Crimean hemorrhagic fever: diagnosis

Indications for consultation of other specialists

With the prevalence of meningoencephalitis syndrome - consultation of a neurologist; with cardiovascular failure, shock - resuscitator; symptoms of myocarditis - cardiologist; with suspected peritonitis - a surgeon; with metrorrhagia - gynecologist.

Indications for hospitalization

Patients with Crimean hemorrhagic fever are subject to an early hospitalization in an infectious hospital, regardless of the severity and period of the course of the disease, with the most gentle transport, excluding shocks and shaking. Transportation of the patient is contraindicated during bleeding. Patients with Crimean hemorrhagic fever should be placed in the box in compliance with the rules of anti-epidemic regimen for pathogens of pathogenicity group I.

Clinical diagnosis of Crimean hemorrhagic fever

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

• The acute onset of Crimean hemorrhagic fever with high fever, hyperemia of the face and visible mucous membranes, spontaneous muscle and joint pains, 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: a two-wave temperature curve.
• The presence of bite marks on the body.
• Epidemiological anamnesis (stay in endemic for the Crimean hemorrhagic fever region, contact with a sick Crimean hemorrhagic fever).
• Seasonality.

[1], [2], [3], [4], [5], [6], [7], [8],

Specific and nonspecific laboratory diagnostics of the Crimean hemorrhagic fever

Nonspecific laboratory diagnostics

• Determination of blood type and Rh factor.
• Clinical blood test. Characteristic: marked leukopenia, lymphocytosis with a neutrophilic shift to the left to stab, a thrombocytopenia, mild anemia, an increase in ESR.
• General urine analysis. In the initial period they reveal: insignificant albuminuria, microhematuria, cylindruria; during the height of the hematuria.
• Coagulogram. Characteristic of Crimean hemorrhagic fever are signs of hypercoagulability (shortening of thrombin time to 10-15 s and blood clotting time, increase of fibrinogen in the blood plasma to 4.5-8 g / l, increase in the prothrombin index to 100-120%) or hypocoagulation (lengthening thrombin time to 25-50 s of the clotting time: reduction of fibrinogen in the blood plasma to 1-2 g / l and prothrombin index to 30-60%).
• Blood chemistry. A decrease in the total protein content in the blood serum (with profuse bleeding), hypoalbuminemia, hyperbilirubinemia, increased activity of alanyl and asparagine aminotransferases is revealed.
• Stool analysis for intestinal bleeding.

Specific laboratory diagnostics

• EIA.
• Methods of fluorescent antibodies (in paired sera).
• PCR.

Instrumental diagnostics of the Crimean hemorrhagic fever

• Ultrasonography of the kidneys, liver, abdominal organs.
• ECG.
• Radiography of the chest.
• CT of the brain.

Example of the formulation of the diagnosis

Crimean hemorrhagic fever with hemorrhagic syndrome, peak period, severe course. Complication: DIC-syndrome, infectious-toxic shock of the II degree.

[9], [10], [11], [12], [13], [14]

Differential diagnosis of Crimean hemorrhagic fever

Crimean hemorrhagic fever differentiates from other hemorrhagic fevers, influenza, leptospirosis, meningococcemia. Typhoid fever, surgical diseases with the syndrome of "acute abdomen"; and also from thrombocytopenic purpura (Verlhof's disease) with characteristic subacute onset, absence of a temperature reaction, hemorrhagic rash from small petechiae to major ecchymosis on the flexor surfaces of the extremities, trunk, frequent nasal and other bleeding, hypochromic anemia, leukocytosis, thrombocytopenia and no changes on the part of cardio-vascular system. Differential diagnosis of Crimean hemorrhagic fever is also performed with hemorrhagic vasculitis (Schönlein-Henoch disease) with acute onset, symmetrical erythematous, hemorrhagic rash on the extensor surfaces of the extremities and near the joints, tachycardia, hemorrhagic nephritis, intestinal bleeding, absence of nasal bleeding and thrombocytopenia.

[15], [16], [17], [18], [19],