Crimean hemorrhagic fever - Diagnosis

Indications for consultation with other specialists

If meningoencephalitis syndrome predominates, consult a neurologist; if there is cardiovascular failure or shock, consult a resuscitator; if there are symptoms of myocarditis, consult a cardiologist; if there is a suspicion of peritonitis, consult a surgeon; if there is metrorrhagia, consult a gynecologist.

Indications for hospitalization

Patients with Crimean hemorrhagic fever are subject to prompt hospitalization in an infectious diseases hospital, regardless of the severity and period of the disease, with the most gentle transportation, excluding jolts and shaking. Transportation of the patient is contraindicated during the period of bleeding. A patient with Crimean hemorrhagic fever should be placed in a box in compliance with the rules of the anti-epidemic regime for pathogens of the first pathogenicity group.

Clinical diagnostics of Crimean hemorrhagic fever

Clinical diagnosis of Crimean hemorrhagic fever is based on the signs of the disease.

• Acute onset of Crimean hemorrhagic fever with high temperature, hyperemia of the face and visible mucous membranes, spontaneous muscle and joint pain, intense headache, nausea, vomiting, bleeding gums, hemorrhagic enanthem on the mucous membranes, petechial rash with typical localization; hepatomegaly; bradycardia; hypotension; nasal, pulmonary, gastrointestinal, uterine bleeding: two-wave temperature curve.
• The presence of tick bite marks on the body.
• Epidemiological history (stay in a region endemic for Crimean hemorrhagic fever, contact with a patient with Crimean hemorrhagic fever).
• Seasonality.

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Specific and non-specific laboratory diagnostics of Crimean hemorrhagic fever

Non-specific laboratory diagnostics

• Determination of blood type and Rh factor.
• Clinical blood test. Characteristic: pronounced leukopenia, lymphocytosis with a neutrophilic shift to the left to band cells, thrombocytopenia, moderate anemia, increased ESR.
• General urine analysis. In the initial period, the following are revealed: minor albuminuria, microhematuria, cylindruria; during the peak period - hematuria.
• Coagulogram. Crimean hemorrhagic fever is characterized by signs of hypercoagulation (shortening of thrombin time to 10-15 sec and blood clotting time; increase in fibrinogen content in blood plasma to 4.5-8 g/l, increase in prothrombin index to 100-120%) or hypocoagulation (lengthening of thrombin time to 25-50 sec. blood clotting time: decrease in fibrinogen content in blood plasma to 1-2 g/l. and prothrombin index to 30-60%).
• Biochemical blood test. Reveals a decrease in the total protein content in the blood serum (in case of profuse bleeding), hypoalbuminemia, hyperbilirubinemia, and an increase in the activity of alanine and aspartic aminotransferases.
• Stool analysis to detect intestinal bleeding.

Specific laboratory diagnostics

• IFA.
• Fluorescent antibody methods (in paired sera).
• PCR.

Instrumental diagnostics of Crimean hemorrhagic fever

• Ultrasound of the kidneys, liver, abdominal organs.
• ECG.
• Chest X-ray.
• CT scan of the brain.

Example of diagnosis formulation

Crimean hemorrhagic fever with hemorrhagic syndrome, peak period, severe course. Complication: DIC syndrome, infectious toxic shock grade II.

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Differential diagnosis of Crimean hemorrhagic fever

Crimean hemorrhagic fever is differentiated from other hemorrhagic fevers, influenza, leptospirosis, meningococcemia, typhoid fever, surgical diseases with the syndrome of "acute abdomen"; as well as from thrombocytopenic purpura (Werlhof's disease) with a characteristic subacute onset, lack of temperature reaction, hemorrhagic rash from small petechiae to large ecchymoses on the flexor surfaces of the limbs, trunk, frequent nosebleeds and other bleeding, hypochromic anemia, leukocytosis, thrombocytopenia and the absence of changes in the cardiovascular system. Differential diagnostics of Crimean hemorrhagic fever is also carried out with hemorrhagic vasculitis (Schönlein-Henoch disease) with an acute onset, symmetrical erythematous, hemorrhagic rash on the extensor surfaces of the extremities and around the joints, tachycardia, hemorrhagic nephritis, intestinal bleeding, absence of nosebleeds and thrombocytopenia.

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