Crimean hemorrhagic fever - Symptoms

Crimean hemorrhagic fever has an incubation period of 2-14 days (on average 3-5).

There are three clinical forms of the disease:

• Crimean hemorrhagic fever with hemorrhagic syndrome;
• Crimean hemorrhagic fever without hemorrhagic syndrome;
• inapparent form.

Crimean hemorrhagic fever without hemorrhagic syndrome can occur in mild and moderate forms; with hemorrhagic syndrome - in mild, moderate and severe forms. The course of the disease is cyclical and includes the following periods:

• initial period (prehemorrhagic);
• period of peak (hemorrhagic manifestations);
• period of convalescence and remote consequences (residual).

The initial period lasts 3-4 days; symptoms of Crimean hemorrhagic fever appear such as: sudden rise in temperature, severe headache, aches and pains throughout the body (especially in the lower back), severe weakness, loss of appetite, nausea, and vomiting not associated with food intake; in severe cases - dizziness and impaired consciousness. Hypotension and bradycardia are also detected.

During the peak period (2-4 days of the disease), a short-term decrease in body temperature is detected (within 24-36 hours), and then it rises again and on the 6-7th day it begins to lytically decrease (a "two-humped" temperature curve); hemorrhagic syndrome develops in the form of a petechial rash on the lateral surfaces of the chest and abdomen, hemorrhages at injection sites, hematomas, bleeding gums, bloody discharge from the eyes and ears, as well as nasal, pulmonary, gastrointestinal and uterine bleeding. The patient's condition deteriorates sharply: symptoms of intoxication are pronounced, muffled heart sounds, arterial hypotension, bradycardia is replaced by tachycardia, the liver is enlarged. Lethargy, adynamia, sometimes stupor and confusion of consciousness, less often - agitation, hallucinations, delirium are detected. Meningeal symptoms (stiff neck, Kernig's sign) are often expressed, transient anisocoria, pyramidal signs, and convergence disorder are revealed. Patients have a characteristic appearance: the pharynx, face, neck, and upper chest are hyperemic; the sclera are injected; enanthem is expressed on the soft palate and oral mucosa; jaundice rarely occurs. The severity and outcome of the disease are determined by the severity of the hemorrhagic syndrome. Jaundice in combination with other manifestations of liver damage are poor prognostic symptoms of Crimean hemorrhagic fever. The dominance of hepatitis in the clinical picture can lead to a fatal outcome.

The convalescence period is long (from 1-2 months to 1-2 years or more); it begins with the normalization of body temperature, cessation of hemorrhagic syndrome manifestations. The following symptoms of Crimean hemorrhagic fever are characteristic of this period: asthenovegetative disorders: weakness, increased fatigue, dizziness, headaches and heart pain, injection of scleral vessels, hyperemia of the mucous membrane of the oropharynx, hypotension and pulse lability (persist for 2-3 weeks).

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Complications of Crimean hemorrhagic fever

Crimean hemorrhagic fever may be complicated by infectious toxic shock and hemorrhagic shock; DIC syndrome; focal pneumonia; pulmonary edema; acute cardiovascular, renal and hepatic failure; posthemorrhagic anemia.

Non-specific complications of Crimean hemorrhagic fever: pneumonia, otitis, mumps, phlegmon, soft tissue abscesses at injection sites, myocarditis, tonsillitis, peritonitis, thrombophlebitis, sepsis.

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Mortality and causes of death

Crimean hemorrhagic fever has a high mortality rate; with the transmission route of the pathogen being transmitted by transmission, it is 25%; with contact from a sick person, it is up to 50% or more.