GLPS infectious diseases. Methods of treating hemorrhagic fever with renal syndrome Features of transfusion therapy for HFRS

Causes of the disease
Complications and prevention
Treatment of hemorrhagic fever

Hemorrhagic fever with renal syndrome is an acute infectious disease that selectively affects the blood vessels. The disease is accompanied by intoxication, fever and affects the kidneys. Representatives of different genders and ages suffer from the disease. The disease is quite rare, but serious.

The main carriers of the disease are rodents: field mouse, gray mouse, black rat. In animals, the disease occurs without symptoms. The main sources of transmission of the virus are urine, feces, and saliva. Infection is rare. Patients with fever are not contagious. Hemorrhagic fever with renal syndrome can be transmitted from a carrier to a person in various ways:

airborne dust;
food;
contact

The virus is transmitted between rodents during interbreeding or prolonged stay in the same room. Direct contact is required for transmission of the virus. For rodents, there is another way of transmitting the disease (aspiration). Infection occurs by inhaling dust and dry excrement. For humans, infection can mean eating the meat of an infected rodent, direct contact with animal excrement, a bite, or contact with saliva.

Most often, hemorrhagic fever with renal syndrome spreads in the summer. At this time, there is a high probability of contact with infected secretions. Even if you previously caught the animals, one of them turned out to be a carrier of infection, and after contact with it you did not wash your hands, then there is a high probability of infection. Getting rodent saliva into cuts and abrasions can transmit infection.

In winter, infection can occur through aspiration. Farm workers and owners of private houses may be at risk (if there is a possibility that mice or rats live in the house). Hemorrhagic fever with renal syndrome can be transmitted through ticks that are found on the body of rodents. But these ticks do not attack people.

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Symptoms of the disease from 1 to 11 days

The development of the disease may take up to 1 month. In the first 2 weeks, the patient experiences the initial and oliguric stages of disease progression. Hemorrhagic fever with renal syndrome begins to appear from the 1st day of infection. The patient develops a very high temperature (up to 40°C), which is accompanied by chills. After this, symptoms appear:

Weakness throughout the body.
Extreme thirst and dry mouth.
Headache.
Swelling of the neck, face and chest.

A rash similar to an allergic one sometimes appears on the skin of patients. On day 2, the patient may experience swelling of the respiratory tract, severe malaise, and back pain. Typically, no change in the functioning of internal organs is noted at the initial stage of infection. Rarely, patients may have pain in the heart area and difficulty breathing.

The febrile period begins on the 4th day of the incubation period and lasts until the 11th day of illness. A person continues to have a high fever for 2-3 days, but usually it subsides on the 7th day. Following this, there are no significant changes in the patient’s condition. The main symptom that manifests itself most strongly is lower back pain.

If the painful sensations disappear on the 5-6th day of the incubation period, this may mean that the diagnosis was made incorrectly. On the 6th day, patients begin to experience prolonged, causeless vomiting, which can be repeated many times throughout the day. A person's stomach begins to swell and hurt. The swelling of the mucous membrane begins to increase, but no manifestations of the lesion are noted on the skin.

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Symptoms of the disease from 12 to 26 days

On day 12, the patient's temperature may gradually decrease. But this is not at all a sign of improvement in his condition. During this period, internal inflammation of organs may develop. The patient develops irresistible thirst, dry skin, dry mouth, severe headaches and lethargy. The patient cannot sleep, and pain in the lumbar back begins to spread to the entire abdominal cavity.

The level of nitrogenous wastes in the patient’s blood begins to rise sharply. This occurs due to the breakdown of proteins and disruption of the amount of nitrogen excreted by the kidneys. The patient experiences a significant decrease in the amount of urine produced. The more severe the disease, the less urine the body produces per day.

Renal syndrome may be accompanied by isohyposthenuria. This disease develops in almost all patients due to fever and provokes a sharp decrease in urine density. A study of the blood of patients at this stage of the disease shows an increased content of leukocytes in the plasma.

From the 13th day, the patient may stop vomiting and nausea, gain appetite and the ability to move normally. During this time, there may be a significant increase in the amount of daily urine; gradually it reaches a normal value. The person continues to have dry mouth, weakness throughout the body and malaise.

After this stage, slow recovery begins. The final recovery period can take a very long time. This usually takes from 4 to 12 months. Recovery is accompanied by kidney pathologies, dry mouth, and polyuria. If these symptoms continue for too long or are very severe, the patient may need to be readmitted to the hospital.

