Hemorrhagic fever With renal syndrome(GLPS) is acute illness viral origin, characterized by hemodynamic disorders, extensive damage to the vascular system, the formation hemorrhagic diathesis and tissue damage to the kidneys, leading to acute renal failure.

Pathogen

The viral origin of HFRS was confirmed back in 1944, but only in 1976, scientists were able to isolate the direct causative agent of the disease - hantavirus (Hantavirus). Its vital activity is carried out directly in the cytoplasm of the affected cells.

At the same time, hantavirus is able to infect cells of any organs and tissues:

• kidneys;
• lungs;
• liver;
• stomach;
• intestines.

The main carriers of the pathogen are wild mice living in their natural habitats. For example, in the European part of Russia, such a representative is the bank vole, in the Far East - different kinds field mice and Asian wood mouse.

Important! The existence of a virus in the body of rodents has the nature of a latent course, due to the ability of tissues to produce a specific antigen in response to its presence.

The pathogen is released into the environment with urine, feces or saliva of the animal. The penetration of the pathogen into the human body occurs mainly by airborne dust, in rare cases by direct contact (bite or touch of a rodent on damaged skin).

House rats are carriers of the virus in urban environments

Development mechanism

The development of hemorrhagic fever with renal syndrome is characterized by damage to the walls of blood vessels and arteries, especially microvessels and arterioles of the lungs, liver, kidneys, and brain. After infection has entered digestive tract(when eating contaminated products) or into the lungs (when inhaling dust containing particles of infected excrement), there are two options for the further development of the disease:

1. The death of the virus (occurs with a strong immune response).
2. Reproduction of the virus with subsequent penetration into the bloodstream (viremia).

The vital activity of the virus inside the vascular system occurs by settling it on the endothelium (the inner wall of the vessels), followed by a violation of its structure, which leads to the development of hemorrhagic syndrome. Since the entire volume of blood passes through the filtration system of the renal apparatus, the vascular system of the kidneys is damaged (hemorrhages, edema) with the subsequent development of renal failure (an unfavorable variant of the development of the disease).

Hantavirus can survive up to 12 hours at 0 ºС

With the reverse dynamics, a gradual regression occurs, accompanied by a gradual resorption of hemorrhages and normalization of urination. The process of restoring the work of the body can take about a month, the full restoration of the body can last from 1 to 3 years.

Important! Transferred hemorrhagic fever with renal syndrome leaves a stable immunity that lasts for life.

Symptoms and development of the disease

The clinical picture in HFRS disease has a certain set of symptoms corresponding to a certain stage of the disease. In general, the clinic of the disease includes the following pathological manifestations:

• general intoxication of the body;
• hemodynamic disorders (impaired blood circulation in small and large main arteries);
• impaired renal function;
• hemorrhagic syndrome;
• stomach ache;
• neuroendocrine disorders.

Regardless of the region of the initial origin of the virus and the severity of the course, the main stages of the manifestation of the disease have a certain similarity.

The course of HFRS is usually divided into the following periods:

• incubation;
• feverish (initial);
• oliguric;
• polyuric;
• convalescent.

Important! The main value in the variability, nature and severity of the course of the disease belongs to the intensity immune response and individual characteristics of the infected organism.

The incubation period can last from 2 to 4 weeks and any clinical manifestations during this time period are completely absent. The virus enters the body through the stomach lining respiratory tract or damage to the skin and starts the process of reproduction.

Nosebleeds may be one of the symptoms of HFRS

The feverish period (initial) is characterized by an acute reaction to viral intoxication, accompanied by:

• stimulation of the activity of the hormonal system;
• activation of the immune system;
• microcirculation disorders;
• tissue destruction.

The initial period lasts 1-2 weeks and it is during this time period that the main symptoms of hemorrhagic fever with renal syndrome appear:

• slight cough;
• chills;
• temperature rise to 39–40 ºС
• migraine;
• pain in muscles and joints;
• dry mouth;
• redness of the face, neck;
• hemorrhagic rashes on the shoulders, body, chest;
• hemorrhages in the sclera of the eyeball;
• heaviness in the lumbar region;
• hypotension;
• decrease in diuresis (noted by the end of the febrile period).

Hyperemia of the face and upper body is called "hood syndrome"

Oliguric period (peak of the disease). It is characterized by the further development of the emerging disorders:

• circulatory disorders;
• oxygen starvation of tissues;
• general damage to body systems;
• necrotic, dystrophic changes in the tissues of the kidneys and liver.

The greatest changes occur in the kidneys, as a result of which a persistent or temporary violation of their filtering function develops and manifests itself, most often in the form of acute interstitial nephritis. Kidney damage is multifaceted.

On the one hand, there is an increase in the permeability of the walls of blood vessels and a violation of microcirculation, which leads to the appearance of serous edema causing compression of the renal tubules and a violation of their reabsorbing function. On the other hand, the effect of immune complexes negatively affects the filtration capacity of the glomeruli. As a result, ischemic and necrotic changes occur.

Despite the decrease in temperature, the patient does not feel relief, since along with the existing disorders, there are:

• sharp and excruciating pain in the lower back;
• nausea;
• vomit;
• hiccups
• stomach ache;
• stomach or intestinal bleeding;
• pulmonary edema.

Important! Almost all patients with HFRS have a violation of the work of the central nervous system associated with the occurrence of focal tissue lesions and general intoxication.

