HEMORRHAGIC FEVER WITH RENAL SYNDROME
Hemorrhagic fever with renal syndrome (syn.: Hemorrhagic nephrosonephritis) - an infectious disease characterized by fever, kidney damage and in some cases the development of hemorrhagic syndrome.
The causative agent is a virus. The source of the causative agent of infection are rodents (red vole, large vole, field and forest mouse, etc.), which release the virus with urine and feces. Human infection occurs through air-dust by inhalation with air of dust containing dried particles of rodent excreta, as well as by alimentary and through the damaged skin of the hands when in contact with rodents and their feces. The rise in incidence occurs in the summer and autumn months, due to field work, mass departure of citizens outside the city, migration of rodents, etc. Diseases are registered in the forest and forest-steppe zones, riparian forests of the steppe zone of the European part of Russia, Asia
Clinical picture. The incubation period lasts 4-49 days, usually 14 to 21 days. Usually the disease begins acutely, less often the prodromal period precedes the onset of the disease: weakness, weakness, chilling, discomfort when swallowing, slight pain in muscles, joints, low-grade fever. During the disease there are four periods - febrile, oliguric, polyuric, convalescence.
The febrile period (the 1-3rd day of the disease) is characterized by a rapid rise in temperature up to 38-40 ° C, chills, headache, pains in the muscles of the back and lumbar region, photophobia, and dry cough. On examination, there is a bright hyperemia of the face, neck, upper chest, vascular injection of the sclera and conjunctiva ("rabbit eyes"), hyperemia of the pharynx, petechiae on the mucous membrane of the hard palate. During the oliguric period (from the 4th to the 8th — 12th day of illness) the temperature decreases, but the patient's condition worsens. Low back pain intensifies (sometimes they become unbearable), vomiting often occurs, diarrhea is possible, the liver and spleen are enlarged. The face of the patient is puffy, the eyelids are pasty, the skin is pale. The amount of excreted urine decreases progressively up to anuria. On palpation in the lumbar region there is a sharp pain. A picture of acute renal failure develops. On the 3-6th day of the disease, patients (mainly with severe acute renal failure) often show signs of hemorrhagic syndrome: petechial rash, mainly on the chest, hemorrhages in the sclera, nasal and intestinal bleeding.
The polyuria period (from 9–13th to 20–24th day) is characterized by an increase in diuresis (up to 3–5 liters per day or more), which indicates recovery, the back pain gradually subsides, vomiting stops, sleep and appetite are restored . Expressed thirst, weakness. Significantly reduced urine density.
The recovery period proceeds slowly, with a gradual restoration of renal function, accompanied by prolonged asthenia, the lability of the cardiovascular system.
The diagnosis is made on the basis of data of the epidemiological history (contact with rodents, migration of rodents to settlements), the clinical picture and laboratory tests of blood and urine. In the blood, leukopenia is detected, which is replaced by neutrophilic leukocytosis, an increase in the number of erythrocytes and a decrease in the number of platelets, a significant increase in ESR, an increase in the content of residual nitrogen. The amount of protein in the urine increases significantly, cylinders appear, blood, the relative density of urine is reduced.
The treatment is carried out in the hospital. Patients need complete rest. Assign a milk-vegetable diet. There are no specific treatment methods. With the threat of acute renal failure, prednisone , antihistamines, protease inhibitors are prescribed. According to indications, hemodialysis is carried out, heparin is used. Discharged patients from the hospital after the disappearance of the main clinical manifestations.
The prognosis is serious, mortality is 1 - 10%.
Prevention is aimed at the extermination of rodents in natural foci, to prevent people from contact with rodents and their feces and the possibility of contamination by rodents with food and water from rodents. If necessary, placing people on the ground in natural foci choose places not inhabited by rodents, such places are cleared of weeds, grass, shrubs, dead trees.