Often the disease contributes to disruption of the excretory-secretory function of the tubules and other less pronounced disorders. Such processes can continue in the human body for a very long time, and it may take up to 10 years to fully restore all body functions. However, during this time the disease will not develop into a chronic form of renal failure.

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Complications and prevention

After illness, patients sometimes experience complications. They are expressed through:

development of infectious-toxic shock;
renal failure;
swelling of the respiratory tract;
internal hemorrhages;
frequent seizures;
loss of consciousness;
dilated pupils;
partial loss of pulse.

As the disease progresses, many patients may experience vomiting and nausea. Often the consequences are expressed through hiccups and increased fatigue and drowsiness. Patients often develop nervous tics and involuntary movements of the facial muscles. When examining a blood test in plasma, the content of urea and creatinine increases sharply. Complications may be accompanied by severe lower back pain and heavy bleeding.

Prevention of hemorrhagic fever with renal syndrome involves careful behavior of people in parks, forests, and plantings. It is important to observe the rules of personal hygiene. On the territory of private sectors, preventive work should be carried out to eliminate rodents from the territory of the populated area. People need to be extremely careful when coming into contact with rodents.

Acute viral zoonotic disease of viral etiology.

Characteristics of the causative agent of hemorrhagic fever with renal syndrome

The causative agent of HFRS is classified in the bunyavirus family (Bunyaviridae) and is classified into a separate genus Hantavirus, which includes several serovars: Puumala, Dobrava, Seul, and Hantaan viruses. These are RNA-containing viruses up to 110 nm in size, they die at a temperature of 50 ° C for 30 minutes, and at 0-4 ° C (the temperature of a household refrigerator) they persist for 12 hours. Tropen to endothelial cells, macrophages, platelets, and renal tubular epithelium. It binds to cells that have specific receptors on their membranes (integrins).

Routes of infection: airborne dust (inhalation of the virus from dried rodent feces); fecal-oral (eating foods contaminated with rodent excrement); contact (contact of damaged skin with objects of the external environment contaminated with rodent secretions, such as hay, brushwood, straw, feed).

A person has absolute susceptibility to the pathogen. In most cases, autumn-winter seasonality is typical.

After an infection, strong immunity is formed. Repeated diseases do not occur in one person.

Symptoms of GLPS The disease is characterized by cyclicality!

1) incubation period - 7-46 days (on average 12-18 days), 2) initial (febrile period) - 2-3 days, 3) oligoanuric period - from 3 days of illness to 9-11 days of illness, 4) period early convalescence (polyuric period - after the 11th - until the 30th day of illness), 5) late convalescence - after the 30th day of illness - up to 1-3 years.

Sometimes the initial period is preceded by prodromal period: lethargy, increased fatigue, decreased performance, pain in the limbs, catarrhal phenomena. Duration no more than 2-3 days.

Initial period characterized by the appearance of headaches, chills, myalgia, arthralgia, and weakness.

The main symptom of the onset of HFRS is a sharp increase in body temperature, which in the first 1-2 days reaches high numbers - 39.5-40.5 ° C. Fever can persist from 2 to 12 days, but most often it is 6 days. The peculiarity is that the maximum level is not in the evening, but in the daytime and even in the morning. In patients, other symptoms of intoxication immediately increase - lack of appetite, thirst appears, patients are lethargic, sleep poorly. Headaches are widespread, intense, increased sensitivity to light stimuli, pain when moving the eyeballs. 20% have visual impairment - “fog before the eyes,” flickering spots, decreased visual acuity (swelling of the optic disc, stagnation of blood in the vessels). When examining patients, “hood syndrome” (craniocervical syndrome) appears: hyperemia of the face, neck, upper chest, puffiness of the face and neck, injection of scleral vessels (there are hemorrhages in the sclera, sometimes affecting the entire sclera - red cherry symptom) and conjunctiva. The skin is dry, hot to the touch, the tongue is covered with a white coating. Already during this period, heaviness or dull pain in the lower back may occur. With high fever, the development of infectious-toxic encephalopathy (vomiting, severe headache, stiff neck, Kernig's, Brudzinski's symptoms, loss of consciousness), as well as infectious-toxic shock, is possible. Oliguric period. It is characterized by a practical decrease in fever on days 4-7, the condition does not improve. Constant pain in the lower back of varying severity appears - from aching to sharp and debilitating. In severe cases of HFRS, after 2 days from the moment of painful renal syndrome, they are accompanied by vomiting and aching abdominal pain in the area of the stomach and intestines, oliguria. Laboratory tests - decreased specific gravity of urine, protein, red blood cells, casts in the urine. The content of urea, creatinine, and potassium in the blood increases, and the amount of sodium, calcium, and chlorides decreases.