Table: HFRS symptom severity criteria

Symptom	Severity	Condition assessment
Hemodynamic disorders	Arterial pressure - 100 mm Hg.	Lung
	Arterial pressure - 90 mm Hg.	Medium
	Arterial pressure - 80 mm Hg.	heavy
	state of shock	heavy
Hemorrhagic syndrome	Visible hemorrhages on the surface of the skin and mucous membranes	Lung
	Bleeding without life threatening	Medium
	Life threatening bleeding	heavy
Renal disorders	Violations of diuresis (oliguria) less than 500 ml / day for 1-2 days	Lung
	Diuresis disorders (oliguria) less than 500 ml/day for 3 days	Medium
	Anuria not more than 50 mg/day	heavy
Rupture of the capsule of the kidney		heavy
Brain disorders	cerebral edema	heavy
	Hemorrhages in the brain	heavy
	Serous meningoencephalitis	heavy

polyuric period. As a result of the development of specific immunity, there is a gradual suppression of the activity of the pathogen and regression in the damaged organs. Diuresis is restored, vomiting stops, appetite normalizes, pain in the abdomen and lower back decreases, and then completely disappears. The duration of recovery can be within one or several weeks and depends on the severity of the course of the disease and the individual characteristics of the organism.

convalescence period. The duration of the recovery period takes up to one year and is characterized by:

• the formation of stable immunity;
• restoration of hemostasis;
• normalization of the filtration function of the glomeruli;
• improvement in physical condition.

However, despite the normalization of glomerular filtration, the recovery of tubular disorders is much slower. Also, general weakness persists for a long time, there is a decrease in working capacity and rapid fatigue.

The deterioration of visual acuity is associated with impaired blood circulation in the retina of the eye.

Diagnostics

Diagnosis of hemorrhagic fever with renal syndrome includes a comprehensive assessment of the patient's condition, which takes into account:

• the likelihood of contact with infection vectors or stay in rodent habitats (epidemiological history);
• results of instrumental examination (ultrasound internal organs);
• severity of symptoms;
• cyclical course of the disease;
• results of laboratory research methods.

Table: Characteristics of HFRS symptoms

№	signs	Characteristic
	Fever	Temperature about 39.5 ºС, duration 4–8 days
	Vascular lesions	Hemorrhages in the sclera, hemorrhagic rash, bruising with pinching and squeezing, loss of visual acuity
	Deterioration after temperature decrease	Characterizes the onset of the peak of the disease (oliguric period)
	Cyclic manifestations of the disease	In all patients with HFRS, a pronounced cyclicity of the disease is necessarily observed. Identified from 2 to 5 periods (initial, oliguric, polyuric, convalescent)
	At the height of the disease, signs of various disorders simultaneously appear.	During the oliguric period, the patient has signs of intoxication, impaired renal function, endocrine and hemorrhagic disorders, and abdominal syndrome.
	Development of specific complications	Toxic shock, pulmonary edema, intracranial and cardiac hemorrhages, rupture of the renal capsule.

Laboratory diagnostic methods include the following studies:

• laboratory analysis of blood and urine;
• blood chemistry;
• coagulogram.

The informational value of these studies, from the point of view of diagnosis, is relative, since they only reflect the degree of intensity of the manifestation of pathological symptoms.

The final diagnosis is made on the basis of serological studies (enzymatic immunoassay, RNIF), which make it possible to detect even mild forms of the disease at an early stage. By using enzyme immunoassay(ELISA) in the blood serum reveal specific antibodies to hantavirus classes lgM and lgG.

Important! In rare cases, antibodies cannot be detected due to abnormalities in immune system sick.

Treatment

Treatment of hemorrhagic fever with renal syndrome can be conditionally divided into two areas:

1. antiviral therapy.
2. Complex treatment of the main pathogenetic symptoms.

Conducting antiviral therapy is advisable in the initial period of the disease. For this purpose, a combination of two drugs is used - Ribavirin and Virazole, with a subsequent transition to taking only Ribavirin.

The use of Ribavirin helps to reduce the intensity of all manifestations (fever, vomiting, pain, etc.)

Due to the fact that with HFRS a complex of diverse symptoms is determined, difficulties in diagnosis cause a delay in hospitalization of patients, which leads to the use of therapy directed:

• for the prevention of acute renal failure;
• pulmonary and cerebral edema;
• reduction of intoxication manifestations;
• stimulation of the restoration of the vascular wall;
• normalization of the cardiovascular system.

Table: List medicines used in the treatment of HFRS

Group of medicines	Preparations	Indications
Immunostimulants	Tiloron	Stimulation of antiviral activity
Pyrazolones	Metamizole sodium	Anti-inflammatory, antipyretic effect
proton pump inhibitor	Omez	Prevention of erosive changes in the gastric mucosa
Antiplatelet agents, vasodilators	Dipyridamole	Improvement of microcirculation
Hemostatics	Sodium etamsylate	Strengthening blood vessels
Glucocorticoids	Dexamethasone	Removal of toxic shock, cerebral edema
	Prednisolone
Blood substitutes	Albumen	Replenishment of blood volume
	Plasma
Purines	Pentoxifylline	Restoration of microcirculation
Sulfonamides	Furosemide	Stimulation of the urinary function
vitamins	Riboflavin	Recovery of the nervous system
	A nicotinic acid
	Thiamine

Severe damage to internal organs that occurs with HFRS leads to a long rehabilitation period, sometimes up to several years. Therefore, all patients who have had this disease should be under constant medical supervision for the timely detection of the consequences of the disease and their treatment.

Hemorrhagic fever with renal syndrome (HFRS) or mouse fever should be familiar to every inhabitant of Russia.

The disease is dangerous with the likelihood of severe complications. The number of deaths among patients in Russia reaches 8%.

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The site provides background information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious physician. All drugs have contraindications. You need to consult a specialist, as well as a detailed study of the instructions! .

What causes HFRS

it viral disease which affects blood vessels and kidneys. The causative agent of the disease is the Hantaan virus, belonging to the Bunyavirus family.

Between animals, this virus is spread by flea or tick bites. Rodents are latent carriers of the virus and will release it into the environment with faeces, urine and saliva.

