consequences. As a result, the risk of developing the following serious pathologies is not excluded:

Important! Not to be underestimated possible consequences GLPS. With absence proper treatment eat high risk lethal outcome.

Hemorrhagic fever with renal syndrome in children can develop at any age, even in infants. Harbingers of the disease, as a rule, are absent, but the onset of the course is acute. High temperature lasts up to a week, complaints of headache, drowsiness, weakness. Most of the time the child spends in bed. Back pain in the kidney area begins to appear already on initial stage development of pathology.

Characteristic symptoms

The vegetation period of the disease is up to thirty days. In hemorrhagic fever with renal syndrome, the symptoms will depend on the stage of the disease. There are several of them:

Recovery occurs on the 20-25th day and can last from three months to one year. This stage is accompanied by kidney disease, pyelonephritis, as well as a feeling of thirst and dryness in the oral cavity. In the case of prolonged and pronounced manifestations of these symptoms, it is possible to re-place the patient in a hospital.

Often, HFRS can be accompanied by impaired excretory-secretory function of the tubules. Such phenomena can persist for quite a long time. It can take up to 10 years for the body to fully recover. However, it should be noted that even over such a long period of time, the pathology will not acquire chronic form kidney failure.

Important! The sooner you turn to a specialist, the greater the likelihood of maintaining health and preventing complications.

Diagnosis, therapy and prevention of the disease

To diagnose the disease, first of all, it is necessary to conduct a general examination in order to identify the nature, localization and severity of the hemorrhagic rash, as well as the presence of hemorrhages in different departments.

Mandatory conduct differential diagnosis to exclude diseases such as typhoid fever, other types of fever, tick-borne encephalitis and influenza.

To determine HFRS, epidemiological indicators, the probability of finding a patient in the focus of the epidemic, as well as general data on the incidence in this place and the seasonal period are taken into account. Associated symptoms are also subject to attention.

Additionally, a number of laboratory tests are prescribed. These include:

• general analysis of urine and blood;
• Zimnitsky test;
• biochemical analysis;
• immunopathy;
• electrocardiogram;
• CT scan;
• polymerase chain reaction.

Upon confirmation of the presence of the disease, the patient is immediately placed in a therapeutic or infectious hospital.

It is strictly forbidden to treat the disease on an outpatient basis, since the patient must always be under the supervision of specialists.

Treatment

As mentioned above, a person diagnosed with HFRS should be constantly under medical supervision, which will allow monitoring the work of the kidneys. When transporting a patient, extreme care must be taken, since the possibility of rupture of the renal capsule is not excluded.

Hemorrhagic fever with renal syndrome should be treated with bed rest for one to four weeks.

The duration will depend on the severity of the pathology.
It is also necessary to exercise strict control over the volume of fluid that is lost and consumed by the patient.

In the febrile stage, drugs of the following groups are prescribed:

• antioxidant;
• antiviral;
• detoxification.

In addition, the necessary measures are taken to prevent the manifestation of DIC.

Etiotropic therapy consists in taking chemotherapy drugs or immunobiological drugs (hyperimmune plasma, donor immunoglobulin and others), Amiksin, Yodantrypin, Cycloferon. Intoxication is suppressed by glucose solution and saline solution with acetylsalicylic acid.

If the temperature reaches 39 degrees and above, then anti-inflammatory drugs with antipyretic action (Ibuprofen, Analgin) are used. With the manifestation of infectious-toxic shock (ITS), the patient is administered with a dropper cardiac glycosides, Hydrocortisone with Reopoliglyukin. With ITSH, it is forbidden to use Poliglukin, antispasmodics, Hemodez.

If there is a convulsive syndrome, then it is advisable to use such drugs:

During the oliguric stage, therapeutic measures are aimed at eliminating azotemia, reducing protein catabolism and intoxication. In addition, carry out the correction of water-electrolyte and acid-base balance.

In case of complications due to infection, antibiotics of the group of semi-synthetic penicillins (Augmentin, Amoxicillin) are prescribed.

Disease prevention

Since they have not yet been able to develop a specific vaccine, in order to prevent hemorrhagic fever with renal syndrome, it is recommended to take Yodantipyrin according to the scheme. In addition, compliance with general, not complex recommendations will help prevent outbreaks of the epidemic:

1. Extermination of rodents in places of the lesion.
2. Mandatory use of respirators, if work is performed in very dusty places.
3. Grain and other products are recommended to be stored in warehouses where there is no access to rodents.
4. Avoid contact with animal excrement, in particular rodents.
5. Observe the rules of personal hygiene (wash your hands as often as possible, use disposable wipes, and so on).

Whatever the disease may be, it is easier to prevent it than to treat it for a long time. However, this is not always possible. HFRS is a fairly serious disease, with the first signs of which you should immediately seek medical help.

The first description of it was made in 1935 in the Far East, then it turned out that it is common in the Moscow, Tula, Yaroslavl, Samara, Tver regions, the Urals. The disease is characterized by selective damage to the blood vessels of the kidneys.

The infection is caused by viruses of the genus Hantaviruses, their carriers are forest and field mice. The virus is released into the environment with saliva and feces of rodents, infection occurs by inhalation of air contaminated with particles of dried mouse excretions, and the food route of infection is also possible - through food.

People are quite susceptible to the disease, but a sick person does not pose a danger to others. The transferred infection leaves behind stable lifelong immunity.

What's happening?

The incubation period is 7-46 days. The causative agent of HFRS affects the blood vessels. As a result, their permeability increases, the release of plasma - the liquid part of the blood - into the surrounding tissues occurs. The blood itself thickens, the work of its coagulation system is disrupted. To a greater extent, the vessels of the kidneys suffer, acute renal failure develops, and even rupture of the kidney is possible. In addition, the general reactions of the body to the invasion of the virus are also characteristic - high temperature (fever), intoxication, and others.

The disease usually begins suddenly, with acute and intense headaches, mainly in the supraorbital and temporal regions. At the same time - within a few hours - the body temperature rises. It quickly reaches 38-40°C. By the end of the first day, many patients report a decrease in visual acuity. Nausea is also noted, reaching vomiting, hiccups often appear.

The temperature is maintained for 3-5 days, then gradually decreases, but the condition of the patients does not improve, but vice versa. At this time, a renal syndrome develops, characterized by pain in the lumbar region and abdomen, a decrease in the amount of urine excreted, in severe cases, anuria (complete absence of urine) is possible.

By the end of the second week of illness, vomiting stops, pain in the lower back and abdomen disappears, the amount of daily urine can reach 5 liters or more. The transition to the recovery period is usually noted by the 4th week of the disease.

Diagnostics

In the first period of the disease, it is difficult to recognize HFRS. From acute respiratory diseases it can be distinguished by the absence of a runny nose, cough and other symptoms of respiratory tract damage, and from intestinal infections by the late onset of abdominal pain and vomiting, which only intensify with the course of the disease.

The main diagnostic sign is a sharp decrease in the amount of urine and a deterioration in the patient's condition after normalization of body temperature. Laboratory confirmation of the diagnosis of HFRS is also possible.

Treatment

Treatment is carried out in the conditions of the infectious diseases department. Anti-inflammatory treatment is prescribed, normalization of urine output. Do not use drugs that increase kidney damage.

Prevention

It comes down to measures to protect against rodents while in nature. Thus, thickets of grass should be avoided, and food supplies should be stored in places and containers inaccessible to mice.