At the same time, hemorrhagic syndrome also appears. A pinpoint hemorrhagic rash appears on the skin of the chest, in the armpits, and on the inner surface of the shoulders. The stripes of the rash may be located in certain lines, as if from a “lash”. Hemorrhages appear in the sclera and conjunctiva of one or both eyes - the so-called “red cherry” symptom. 10% of patients develop severe manifestations of hemorrhagic syndrome - from nosebleeds to gastrointestinal ones.

A peculiarity of this period of HFRS is a peculiar change in the function of the cardiovascular system: a decrease in heart rate, a tendency to hypotension, and muffled heart sounds. The ECG shows sinus bradycardia or tachycardia, and extrasystoles may appear. Blood pressure during the period of oliguria with initial hypotension can turn into hypertension (due to sodium retention). Even within one day of illness, high blood pressure can be replaced by low blood pressure and vice versa, which requires constant monitoring of such patients.

In 50-60% of patients during this period, nausea and vomiting are recorded even after a small sip of water. Pain in the abdomen of an excruciating nature is often bothered. 10% of patients have loose stools, often mixed with blood.

During this period, symptoms of damage to the nervous system occupy a prominent place: patients have severe headache, stupor, delusional states, often fainting, and hallucinations. The reason for such changes is hemorrhages in the brain.

It is during the oliguric period that one must be wary of one of the fatal complications - acute renal failure and acute adrenal insufficiency.

Polyuric period (or early convalescence). Characterized by gradual restoration of diuresis. Patients feel better, the symptoms of the disease regress. Patients excrete a large amount of urine (up to 10 liters per day), low specific gravity (1001-1006). After 1-2 days from the onset of polyuria, laboratory indicators of impaired renal function are restored. By the 4th week of illness, the amount of urine excreted returns to normal. For another couple of months, slight weakness, slight polyuria, and a decrease in the specific gravity of urine persist.

Late convalescence. Can last from 1 to 3 years. Residual symptoms and their combinations are divided into 3 groups:

Asthenia - weakness, decreased performance, dizziness, decreased appetite. Dysfunction of the nervous and endocrine systems - sweating, thirst, itching, impotence, increased sensitivity in the lower extremities. Renal residual effects - heaviness in the lower back, increased diuresis up to 2.5-5.0 l, the predominance of nighttime diuresis over daytime, dry mouth, thirst. Duration is about 3-6 months.

Hemorrhagic fever with renal syndrome (HFRS) (hemorrhagic nephrosonephritis, Tula, Ural, Yaroslavl fever) is an acute infectious disease of a viral nature, characterized by fever, intoxication, hemorrhagic and renal syndromes.

Epidemiology

Hemorrhagic fever with renal syndrome is a typical zoonotic infection. Natural foci of the disease are located in the Far East, Transbaikalia, Eastern Siberia, Kazakhstan and the European part of the country. The reservoir of infection is mouse-like rodents: field and forest mice, rats, voles, etc. The infection is transmitted by gamasid mites and fleas. Mouse-like rodents carry the infection in a latent form, less often in a clinically expressed form, and they release the virus into the external environment with urine and feces. Ways of transmission of infection:

aspiration route - when inhaling dust with suspended infected secretions of rodents;
contact route - when infected material gets into scratches, cuts, scarifications or when rubbed into intact skin;
nutritional route - when consuming food products infected with rodent secretions (bread, vegetables, fruits, etc.).

Direct transmission from person to person is unlikely. Hemorrhagic fever with renal syndrome occurs in sporadic cases, but local epidemic outbreaks are possible.

Children, especially those under 7 years old, rarely get sick due to limited contact with nature. The greatest number of diseases is recorded from May to November, which coincides with the migration of rodents into residential and commercial premises, as well as with the expansion of human contact with nature and agricultural work.

Prevention of hemorrhagic fever with renal syndrome

Prevention is aimed at exterminating mouse-like rodents in natural foci, preventing contamination of food and water sources with rodent excrement, and strict adherence to the sanitary and anti-epidemic regime in and around residential premises.

Classification

Along with typical ones, there are erased and subclinical variants of the disease. Depending on the severity of hemorrhagic syndrome, intoxication and renal dysfunction, mild, moderate and severe forms are distinguished.