The virus is characterized by resistance to negative temperatures and dies within half an hour at a temperature of 50 degrees. The peculiarity of the virus is that it infects the inner shell blood vessels(endothelium).

There are 2 types of virus:

1. Eastern type. The type prevails in the Far East; the Manchurian field mice are the carrier of the infection.
2. The Western type is common in the European part of Russia. The peddler is a red and red-backed vole.

It is noted that the first type is more dangerous and causes from 10 to 20% of deaths, the second - up to 2%. There are several ways to get this disease.

Infection occurs when a person comes into contact with secretions of infected rodents by inhalation, ingestion, or when they come into contact with damaged areas of the skin. The disease has an autumn-winter seasonal character.

Symptoms of this disease

The course of HFRS is divided into several periods.

Depending on the stage of the course of the disease, the patient manifests symptoms of the disease.

1. incubation period. This stage lasts about 20 days. At this stage, the disease does not manifest itself. The patient may not be aware of the infection.
2. The initial (febrile) period lasts 3 days.
3. Oligoanuric lasts about a week.
4. Polyuric (early convalescence) - from 2 to 3 weeks.
5. Late convalescence begins approximately from the second month of the course of the disease and lasts up to 3 years.

The initial stage of the disease is characterized by a significant jump in body temperature in the morning and afternoon. The patient is accompanied by insomnia, body aches, fatigue, lack of appetite.

There is a headache, a painful reaction to light stimuli, conjunctivitis. A white coating forms on the tongue. There is redness of the upper body.

In the third stage of the disease, the temperature decreases somewhat, but other pronounced symptoms appear.

Characteristic of this period are pain in the lower back, which in severe form of the disease may be accompanied by nausea, vomiting, aching pains in the abdomen.

The volume of urine excreted is reduced. Due to this, the level of potassium and urea in the blood increases, and the level of calcium and chlorides decreases.

Appears on the patient's skin small rash(hemorrhagic syndrome). The most commonly affected areas are the chest, armpits and shoulders. This is accompanied by nasal and gastrointestinal bleeding.

The patient's cardiovascular system malfunctions: the pulse becomes less frequent, arterial pressure in a short period it develops from low to high and vice versa.


A characteristic symptom of hemorrhagic fever with renal syndrome is damage to the nervous system. Hemorrhages in the patient's brain can provoke hallucinations, deafness, fainting. At the stage of oliguria, the patient has complications - acute renal and adrenal insufficiency.

At the stage of early convalescence, the patient feels relief. Initially, there is an abundant excretion of urine (up to 10 liters per day), then diuresis gradually returns to normal.

Late convalescence is characterized by residual manifestations of symptoms. The patient feels a general malaise - dizziness, weakness, increased sensitivity in the legs, need for fluid, increased sweating.

Features of the development of HFRS

The development of HFRS begins in a patient with incubation period in the first 2-3 weeks after infection. The infection enters the body through the mucous membrane of the respiratory tract or digestive system, less often through open wounds on the skin.

If a person has strong immunity, the virus dies. It starts to multiply.

Then the infection enters the bloodstream and the patient begins to manifest an infectious-toxic syndrome. Once in the blood, the virus settles on the endothelium.

To a greater extent, the vessels of the kidneys are affected. From the patient's body, the infection is excreted in the urine.

At this time, the patient may experience acute renal failure. Regression sets in, and body functions are restored. The recovery process is complex and proceeds slowly, this period can last up to 3 years.

Diagnosis of pathology

The first symptoms of the disease are similar to SARS, so the patient often hesitates to seek help from a medical institution. Consider the features in the symptoms of HFRS on early stages the development of the disease.

Firstly, with ARVI, the patient's temperature rises in the evening, while with HFRS this occurs mainly in the morning. Another feature of the disease is the reddening of the skin of the upper body of a person, the eyeballs.

In the later stages of the development of the disease, clearer symptoms appear. This is a hemorrhagic rash, a decrease in the volume of urine excreted, pain in the lumbar region.

At the first suspicion of the development of hemorrhagic fever, you should consult a doctor. When making a diagnosis, the seasonal factor, the likelihood of the patient staying in endemic foci and other epidemiological characteristics are taken into account.

To make an accurate diagnosis, differential and laboratory diagnostics are used. During differential research methods, specialists exclude other diseases, SARS, influenza, tonsillitis, pyelonephritis.

The patient is constantly monitored to identify new symptoms of the disease.

Laboratory diagnostic methods include urinalysis, general and biochemical analysis of the patient's blood. With HFRS, fresh erythrocytes are found in the patient's urine, the protein level is significantly reduced.

In the blood, the level of urea and creatine increases, and the level of hemoglobin and red blood cells decreases. In the blood serum, the concentration of fats increases and the level of albumin decreases.

Confirm the diagnosis of HFRS by detecting antibodies in the body class IgM and G. For this, enzyme-linked immunosorbent assay is used.

An important feature of the diagnosis of this disease is not the very fact of ongoing research, but their frequency.

The patient must be under constant observation, and the diagnosis is made on the basis of changes that are observed in the results of studies during the course of the disease.

Instrumental diagnostic methods (X-ray, computed tomography, and others) are carried out to identify the degree of damage to internal organs.

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Effective treatment of the disease

When a disease is detected, the patient is strictly shown hospitalization as soon as possible. Due to the fact that the disease is not transmitted from person to person, the treatment of hemorrhagic fever with renal syndrome is carried out in infectious hospitals, in surgical, therapeutic.

Transportation of the patient in the later stages of development is carried out with extreme caution, fearing hemorrhages and rupture of the kidneys.

The patient needs bed rest, diet. During the patient's stay in the hospital, preventive actions to prevent complications.

