Clinical course and symptoms. The incubation period varies more from 6 to 14 days, rarely extends to 25 days. Prodromal phenomena within 3-6 days are observed in some patients. At this time, patients complain of fatigue, headache, pain in the joints. Some patients have nausea, vomiting, and a moderate increase in temperature in the evening. Often the disease begins abruptly, with a fever. Increasing weakness compels the person to go to bed. Body temperature in the first few days ranges of 37.8-38,9 degrees and can reach 39-40A, in severe cases, holding out on high figures from 9 to 20 days. Temperature, with few exceptions, reduced political. Repeated increase on 2-3rd week of a disease indicates the relapse or acceded complications.
The cardiovascular system is affected in varying degrees. The heart sounds are usually moderately muted. Typical lability pulse. In severe cases, heart rate reaches 120 to 150 beats per 1 min. At the height of the disease reasonable possible aetiology. Hypotension and heart failure are observed in severe disease. A sudden drop in blood pressure is common in the elderly.
In the blood of the characteristic radiation with a shift to the left. Leukocytosis is celebrated in the beginning of the disease, and during convalescence. There are also limfopenia, aneosinophilia and toxic granularity of polymorphonuclear leukocytes. ROE in the range of 30-40 mm is observed from the first days of the disease. Normal it becomes to 27-35-th day of illness.
Respiratory organs are affected more constant. The mucous membrane of the upper respiratory tract are usually moderately hyperemic. In the first days of illness can cough with little sputum. In some cases in connection with secondary infection, the mucus becomes purulent. In the sputum contains modified leukocytes, a limited number of red blood cells. Changes in the lungs, detected by percussion and auscultation, grow slow and unstable. The dullness in the inferior lobes of the lung, usually on the one hand, discover a number of patients with the 2nd-4th day of illness. Breathing becomes harsh. Traiterous wheezing with 8-10th day of illness are replaced by moist. Radiographically find pockets of infiltration in one and less frequently in both lungs already on the first week of illness. In the midst of illness are identified ocharovatelnye defeat of lobular, segmental and lobes type. Inflammatory changes are more common in the lower part of the left and less on the right. Sometimes in the presence of physical findings of repeated x-ray examination does not reveal pathological changes. Both lungs are affected relatively rare. Pneumonia, with rare exceptions, flows benign. Morphological changes in the lungs is gradually disappear. Pleura rarely affected.
Patients often complain of nausea, sometimes been vomiting. Language dry and covered grayish-white bloom. In some cases, there is diarrhea and constipation. The increase in the liver, a number of patients is observed from the first days of the disease. The spleen is palpated for some patients.
Kidney in varying degrees, affected in all cases. Daily quantity of urine is reduced. Share it ranges from 1,017 to 1,025. Constantly observed albuminuria, there are indications of the possibility of transient glycosuria. In urine determined urobilinogen and urobilin, hyaline cylinders and leached erythrocytes.
The severity of symptoms of the nervous system varies. In severe cases, along with headache, insomnia and loss of appetite are observed apathy, depression and sometimes psychosis with vivid hallucinations. With lesions of the autonomic nervous system associated sweating and persistent red dermographism.
Produce severe, moderate and mild forms of the disease. Lepin P. Lepine) distinguishes three forms of clinical course of disease: pneumonic flowing as SARS, with relatively little is expressed General toxic phenomena; flu-like; typhoid, proceeding with the expressed intoxication and limited process in the lungs.