Causes of hemorrhagic fever with renal syndrome

The pathogen belongs to the family Bunyaviridae includes two specific viral agents (Hantaan and Piumale), which can be passaged and accumulated in the lungs of a field mouse. Viruses contain RNA and have a diameter of 80-120 nm, are poorly stable: at a temperature of 50 ° C they persist for 10-20 minutes.

Pathogenesis of hemorrhagic fever with renal syndrome

The infection is primarily localized in the vascular endothelium and, possibly, in the epithelial cells of some organs. After the intracellular accumulation of the virus, the viremia phase begins, which coincides with the onset of the disease and the appearance of general toxic symptoms. The hemorrhagic fever with renal syndrome virus has a capillary toxic effect. In this case, damage to the vascular wall occurs, blood clotting is impaired, which leads to the development of thrombohemorrhagic syndrome with the occurrence of multiple blood clots in various organs, especially in the kidneys.

Symptoms of hemorrhagic fever with renal syndrome

The incubation period is from 10 to 45 days, with an average of about 20 days. There are four stages of the disease: febrile, oliguric, polyuric and convalescence.

Feverish period. The disease usually begins acutely with a rise in temperature to 39-41 ° C and the appearance of general toxic symptoms: nausea, vomiting, lethargy, lethargy, sleep disturbance, anorexia. From the first day of the illness, a severe headache is characteristic, mainly in the frontal and temporal regions; dizziness, chills, a feeling of heat, pain in the muscles of the limbs, in the knee joints, aches throughout the body, pain when moving the eyeballs, severe abdominal pain, are also possible. especially in the projection of the kidneys.
The oliguric period in children begins early. Already on the 3-4th, less often on the 6-8th day of illness, body temperature decreases and diuresis drops sharply, and lower back pain intensifies. The condition of children worsens further as a result of increasing symptoms of intoxication and kidney damage. Urine examination reveals proteinuria, hematuria, and cylindruria. Renal epithelium, often mucus and fibrin clots, are constantly detected. Glomerular filtration and tubular reabsorption are always reduced, which leads to oliguria, hyposthenuria, hyperazotemia, and metabolic acidosis. The relative density of urine decreases. As azotemia increases, a clinical picture of acute renal failure occurs, including the development of uremic coma and eclampsia.
The polyuric period begins from 8-12 days of illness and marks the beginning of recovery. The patients' condition improves, lower back pain gradually subsides, vomiting stops, sleep and appetite are restored. Diuresis increases, the daily amount of urine can reach 3-5 liters. The relative density of urine decreases even more (persistent hypoisosthenuria).
The convalescent period lasts up to 3-6 months. Recovery comes slowly. General weakness persists for a long time, diuresis and relative density of urine are gradually restored. The state of post-infectious asthenia can persist for 6-12 months. In the blood in the initial (febrile) period, short-term leukopenia is noted, quickly giving way to leukocytosis with a shift of the leukocyte formula to the left to band and young forms, up to promyelocytes, myelocytes, metamyelocytes. Aneosinophilia, a drop in platelet counts, and the appearance of plasma cells can be detected. ESR is often normal or elevated. In acute renal failure, the level of residual nitrogen in the blood sharply increases, the content of chlorides and sodium decreases, but the amount of potassium increases.

Diagnosis of hemorrhagic fever with renal syndrome

Hemorrhagic fever with renal syndrome is diagnosed on the basis of a characteristic clinical picture: fever, flushing of the face and neck, hemorrhagic rashes on the shoulder girdle like a lash mark, kidney damage, leukocytosis with a shift to the left and the appearance of plasma cells. For diagnosis, the patient’s stay in an endemic zone, rodents in the home, consumption of vegetables and fruits with signs of chewing are important. Specific laboratory diagnostic methods include ELISA, RIF, hemolysis reaction of chicken erythrocytes, etc.

Differential diagnosis

Hemorrhagic fever with renal syndrome is differentiated from hemorrhagic fevers of other etiologies, leptospirosis, influenza, typhus, acute nephritis, capillary toxicosis, sepsis and other diseases.