Medical treatment of the disease includes antibacterial drugs. To save energy, glucose solutions with insulin are prescribed.

Curantil and eufillin normalize microcirculation. To relieve the symptoms of the disease, antipyretic and analgesic drugs are used.

Features of the therapeutic diet

Recovery requires a strict diet. For patients with HFRS, diet No. 4 of 15 therapeutic nutrition systems, developed by the Soviet doctor M.I. Pevzner.

You need to eat often and in small portions. Food should be at medium temperature. Fermentation products (cabbage, plum, sour cream, cheese) should be completely excluded from the diet.

Diet number 4 is aimed at limiting the amount of fat and carbohydrates. Hard-to-digest foods that increase gastric secretion are also excluded from it.


These include:

• Fatty varieties of fish and meat;
• Smoked products;
• Pickles;
• Sausages;
• Sauces;
• Canned food;
• Bakery products;
• Dried fruits;
• Carbonated drinks;
• Sweets.

Dishes should not be spicy or spicy.

Low-fat boiled meat and fish, low-fat cottage cheese, wheat crackers are acceptable for use. From cereals you need oats, rice, buckwheat, semolina, jelly decoctions from these cereals are useful.

Raw fruits and vegetables are not allowed. Compotes, jelly, jelly are prepared from fruits, vegetables are consumed in the form of mashed potatoes.

Help of folk remedies

Effective treatment of the disease is impossible without medical assistance.

Self-medication of this disease leads to serious consequences and death. Before taking this or that folk remedy, you should consult with your doctor.

Doctors advise taking various decoctions aimed at normalizing the functioning of the kidneys. Much is known about phytotherapy medicinal plants, the use of which has a diuretic and anti-inflammatory effect.

The most common decoctions used for HFRS disease:

1. 1 teaspoon of flax seeds and 200 ml of water must be brought to a boil. You need to drink a decoction of 100 ml every 2 hours.
2. 50 g of young birch leaves should be infused for 5 hours in 200 ml of warm water, take 100 ml 2 times a day.
3. Add 2 tablespoons of lingonberry leaves to 200 ml of hot water. Infuse the decoction in a water bath for half an hour, you need to take 100 ml 2 times a day.
4. Add 3 g of dry leaves of orthosiphon (kidney tea) to a glass of boiling water and boil for another 5 minutes. The decoction is insisted for 4 hours and drunk 100 ml before meals.

Herbal preparations are considered the most effective; they are already available in pharmacies in ready-made proportions.

In most of these collections, bearberry leaves are used, they can be brewed separately as a tea.

The composition of fees with bearberry:

• Bearberry leaves, licorice root, cornflower inflorescences in proportions 3:1:1;
• Bearberry leaves, licorice root, juniper fruits in proportions 2:1:2;
• Bearberry leaves, orthosiphon leaves, lingonberry leaves in proportions 5:3:2.

A tablespoon of the collection is brewed in a glass of water. You need to take a decoction of half a glass 3 times a day. To normalize the functioning of the cardiovascular system, currant juice and a decoction of fragrant geranium roots are used.

Currant juice is taken 100 ml 3 times a day. Geranium roots (about 4 pieces) are poured into 1 liter of water and boiled for 20 minutes. You need to drink this decoction in a warm form every 20 minutes.

Application folk remedies possibly to relieve symptoms of the disease. To lower body temperature, they take baths with cool water (about 30 degrees) and drink decoctions of raspberries, honeysuckle and strawberries.

Possible complications of the disease

It has been proven that the most dangerous in terms of complications is the oligoanuric stage of the disease. The period runs from 6 to 14 days of illness.

The complications that hemorrhagic fever can cause are specific and non-specific.

Various complications include:

• Infectious-toxic shock;
• DIC (disseminated vascular coagulation);
• Edema of the brain and lungs;
• Acute cardiovascular failure;
• Various hemorrhages (in the brain, adrenal glands and others) and bleeding;
• Kidney rupture.

Infectious-toxic shock is characterized by acute insufficiency circulation. The patient's arterial pressure drops, insufficiency of internal organs develops.

This complication of the disease is the most common cause of death in HFRS.

With DIC, there is a violation of normal blood circulation in the patient's body. This leads to the development of serious dystrophic changes.

Hypocoagulation develops - the patient's blood clotting ability decreases, thrombocytopenia - the level of platelets in the blood decreases. The patient is bleeding.


Among non-specific complications, diseases are distinguished - pyelonephritis, purulent otitis media, abscesses, pneumonia. Complications of HFRS are dangerous and can often lead to death of the patient.

Patients who have had this disease develop strong immunity to the virus. This statement is substantiated by the fact that there were no cases of re-infection in patients who underwent HFRS.

Timely diagnosis of the disease is important, which will provide effective and qualified treatment.

Disease prevention

In order to prevent hemorrhagic fever with renal syndrome, you must follow the rules of personal hygiene.

You need to thoroughly wash your hands and consumed fruits and vegetables, do not leave food in the reach of rodents.

Use a gauze bandage to protect your respiratory tract from dust that can carry infection.

Main measures general prevention disease is the destruction of the population of murine rodents in the foci of HFRS.

It is necessary to ensure the improvement of territories adjacent to residential buildings, crowded places, food warehouses, and the like. Weeds and thickets should not be allowed to spread.

5 / 5 ( 6 votes)

Zoonotic hantavirus infection characterized by thrombohemorrhagic syndrome and predominant kidney damage. Clinical manifestations include acute fever, hemorrhagic rash, bleeding, interstitial nephritis, and in severe cases, acute renal failure. to specific laboratory methods diagnosis of hemorrhagic fever with renal syndrome belong to RIF, ELISA, RIA, PCR. Treatment consists in the introduction of specific immunoglobulin, interferon preparations, detoxification and symptomatic therapy, hemodialysis.

