Hemorrhagic fever

Hemorrhagic fever - a group of natural focal viral diseases associated with fever, hemorrhagic syndrome and involvement of the nervous system, organs and blood.
Classification of hemorrhagic fevers in the international nomenclature of diseases: hemorrhagic nefrosonefrit (synonym hemorrhagic fever with renal syndrome), Crimean hemorrhagic fever, Omsk hemorrhagic fever, a disease casinorama forests (forest disease India), other tick-borne haemorrhagic fever, a mosquito hemorrhagic fever.
Hemorrhagic nefrosonefrit.
The causative pathogen is not selected.
The disease occurs in the far East, in Yaroslavl, Kalinin and other regions of the USSR, and also in some countries of Europe and Asia. The season may - November, but there are diseases and winter.
Human infection occurs by contact with objects and eating foods contaminated with secretions of voles (Microtus), through ticks, airborne dust infection; infection of people from each other practically is not installed.
Pathological changes: swollen-destructive defeat to the small blood vessels in all organs, the output of plasma and blood outside of the vascular wall, bilateral serosanguineous jade and segmental hydronephrosis.
Transferred disease leaves a lasting immunity.
The clinical picture. The incubation period 11-24 days. During the prodromal period (2-3 days) - a slight indisposition, scratchy sore throat, catarrhal angina, mild pain in the joints. Often, the disease starts acutely. Distinguish four periods in the course of the disease.
The first period (2-3 days) - Feverish. Temperature 39-40 degrees, the chills, weakness, headache, aching bones and muscles, dry cough, flushing of the face, neck, conjunctiva of the eyes ("rabbit" eye), sleep disorder, photophobia, dizziness. Erythrocytes 5 500 000, leukocytes 3000-4000; ROHE 2-4 mm per hour.
The second period (from 4 to day 7) - hemorrhagic manifestations. Multiple minor bleeding in all organs and tissues, and therefore violated their function. Temperature decreases back pain worse, appear petechiae on the skin side surfaces breast closer to the armpits, rarely on his feet. Expressed hematuria, a mixture of fresh blood in vomitus, bleeding wear, gums, intestinal bleeding.
Language dry, brown, the smell of raw meat from the mouth. Belly swollen, chair detained. Liver half of the patients stands out from the edge of the ribs on 3-4 cm In urine significant amounts of protein, lots of erythrocytes in the field of view, cells of the epithelium, hyaline cylinders. 7-th day develops anuria. The number of red blood cells to 6 000 000, Hb 16-16,6 g%, white 20 000 to 63 000, a sharp shift leukocyte left, increasing the number of cells Turk (cells irritation), ROE slowed down. Time clotting of blood is slowed down, bleeding time increased. Residual nitrogen in the blood sometimes rises up to 200 mg%. Notes meningeal syndrome unchanged spinal fluid, possible serous meningitis (see) and meningoencephalitis (see Encephalitis).
The third period (from 8-th day of illness), of the organ lesions. The temperature decreases to normal within 36-48 hours. The state becomes heavy, appear psychosis, impaired taste and smell, there is a thirst, hiccups, vomiting, abdominal pain. Pulse up to 50 beats per 1 min. In urine appear vibronnye cylinders, residual nitrogen increased to 400 mg%, total protein blood decreases.
The fourth period (4th - 6th week) - convalescence. Stops vomiting, appears polyuria (see), back pain does not disappear for a few weeks.
Complications: bleeding in the brain, the mesentery, the pancreas, the infarction, the gap kidneys, ezoterichesky uremia (see), pneumonia.
Differential diagnosis is carried out with the flu, Busselton leptospirosis, epidemic encephalitis, with diseases of the group "acute abdomen", Omsk and Crimean hemorrhagic fever.
Forecast in some cases severe, the case fatality rate of 3-5%.
Specific treatment is not. Prescribe antibiotics such as penicillin to prevent complications associated with secondary infection. To combat the intoxication of organism and reduction of permeability of vessels entering 10-20 ml of 10% solution of chloride calcium intravenously; 10 ml of 5% solution of ascorbic acid 2 times a day intravenously; isotonic solution of sodium chloride and 5% solution of glucose to 4-5 liters per day intravenously and enemas drip method. Diet dairy plant. The result of treatment depends mainly on care; patient needed rest, as sharp movements can lead to rupture of the kidneys and death.
To this group of diseases is and epidemic nephropathy Scandinavia, which is transmitted to humans and the mouse-like rodents; found in Sweden, Norway. The disease occurs more benign. Prevention - protection of persons against blood-sucking insects, as well as the destruction of ticks and rodents (see Disinsection, Deratization). Specific prevention is not developed.
Crimean hemorrhagic fever is caused filterable virus Haemorrhagogenes Tchumacovi, which remains in the grip of a kind Hyalomma and in the body of patients during a fever. Sick people working in the field. Season - June - September. The disease occurs in the southern steppe regions of the USSR and Bulgaria.
Pathogenesis and pathoanatomical changes depend on the defeat of the capillaries of the skin, mucous membranes and internal organs, which are value added permeable.
The clinical picture. The incubation period is 2 to 12 days. Fever persists for 3 to 12 days with headache, chills. His face red, vessels of sclera and conjunctiva expanded, lips red, Zev hyperemia. On 4-6th day of illness on the sides of the chest, abdomen and waist appears punctulata hemorrhagic rash. The oral mucous membrane bleeding, frequent nasal, lung, uterine bleeding, continued for 5 days and more. Blood pressure is low; bradycardia. In the urine, a small amount of protein. The consciousness is clear, but the patient and dynamic, sleep disturbed. May be meningeal syndrome. In the first days the quantity of hemoglobin increased, then comes hypochromic anemia, leukopenia (4000) with stab shift. With the fall of the temperature begins a period of slow recovery. Transferred disease leaves immunity. Mortality 3-8%.


Treatment: intravenous calcium chloride (10 ml 10% solution), ascorbic acid (5-10 ml of 5% solution), blood transfusion, large quantities of liquid, intramuscularly antibiotics, menadione.
Prevention should be aimed at the control of ticks and protection of people from their bites.
Omsk hemorrhagic fever is caused filterable virus Haemorrhagogenes sibiricus, which is in the blood of patients, mites of the genus Dermacentor. Sick people working in the steppe. The season is may - August. The disease was observed in the Baraba steppe before the introduction of specific vaccines are now found in a small number and only among unvaccinated. Once through the skin, the virus can penetrate any tissues and organs. Section reveals a plethora of organs, bleeding in glands, the adrenal glands and Central nervous system, swelling and tissue destruction of the liver and heart.
The clinical picture. The incubation period of 2-7 days. Beginning acute, headache, pain in the limbs and back, patients in appearance similar to patients Crimean hemorrhagic fever, but the hemorrhagic syndrome in them is weaker. Changes in the blood are the same as in the Crimean hemorrhagic fever. Disorders of the Central nervous system is expressed more frequent meningoencephalitis. In 40% of patients on the 3-4th day of the disease affects the lungs. 15-20-day sickness possible secondary temperature rise. Transferred disease leaves immunity. The case fatality rate to 1%Treatment: the same as in the Crimean hemorrhagic fever, mandatory strict bed rest. Prevention - the fight against ticks; apply the vaccine.