Treatment of hemorrhagic fever with renal syndrome

Treatment is carried out in a hospital. Prescribe bed rest, a full diet with limited meat dishes, but without reducing the amount of table salt. At the height of intoxication, intravenous infusions of hemodez, 10% glucose solution, Ringer's solution, albumin, and 5% ascorbic acid solution are indicated. In severe cases, glucocorticoids are prescribed at the rate of 2-3 mg/kg per day of prednisolone in 4 doses, the course is 5-7 days. In the oliguric period, mannitol and polyglucin are administered, and the stomach is washed with a 2% sodium bicarbonate solution. With increasing azotemia and anuria, extracorporeal hemodialysis is resorted to using an artificial kidney apparatus. In case of massive bleeding, transfusions of blood products and blood substitutes are prescribed. To prevent thrombohemorrhagic syndrome, sodium heparin is administered. If there is a threat of bacterial complications, antibiotics are used.

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

The causative agent is the Hantaan virus, which is localized mainly in the lungs of rodents and is characterized by the fact that it affects the inner lining of blood vessels. There are eastern and western types of the disease. The eastern type is the most toxic, capable of modification, and carries the highest percentage of deaths.

Routes of infection

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

when inhaling air that contains dust from dried rodent excrement;
when consuming dirty foods that contain particles of field mouse 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 HFRS pathogen, infection mainly occurs in autumn or winter. In urban environments, the virus can be carried by rats. People who are at risk include:

periodically visit the forest to pick berries and mushrooms;
living in forests or near forest belts;
gardeners and summer residents;

working on drilling rigs, logging and oil pipelines;
vacationers in the lap of nature, in holiday homes 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 the patients there are mainly men. If a person has had HFRS once, he develops a 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, with good immunity, the virus dies. But in a weakened body, it begins to multiply, the incubation period lasts 5–35 days, can pass latently and manifest itself in an acute form, when large-scale intoxication of the body has already occurred.

Once in the blood, the Hantaan virus attacks the blood vessels from the inside, which causes hemorrhagic fever, then it penetrates into the kidneys with urine. Over the course of 7–9 days, renal failure develops, and it is this period of the disease that can become critical.

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

Hemorrhagic fever with renal syndrome has a cyclical 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 increase in temperature to 40 0 C, which is accompanied by severe headache, chills, weakness, aches in the joints and the whole body, usually lasting 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. At the same time, sharp pain appears 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 flow, the patient feels better, lasts mainly up to a month from the onset of the disease;
The recovery period lasts up to three years.

In hemorrhagic fever with renal syndrome, 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, and pain in the joints may appear; this lasts three days. The symptoms are very similar to ARVI, 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.

Feverish period

Characterized by high fever throughout the week, it differs from other diseases in that the maximum increase occurs in the morning or afternoon. At the same time, 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;
blurred vision in the form of a veil;
swelling of the face and neck, redness of the skin;
burst blood vessels in the eyes;
there is a white coating on the tongue.

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

Oliguric period

During this period of HFRS, pain appears in the kidney area; it can be sharp or debilitating. In severe cases of the disease, vomiting and pain in the abdominal region occur, as in case of poisoning.

Next comes oliguria (impaired urine outflow), laboratory tests reveal the presence of protein and red blood cells in the urine, and the level of urea in the blood increases, as in diabetes mellitus. A hemorrhagic rash spreads on the chest, armpits and shoulders. Some may experience bleeding from the nose, as well as internal gastrointestinal bleeding.

This period of the disease is characterized by a significant change in the functioning of the cardiovascular system:

decreased heart rate;
a decrease in blood pressure followed by an increase to a hypertensive crisis;
the tone of the heartbeat 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 provoked by a small sip of liquid. Severe pain in the intestines and diarrhea with blood indicate serious intoxication of the body.

Symptoms that indicate damage to the central nervous system become clear:

intense diffuse headache that does not affect only the eye area;
loss of consciousness, in this case we can say with confidence that the vessels of the brain burst and blood enters the medulla;

the patient is in a state as if he was stunned;
Feverish delirium and hallucinations may appear.

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

Early convalescence

Early convalescence (polyuric period) is a period of regression of HFRS, during which the patient begins to experience relief, the symptoms of the disease gradually recede. Urinary excretion is normalized, first 10 liters per day, then a normal amount of urine is achieved.

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

Recovery period of the body

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

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

decreased sex drive;
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 warning signs.

The elevated temperature lasts for a week, accompanied by severe headache and drowsiness. The child involuntarily tries to stay in bed and 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.

A 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 skin rash;
pain in the kidney area;
urinary retention;
burst scleral vessels;
confusion.

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

Treatment

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

The patient needs to remain in bed for 2–4 weeks and control the amount of fluid he drinks and excretes.