ICD-10

A98.5

General information

Hemorrhagic fever with renal syndrome (HFRS) is a natural focal viral disease, the characteristic features of which are fever, intoxication, increased bleeding and kidney damage (nephrosonephritis). On the territory of our country, endemic regions are the Far East, Eastern Siberia, Transbaikalia, Kazakhstan, the European territory, therefore HFRS is known under various names: Korean, Far Eastern, Ural, Yaroslavl, Tula, Transcarpathian hemorrhagic fever, etc. Every year in Russia, from 5 to 20 thousand cases of hemorrhagic fever with renal syndrome. The peak incidence of HFRS occurs in June-October; the main contingent of patients (70-90%) are men aged 16-50 years.

Causes of HFRS

The causative agents of the disease are RNA-containing viral agents of the genus Hantavirus (hantaviruses), belonging to the Bunyaviridae family. For humans, 4 serotypes of hantaviruses are pathogenic: Hantaan, Dubrava, Puumala, Seoul. In the external environment, viruses remain stable for a relatively long time at a negative temperature and are unstable at a temperature of 37°C. Viruses are spherical or helical, 80-120 nm in diameter; contain single-stranded RNA. Hantaviruses have tropism for monocytes, cells of the kidneys, lungs, liver, salivary glands and multiply in the cytoplasm of infected cells.

Carriers of causative agents of hemorrhagic fever with renal syndrome are rodents: field and forest mice, voles, house rats, which become infected from each other through the bites of ticks and fleas. Rodents carry the infection in the form of a latent virus carrier, releasing pathogens into the external environment with saliva, feces and urine. The entry of material infected with rodent secretions into the human body can occur by aspiration (when inhaled), contact (when it comes into contact with the skin) or alimentary (when eating) by. To the group increased risk the incidence of hemorrhagic fever with renal syndrome includes agricultural and industrial workers, tractor drivers, drivers who are actively in contact with environmental objects. Human morbidity directly depends on the number of infected rodents in a given area. HFRS is registered mainly in the form of sporadic cases; less often - in the form of local epidemic outbreaks. After the infection, persistent lifelong immunity remains; cases of recurrence are rare.

The pathogenetic essence of hemorrhagic fever with renal syndrome is necrotizing panvasculitis, DIC and acute renal failure. After infection, the primary replication of the virus occurs in the vascular endothelium and epithelial cells of internal organs. Following the accumulation of viruses, viremia and generalization of infection occur, which are clinically manifested by general toxic symptoms. In the pathogenesis of hemorrhagic fever with renal syndrome, an important role is played by the formed autoantibodies, autoantigens, CEC, which have a capillary toxic effect, cause damage to the walls of blood vessels, impaired blood clotting, the development of thrombohemorrhagic syndrome with damage to the kidneys and other parenchymal organs (liver, pancreas, adrenal glands, myocardium) , CNS. The renal syndrome is characterized by massive proteinuria, oligoanuria, azotemia, and impaired acid-base balance.

Symptoms of HFRS

Hemorrhagic fever with renal syndrome is characterized by a cyclic course with a succession of several periods:

• incubation (from 2-5 days to 50 days - an average of 2-3 weeks)
• prodromal (2-3 days)
• febrile (3-6 days)
• oliguric (from 3-6 to 8-14 days of HFRS)
• polyuric (from 9-13 days of HFRS)
• convalescent (early - from 3 weeks to 2 months, late - up to 2-3 years).

Depending on the severity of symptoms, the severity of infectious-toxic, hemorrhagic and renal syndromes, typical, erased and subclinical variants are distinguished; light, moderate and severe forms hemorrhagic fever with renal syndrome.

After the incubation period, a short prodromal period begins, during which fatigue, malaise, headaches, myalgia, low-grade fever are noted. The feverish period develops acutely, with an increase in body temperature to 39-41 ° C, chills and general toxic symptoms (weakness, headache, nausea, vomiting, sleep disorders, arthralgia, body aches). Characterized by pain in the eyeballs, blurred vision, flickering "flies", seeing objects in red. At the height of the febrile period, hemorrhagic rashes appear on the mucous membranes of the oral cavity, skin chest, axillary areas, neck. An objective examination reveals hyperemia and puffiness of the face, injection of vessels of the conjunctiva and sclera, bradycardia and arterial hypotension up to collapse.

In the oliguric period of hemorrhagic fever with renal syndrome, the body temperature drops to normal or subfebrile figures, but this does not lead to an improvement in the patient's condition. At this stage, the symptoms of intoxication are even more intensified and signs of kidney damage appear: back pain increases, diuresis sharply decreases, arterial hypertension develops. In the urine, hematuria, proteinuria, cylindruria are detected. With an increase in azotemia, acute renal failure develops; in severe cases, uremic coma. Most patients experience intractable vomiting and diarrhea. Hemorrhagic syndrome can be expressed to varying degrees and include gross hematuria, bleeding from injection sites, nasal, uterine, gastrointestinal bleeding. In the oligouric period, severe complications (hemorrhages in the brain, pituitary gland, adrenal glands) can develop, causing death.

The transition of hemorrhagic fever with renal syndrome to the polyuric stage is marked by subjective and objective improvements: normalization of sleep and appetite, cessation of vomiting, disappearance of pain in the lower back, etc. Characteristic features this period is an increase in daily diuresis up to 3-5 liters and isohyposthenuria. During polyuria, dry mouth and thirst persist.

The period of convalescence in hemorrhagic fever with renal syndrome can be delayed for several months and even years. In patients, post-infectious asthenia persists for a long time, characterized by general weakness, decreased performance, fatigue, and emotional lability. The syndrome of vegetative dystonia is expressed by hypotension, insomnia, shortness of breath with minimal exertion, and increased sweating.

