Hemorrhagic fever

Hemorrhagic fever with renal syndrome (hemorrhagic nephrozonephritis) is a viral, natural focal disease that occurs with intoxication, fever, a peculiar kidney syndrome, and hemorrhagic manifestations.

Etiology, pathogenesis. The causative agent belongs to the group of arboviruses. In the feverish period of the disease, the virus is contained in the blood, causing infectious-toxic damage to the nervous system and severe hemorrhagic capillarotoxicosis. Characterized by the defeat of the kidneys with the development of acute renal failure.

Symptoms, course. The incubation period is from 11 to 23 days. The disease begins acutely. There is a fever (38-40 ° C), headache, insomnia, myalgia, photophobia. The face, neck, upper parts of the trunk are hyperemic, the vessels of the sclera are injected. By the 3rd-4th day of the disease the condition worsens, there is pain in the abdomen, vomiting, hemorrhagic syndrome (hemorrhagic rash, nosebleeds, hemorrhages at the injection sites, etc.). Pain in the abdomen and lower back increases to unbearable, the amount of urine decreases, its relative density is low (up to 1.004), anuria may occur, azotemia increases; Acute renal failure may lead to uremic coma. After lowering body temperature to normal, the patient's condition does not improve. Increases toxicosis (nausea, vomiting, hiccough), sleep is broken, sometimes there are meningeal symptoms. Characteristic of the absence of jaundice, an increase in the liver and spleen. Spontaneous rupture of the kidneys may occur. Transportation of the patient during this period should be very cautious. In the process of recovery, the signs of the disease gradually decrease, and for a long time the asthenia is preserved. After this period, typical polyuria (up to 4-5 l / day), which lasts up to 2 months.

Diagnosis is based on a characteristic clinical symptomatology; Specific methods of laboratory diagnosis have not yet entered into widespread practice. It is necessary to differentiate from leptospirosis, fever Ku, pseudotuberculosis.

Treatment. There is no etiotropic therapy. Recommended bed rest, milk-vegetable diet, vitamins. Prescribe prednisolone from 50 to 120 mg / day. After normalization of body temperature, the dose is gradually reduced. Duration of the course is 8-15 days. In the first days of IV, 5% glucose solution or isotonic sodium chloride solution is added with the addition of 1% potassium chloride solution (50 ml per 1 liter of isotonic solution), 5% solution of ascorbic acid (20 ml / day ) And 4% sodium hydrogen carbonate solution (50 ml per 1 liter of solution). For a day, introduce 1-1.5 liters. In the absence of arterial hypotension in the phase of oliguria, mannitol or furosem 1 / 1d (lasix) is prescribed. It is recommended to wash the stomach with 2% sodium hydrogen carbonate solution and siphon enemas. With severe pain, a pantopone is prescribed. With the growth of renal failure, the patient needs to undergo extracorporeal hemodialysis.

The prognosis is favorable; Sometimes serious complications arise (renal rupture, uremic coma, meningoencephalitis), which threaten the patient's life. Workability is restored slowly, sometimes after 2 months.

Prevention. Fighting rodents, protecting their products. The patients are isolated. The current and final disinfection is carried out in the room where the patients are kept.