The following is used as drug therapy for hemorrhagic fever with renal syndrome:

treatment with antibiotics (penicillin group);
a glucose solution with insulin is injected drip-wise;
taking prednisolone;
ascorbic acid and calcium gluconate are used in the composition of drugs to eliminate intoxication;
dopamine is prescribed to improve urine output;
aminophylline, chimes;
hemodialysis is used for severe intoxication;
medicines to lower fever;
antispasmodics;
specific antiviral drugs and immunomodulators - amiksin, immunoglobulin, virazole.

The drugs are used comprehensively, intensive therapy lasts 5–7 days, then the doctor can selectively discontinue the drugs when the desired effect is achieved and the patient’s condition is alleviated.

For hemorrhagic fever with renal syndrome, treatment should be accompanied by proper nutrition. The diet should be divided into 5-6 meals and limited to portions of no more than 300 grams. Food should not be heavy or rough; it is better to cook soups and purees.

If infectious-toxic shock has developed, antispasmodics and hemodesis are not prescribed. First, intoxication is reduced by washing the stomach and intestines. When sick, it is necessary to take absorbents.

If convulsive syndrome develops during illness, Relanium or chlorpromazine is prescribed. When the patient begins to recover, he is prescribed restoratives and vitamins.

Preventive measures

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

observing the rules of personal hygiene, especially while being in the open air or in rural areas;
water from any natural source must be boiled;
you should not handle rodents, especially for children;
all products intended for outdoor consumption must be tightly packaged;
Before drinking or eating, you must wash your hands thoroughly with soap;

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 a barn or in a 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, and prevent them from eating berries, fruits and vegetables unwashed.

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

With timely intensive treatment, the prognosis can be favorable, as chronic pyelonephritis and hypertension can develop as a consequence of the illness. Fatal cases of the disease account for no more than 8% of sick people.

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral zoonotic natural focal disease that is accompanied by a severe increase in body temperature and renal failure. It is caused by the RNA viruses Hantaan - Hantaan, distributed mainly in the east, and Puumala - Puumala, localized in the western regions of Europe.

The first virus is more dangerous; the mortality rate for HFRS incidence is up to 20%. The second one causes a disease with a less severe course and a mortality rate of up to 2%. In the Far East, there are cases of HFRS caused by the Seoul virus – Seoul. This disease is transmitted in a mild form.

Causes and pathogenesis

Viruses initially enter the body of rodent carriers (house and field mice, rats, jerboas, bats), which infect each other through airborne droplets and carry HFRS in a latent form, that is, they do not get sick. A person can become infected in the following ways:

contact: in contact with rodents, their feces;
airborne dust: inhalation of air containing tiny particles of dried rodent feces;
fecal-oral: ingestion of dirty food containing particles of rodent excrement while eating.

People are susceptible to the pathogen in 100% of cases. Men aged 16 to 70 years suffer most from hemorrhagic fever with renal syndrome.

Hemorrhagic fever with renal syndrome (HFRS) is characterized by seasonality and the presence of endemic areas. Peaks of incidence occur from early summer to early winter. In Russia, the highest incidence of hemorrhagic fever with renal syndrome was recorded in Tatarstan, Udmurtia, Bashkortostan, as well as in the Samara and Ulyanovsk regions.

Frequent cases of morbidity are recorded in the Volga region and the Urals in broad-leaved zones. To a lesser extent, cases of HFRS have been recorded in the Eastern Siberian region.

A single exposure to hemorrhagic fever with renal syndrome provides lasting immunity for life.

The virus in the human body settles on the mucous membranes of the respiratory and digestive systems. It then multiplies and enters the blood. During this period, the patient experiences intoxication syndrome due to infection entering the bloodstream.

Subsequently, Khantaan is localized on the inner wall of the vessel and violates its integrity. The patient develops hemorrhagic syndrome. The virus is eliminated from the body by the urinary system, so the following occurs:

damage to the renal vessels;
inflammation and swelling of kidney tissue;
development of acute renal failure.

This period of HFRS is especially dangerous and is characterized by an unfavorable fatal outcome. In favorable cases, the reverse process begins: resorption of hemorrhages, restoration of excretory functions of the kidneys. The duration of the recovery period for HFRS can range from one to three years.

Species and types

Currently, there is no single accepted classification of HFRS.

Depending on the territory in which the disease is registered, the following types of HFRS are distinguished:

Yaroslavl form of fever;
Transcarpathian form of HFRS;
Ural form of HFRS;
Tula form of HFRS;
Far Eastern form of HFRS;
Korean form of fever, etc.