Specific complications of severe clinical variants of HFRS can be toxic shock, hemorrhages in parenchymal organs, pulmonary and cerebral edema, bleeding, myocarditis, meningoencephalitis, uremia, etc. bacterial infection possible development of pneumonia, pyelonephritis, purulent otitis media, abscesses, phlegmon, sepsis.

Diagnosis of HFRS

Clinical diagnosis of HFRS is based on the cyclical course of infection and the characteristic change of periods. When collecting an epidemiological history, attention is drawn to the patient's stay in an endemic area, possible direct or indirect contact with rodents. When conducting a non-specific examination, the dynamics of changes in indicators of general and biochemical analysis urine, electrolytes, biochemical blood samples, CBS, coagulograms, etc. In order to assess the severity of the course and prognosis of the disease, ultrasound of the kidneys, FGDS, chest X-ray, ECG, etc. are performed.

specific laboratory diagnostics hemorrhagic fever with renal syndrome is carried out using serological methods (ELISA, RNIF, RIA) in dynamics. Antibodies in the blood serum appear at the end of the 1st week of illness, by the end of the 2nd week they reach their maximum concentration and remain in the blood for 5–7 years. The RNA of the virus can be isolated using a PCR study. HFRS is differentiated from leptospirosis, acute glomerulonephritis, pyelonephritis and enterovirus infection, other hemorrhagic fevers.

HFRS treatment

Patients with hemorrhagic fever with renal syndrome are hospitalized in an infectious diseases hospital. They are assigned strict bed rest and diet No. 4; monitoring of water balance, hemodynamics, indicators of the functioning of the cardiovascular system and kidneys is carried out. Etiotropic therapy of hemorrhagic fever with renal syndrome is most effective in the first 3-5 days from the onset of the disease and includes the introduction of donor specific immunoglobulin against HFRS, the appointment of interferon drugs, antiviral chemotherapy drugs (ribavirin).

In the febrile period, infusion detoxification therapy is carried out (intravenous infusions of glucose and saline solutions); prevention of DIC-syndrome (introduction of antiplatelet drugs and angioprotectors); in severe cases, glucocorticosteroids are used. In the oliguric period, diuresis is stimulated (administration of loading doses of furosemide), correction of acidosis and hyperkalemia, and prevention of bleeding. With increasing acute renal failure, the transfer of the patient to an extracorporeal infectious disease specialist, a nephrologist and an ophthalmologist is shown throughout the year. Severe course is associated with a high risk of complications; mortality from HFRS ranges from 7-10%.

Prevention of hemorrhagic fever with renal syndrome consists in the destruction of mouse-like rodents in natural foci of infection, the prevention of contamination of dwellings, water sources and food with rodent secretions, and the deratization of residential and industrial premises. Specific vaccination against HFRS has not been developed.

Hemorrhagic fever with renal syndrome is a viral disease that is characterized by an aggressive onset of symptoms. The pathology is characterized by lesions of the vascular and urinary systems, severe intoxication of the body. This is a fairly rare disease that is very difficult to tolerate by humans and causes a lot of complications. The hemorrhagic fever virus with renal syndrome was first detected in the lungs of rodents.

Causes and ways of transmission

Mice and rats are among the main carriers of this disease.

In the presence of a disease in an animal, no symptoms appear. The main sources through which the virus is transmitted are fecal saliva and urine. However, it should be noted that infection is possible only in rare cases. As a rule, patients with a fever do not spread the virus..

Transmission of hemorrhagic fever is possible in several ways, the main of which are:

• food;
• airborne;
• contact.

Human infection is possible with:

• the use of meat affected by the virus;
• direct contact with animal feces;
• bite;
• contact with animal saliva.

In most cases, the spread of HFRS occurs in the spring and summer. It is then that the risk of the likelihood of interaction with secretions infected with the virus increases significantly.

Even through contact with an animal that is a carrier of the infection, if hands were not washed after, you can get the causative agent of the disease. The saliva of a rodent that has fallen into a wound or abrasion also causes the transmission of the virus.

In winter, infection is possible by aspiration contact. The risk group includes people engaged in farming, owners living in private homes (if there are rats or mice in the room). Among other things, ticks located on the body of an animal may also be carriers of the causative agent of pathology, but, as a rule, they do not pass to humans.

Untimely access to a doctor leads to rather unpleasant consequences. As a result, the risk of developing the following serious pathologies is not excluded:

Important! Not to be underestimated possible consequences GLPS. With absence proper treatment there is high risk lethal outcome.

Hemorrhagic fever with renal syndrome in children can develop at any age, even in infants. Harbingers of the disease, as a rule, are absent, but the onset of the course is acute. High temperature lasts up to a week, complaints of headache, drowsiness, weakness. Most of the time the child spends in bed. Back pain in the kidney area begins to appear already on initial stage development of pathology.

Characteristic symptoms

The vegetation period of the disease is up to thirty days. In hemorrhagic fever with renal syndrome, the symptoms will depend on the stage of the disease. There are several of them:

Recovery occurs on the 20-25th day and can last from three months to one year. This stage is accompanied by kidney disease, pyelonephritis, as well as a feeling of thirst and dryness in the oral cavity. In the case of prolonged and pronounced manifestations of these symptoms, it is possible to re-place the patient in a hospital.

Often, HFRS can be accompanied by impaired excretory-secretory function of the tubules. Such phenomena can persist for quite a long time. It can take up to 10 years for the body to fully recover. However, it should be noted that even over such a long period of time, the pathology will not acquire chronic form kidney failure.

Important! The sooner you turn to a specialist, the greater the likelihood of maintaining health and preventing complications.