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

Western type of HFRS - caused by the Puumala virus; severe course in 10%, accompanied by oligoanuria and hemorrhagic symptoms. Mortality – 1-2%; distribution on European territory;
The eastern type of HFRS is caused by the Hantaan virus. A very severe course in 40-45% of cases, accompanied by acute renal failure syndrome and hemorrhagic syndrome. Mortality – about 8%, distribution mainly in agricultural areas of the Far East;
HFRS is caused by the Seoul serotype. The course is relatively mild in 40-50%, accompanied by the development of hepatitis and disorders of the respiratory system. Common among urban residents in the Far East.

Depending on the zone or territory in which HFRS infection occurs:

in the forest (forest type of HFRS) - while picking mushrooms and berries in contact with contaminated dried feces of sick rodents;
in everyday life (domestic type of HFRS);
in production (production type GLPS) - work in the forest zone, on oil pipelines in the taiga, on drilling rigs;
on a personal plot (dacha type GLPS);
on vacation in tent cities, camps, etc.;
in agricultural fields.

Stages and symptoms of the disease

The symptomatic specificity of the disease varies depending on the stage of HFRS. There are only four stages and they are characterized by cyclical alternation. In other words, some time after the fourth stage, the first begins again, and so on.

Only the course of HFRS caused by the Seoul serotype is characterized by acyclicity.

The incubation period for hemorrhagic fever with renal syndrome lasts about 2-4 weeks, during which time symptoms do not appear.

The initial or febrile period of HFRS is no more than 7 days, most often 3-4 days. It begins acutely: the patient’s body temperature on the first day reaches 38.5-40.5 C. The person feels headaches, back and muscle pain, general malaise, dry mouth and thirst, flashing “midges” before the eyes and blurred images. During this period, minor hemorrhages may be observed on the mucous membrane of the palate and sclera.
The oliguric period of HFRS is about a week. The body temperature drops, but the condition becomes worse. The patient develops nosebleeds, bruises on the body, and ulcerated sclera. A red rash forms in the chest area, in the armpits and on the lower extremities, which is a manifestation of numerous capillary ruptures. There is an increase in complaints of pain in the back and abdomen. The daily volume of urine decreases. Sometimes an increase in the size of the liver is diagnosed.
The polyuric period of HFRS begins on days 10-13. The daily volume of urine increases to 6 liters. Low urine density is detected in the absence of its fluctuations, which is a sign of acute renal failure.
The convalescent period of HFRS is the longest, begins on days 20-22 and lasts about six months. It is characterized by an improvement in the patient’s general condition and normalization of diuresis. Recovery with mild degrees of HFRS severity is observed after 1 month, and with moderate severity - only after 5-6 months. In patients who have suffered a severe form of HFRS, asthenic syndrome manifests itself throughout life.

Symptoms of various hemorrhagic fever syndromes

The three main syndromes of the disease have varying degrees of manifestation depending on the severity of HDL:

intoxication;
hemorrhagic;
renal

Hemorrhagic fever with mild renal syndrome manifests itself:

a three- or four-day increase in the patient’s temperature to 38 0C;
minor headaches;
temporary agnosia;
pinpoint hemorrhages;
there is a decrease in diuresis;
laboratory tests in the urine reveal an increase in the level of protein and urea;

The average degree of HFRS is characterized by:

a five- or six-day increase in body temperature to 39-40 0C;
quite severe cephalalgia;
hemorrhages on the skin and mucous membranes are multiple;
periodically the patient vomits blood;
the heart rate increases, which is the appearance of the initial stage of infectious-toxic shock;
oliguria in patients lasts about 3-5 days;
laboratory tests in the urine indicate an increase in the level of protein, creatinine, and urea.

Severe HFRS is accompanied by:

prolonged (more than 8 days) increase in the patient’s body temperature to 40-41 oC;
repeated vomiting of blood;
systemic hemorrhages of the skin and mucous membranes.

Signs of infectious intoxication:

digestive disorders;
weakness;

From the urinary system:

porteinuria;
oliguria;
hematuria;
increased levels of urea and creatinine.

Children of all ages, even infants, are susceptible to HFRS. The course of the disease in them is distinguished by a very acute onset, which is not preceded by symptoms. Children become weak and tearful, lie down more, and complain of headaches and back pain in the lumbar region already at the first stage of the disease.

Diagnosis of hemorrhagic fever

To make an accurate diagnosis of HFRS, it is important to take into account the patient’s epidemiological history, the presence of clinical manifestations of the disease, and data from laboratory and serological studies. If necessary, an FGDS, ultrasound, computed tomography, or x-ray examination may be required.

If the patient has symptoms of hemorrhagic fever with renal syndrome, the possibility of contact with field mice and other rodents that are carriers of the disease is clarified. The clinical picture of HFRS is characterized by fever for 7 days, redness of the scalp and neck. In addition, hemorrhagic syndrome and symptoms of renal failure are observed with a decrease in body temperature.

Diagnosis of HFRS is carried out using the following laboratory and serological tests:

general analysis of urine and blood;
indirect immunofluorescence reaction;
radioimmunoassay;
passive hemagglutination reaction in paired sera.

Leukopenia is diagnosed in the patient's blood during the initial period, accompanied by a persistent increase in body temperature. At the following stages of HFRS, an increase in ESR, neutrophilic leukocytosis and thrombocytopenia, and the appearance of plasma cells in the blood are noted. The appearance of antibodies to the virus in a patient is diagnosed on the 7th-8th day of the disease, the maximum of which is observed on the 13th-14th day.

Hemorrhagic fever with renal syndrome is similar in course to other diseases that are characterized by increased body temperature: typhoid fever, tick-borne rickettsiosis and encephalitis, leptospirosis and simple influenza. Therefore, when identifying HFRS, differential diagnosis is important.

Treatment of the disease

Treatment of patients with hemorrhagic fever with renal syndrome is carried out only in the infectious diseases department of the hospital. The patient must be prescribed bed rest, especially during the period of illness with hyperthermia. A diet rich in carbohydrates with the exception of meat and fish is indicated (dietary table No. 4).

Treatment aimed at eliminating the cause of HFRS can give a positive effect only in the first 5 days of the disease.

Drug treatment is prescribed with drugs that inhibit RNA synthesis. In addition, the patient is treated with human immunoglobulin, alpha interferons and interferon inducers are prescribed orally and rectally.

Hemorrhagic fever with renal syndrome is characterized by multiple pathogenic changes in organs. Consequently, therapy is also aimed at eliminating these pathogenic changes caused by the syndrome of intoxication and renal failure, hemorrhagic syndrome. Patients are prescribed:

glucose and polyionic solutions;
calcium preparations;
ascorbic acid;
aminophylline;
papaverine;
heparin;
diuretics, etc.

Patients are also treated to reduce the body's sensitivity to the virus. Symptomatic treatment of HFRS includes relief of vomiting, pain symptoms, and restoration of the cardiovascular system.

In severe forms of HFRS, hemodialysis and other methods of correcting hemodynamics and disorders of the blood coagulation system are indicated.

During the recovery period of HFRS, the patient needs restorative therapy and adequate nutrition. The patient is also prescribed physiotherapy, physical therapy complex and massage.

Prognosis and prevention

If the patient receives adequate therapy in time (at the stage of fever), then recovery occurs.

However, in most cases, after suffering from hemorrhagic fever with renal syndrome, residual effects are observed for six months. These include:

asthenic syndrome (weakness, fatigue);
painful manifestations of the kidneys (swelling of the face, dry mouth, lumbar pain, polyuria);
disruption of the endocrine and nervous systems (pleurisy, pituitary cachexia);
development of cardiomyopathy due to an infectious disease (shortness of breath, heart pain, rapid heartbeat);
very rarely chronic pyelonephritis develops.

People who have had HFRS need to be monitored by a nephrologist, ophthalmologist and infectious disease specialist every three months for one year.

The severe course of this disease is dangerous due to the risk of complications, which in 7-10% of cases lead to death.

Prevention of hemorrhagic fever with renal syndrome consists of observing personal hygiene measures, especially for people who live in endemic areas. After being in forests, fields, or garden plots (in areas where rodents spread), you need to thoroughly wash your hands and disinfect your clothes. Food products must be stored in airtight containers.

To avoid contracting hemorrhagic fever with renal failure, you should only drink boiled water.

When working in dusty conditions (in a field, in a barn, etc.), wear a mask or respirator over your face to prevent airborne infection.

Under no circumstances should you handle, touch or pet rodents. In natural hotspot areas, it is necessary to carry out timely deratization and thorough cleaning of residential premises.

Vaccination against HFRS is impossible due to lack of development.