Diagnosis, therapy and prevention of the disease

To diagnose the disease, first of all, it is necessary to conduct a general examination in order to identify the nature, localization and severity of the hemorrhagic rash, as well as the presence of hemorrhages in different departments.

Mandatory conduct differential diagnosis to rule out diseases such as typhoid fever, other types of fever, tick-borne encephalitis and flu.

To determine HFRS, epidemiological indicators, the probability of finding a patient in the focus of the epidemic, as well as general data on the incidence in this place and the seasonal period are taken into account. Associated symptoms are also subject to attention.

Additionally, the passage of a series is assigned laboratory research. These include:

• general analysis of urine and blood;
• Zimnitsky test;
• biochemical analysis;
• immunopathy;
• electrocardiogram;
• CT scan;
• polymerase chain reaction.

Upon confirmation of the presence of the disease, the patient is immediately placed in a therapeutic or infectious hospital.

It is strictly forbidden to treat the disease on an outpatient basis, since the patient must always be under the supervision of specialists.

Treatment

As mentioned above, a person diagnosed with HFRS should be constantly under medical supervision, which will allow monitoring the work of the kidneys. When transporting a patient, extreme care must be taken, since the possibility of rupture of the renal capsule is not excluded.

Hemorrhagic fever with renal syndrome should be treated with bed rest for one to four weeks.

The duration will depend on the severity of the pathology.
It is also necessary to exercise strict control of the volume of fluid that is lost and consumed by the patient.

In the febrile stage, drugs of the following groups are prescribed:

• antioxidant;
• antiviral;
• detoxification.

In addition, the necessary measures are taken to prevent the manifestation of DIC.

Etiotropic therapy consists in taking chemotherapy drugs or immunobiological drugs (hyperimmune plasma, donor immunoglobulin and others), Amiksin, Yodantrypin, Cycloferon. Intoxication is suppressed by glucose solution and saline solution with acetylsalicylic acid.

If the temperature reaches 39 degrees and above, then anti-inflammatory drugs with antipyretic action (Ibuprofen, Analgin) are used. With the manifestation of infectious-toxic shock (ITS), the patient is administered with a dropper cardiac glycosides, Hydrocortisone with Reopoliglyukin. With ITSH, it is forbidden to use Poliglukin, antispasmodics, Hemodez.

If there is a convulsive syndrome, then it is advisable to use such drugs:

During the oliguric stage, therapeutic measures are aimed at eliminating azotemia, reducing protein catabolism and intoxication. In addition, carry out the correction of water-electrolyte and acid-base balance.

In case of complications due to infection, antibiotics of the group of semi-synthetic penicillins (Augmentin, Amoxicillin) are prescribed.

Disease prevention

Since they have not yet been able to develop a specific vaccine, in order to prevent hemorrhagic fever with renal syndrome, it is recommended to take Yodantipyrin according to the scheme. In addition, compliance with general, not complex recommendations will help prevent outbreaks of the epidemic:

1. Extermination of rodents in places of the lesion.
2. Mandatory use of respirators, if work is performed in very dusty places.
3. Grain and other products are recommended to be stored in warehouses where there is no access to rodents.
4. Avoid contact with animal excrement, in particular rodents.
5. Observe the rules of personal hygiene (wash your hands as often as possible, use disposable wipes, and so on).

Whatever the disease may be, it is easier to prevent it than to treat it for a long time. However, this is not always possible. HFRS is a fairly serious disease, with the first signs of which you should immediately seek medical help.

Hemorrhagic fever is a disease whose history began in 1935 in the Far East. Later and to this day, outbreaks of the disease in Russia began to be observed in the regions in the Central region of the country and the Urals.

Hemorrhagic fever with renal syndrome

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease transmitted by small rodents, which is characterized by vascular damage and negatively affects primarily renal function.

The causative agent of hemorrhagic renal fever is Hantavirus from the Bunyavirus family. There are 4 varieties of this type of infection, but only one is found in Russia - Puumala.

Any person is susceptible to Hantavirus, that is, getting Puumala into the bloodstream becomes a catalyst for the pathological process in all people who have not had hemorrhagic fever earlier. But, according to statistics, the vast majority of people who have encountered HFRS are men aged 18 to 50 years.

There are two types of HFRS, divided according to the principle of the source of infection:

• Type I (eastern) is spread by the field mouse, clinical picture is severe, the statistics of death as a result of therapy is 20%;
• Type II (Western) is spread by the bank vole, the symptoms of the disease are milder than in type I, and the mortality rate during treatment is less than 2%.

Basic information about hemorrhagic kidney fever with renal syndrome

Etiology

There are six ways of infection, but all of them are united by human contact with a virus that enters the environment from the saliva and feces of rodents:

1. The forest type is most common, with it a person becomes infected during hiking trips in the forest, searching for mushrooms, picking berries.
2. Household type means that the source of Hantavirus is inside the person's home - this is found in private houses located next to the forest.
3. Production type - occurs during drilling, oil pipeline and other works in the forest.
4. Garden type - relevant among summer residents.
5. The camp type of infection is recorded among children and adolescents vacationing in suburban summer camps.
6. The agricultural route is marked by activity in autumn and winter.

In the vast majority of cases, the virus enters the body by contact with the mucous membrane of the upper respiratory tract, less often through damage to the skin.
On the video, the etiology of hemorrhagic fever:

Pathogenesis

After entering the body, the virus begins to infect the walls of blood vessels from the inside, destroying the inner layer - the endothelium. Vessels become permeable, plasma leaves through perforations vascular system and the blood thickens.

Damage to blood vessels negatively affects the activity of absolutely all systems, but the kidneys suffer the most with HFRS: as the stages of this disease progress, the rate (GFR) decreases, the risk of chronic renal failure increases, requiring hemodialysis in the terminal stage.

Clinical picture

Incubation period

The incubation period of HFRS lasts from 1 to 7 weeks, more often - 3 weeks. At this stage, the patient does not feel the symptoms of the disease, but the pathology in the body already takes place: the walls of the vessels are affected, the composition of the blood changes, and disturbances in the functioning of all systems begin.

Prodromal manifestations

The prodromal period does not always occur and lasts no more than 3 days.

It occurs after the incubation period of HFRS and has the following symptoms:

• weakness;
• headache;
• chills;
• aches in the bones;
• subfebrile condition.

Fever

hemorrhagic fever with renal syndrome is characterized by abrupt start fever, with an increase in body temperature up to 39-40 degrees. It lasts from 2 to 8 days, the peak of the thermometer is not in the evening and night hours, as with influenza or SARS, but in the morning.

High temperature serves as a source of intoxication, because of which a person experiences nausea, pain, chills. Approximately 3 out of 10 patients have visual impairment.

Hemorrhagic period

The hemorrhagic period begins from the moment of appearance on the skin of traces of rash and hemorrhages of the sclera of the eyes. This stage occurs simultaneously with the oliguric stage.

With hemorrhagic syndrome, the following phenomena occur:

• red cherry syndrome - hemorrhages on the whites of the eyes;
• infectious-toxic shock - the reaction of the body in the presence of a virus in it, expressed in a decrease in blood pressure and pathological work of several systems at once;
• internal bleeding.

The photo shows the main manifestations of hemorrhagic fever

Oliguria

It develops from the third day from the onset of HFRS symptoms and, statistically, can last up to 1 month, but usually disappears after 9-12 days.

Oliguria - a decrease in the quantitative indicator of urine excreted during the usual drinking regimen. During this period, changes in the blood are actively taking place: substances previously excreted by the urinary system remain in the blood, poisoning the body.

At the same time, pathological processes in the systems are fixed:

• cardiovascular (hypotension, bradycardia, extrasystole);
• digestive (nausea, vomiting, sometimes with blood);
• nervous (delusions, hallucinations, fainting).

Polyuria

Polyuria begins after the oliguric period, that is, after 9-12 days from the onset of HFRS, and lasts up to 4 weeks.

During this period, the amount of urine, on the contrary, increases dramatically, and diuresis can reach 10 liters. Due to the large amount of urine, its density decreases, and protein and cylinders are also found in it.

A day after the onset of the process of polyuria, the dynamics of restoration of the filtration capacity of the kidneys becomes positive.

convalescence period

After the completion of polyuria, a person recovers. But deviations in laboratory tests can persist for up to three years.

During the recovery period of the body, a person may experience fatigue, face functional disorders of the nervous and endocrine system, in the activity of the kidneys.

On the video, the symptoms and pathogenesis of hemorrhagic fever:

Diagnostics

Differential diagnosis in hemorrhagic fever with nephrological syndrome is required to exclude pathologies:

• flu;
• typhoid fever;
• leptospirosis;
• glomerulonephritis;
• tick-borne rickettsiosis;
• encephalitis;
• pyelonephritis.

To make a diagnosis, the main tool can be called observation of the patient, questioning and examination, with the help of which they fix:

• strict alternation of the described stages in this order;
• the fact of a decrease in the amount of urine excreted after temperature stabilization;
• the presence of hemorrhages on the skin.

The second factor confirming HFRS is epidemiological data on the fact of the possibility of HFRS infection in a given area.

To confirm the diagnosis, laboratory tests are performed:

• a general urine test to detect (the presence of traces of protein in the urine), cylindruria;
• a general blood test to detect an increase in leukocytes, erythrocyte sedimentation rate, plasma cells;
• a biochemical blood test to detect an increase in the level of creatinine and urea, a decrease in albumin;
• , which determines the GFR;
• detection of IgM antibodies.

At the stage of nephrological symptoms, ultrasound of the kidneys and radiography with contrast are prescribed.

Treatment

HFRS therapy is carried out in a hospital under strict bed rest and therapeutic nutrition, which reduces the load on the kidneys. The amount of urine drunk and excreted per day is controlled.

Drug therapy is used primarily to relieve symptoms:

• to relieve intoxication, intravenous glucose infusions (20-40%) and saline are prescribed;
• to restore kidney function and improve the microcirculation of glomeruli, the drugs "Curantil", "Trental", "Eufillin" are used; hormonal preparations(glucocorticosteroids) - "Prednisolone", "Metipred";
• with severe internal hemorrhages, blood and albumin transfusions are performed;
• during the period of oliguria, a hemodialysis machine is used to normalize the composition of the blood and remove excess fluid from the body;
• to reduce body temperature, antipyretics are used: "Paracetomol", "Nise".

If the patient was hospitalized in a hospital in the first 3-5 days from the onset of symptoms, the appointment of immunomodulators and antiviral drugs is recommended.

Complications and consequences

1. Infectious-toxic shock and azotemic uremia - poisoning of the body with decay products during a decrease in kidney GFR or cessation of urination, resulting in multiple organ failure, and then - uremic coma.
2. Rupture of the kidney capsule, which occurs against the background of vascular damage and a high load on cardiovascular system due to the accumulation of fluid during oliguria.
3. Edema of the lungs and brain - the same happens with oliguria, when the body remains a large number of fluid not excreted by inactive kidneys.
4. Lethal outcome - on average, is recorded in 8 percent of cases and depends on the fact of the presence of concomitant somatic pathologies, age, the moment of initiation of adequate therapy.
5. Infectious processes (pyelonephritis, sepsis) belong to a non-specific category of complications, since their development requires the penetration of bacteria into the body, which are catalysts for the described pathologies, during HFRS.

On the video about the prevention of hemorrhagic renal fever: