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Crimean hemorrhagic fever - Treatment
Last reviewed: 06.07.2025
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Drug treatment of Crimean hemorrhagic fever includes specific, pathogenetic and symptomatic treatment. Unreasonable prescription of medical manipulations accompanied by traumatization of the skin and mucous membranes should be avoided. Treatment of Crimean hemorrhagic fever should be carried out under daily monitoring of the coagulogram and platelet count (2 times a day).
Etiotropic treatment of Crimean hemorrhagic fever previously involved the use of hyperimmune specific equine γ-globulin. Currently, some experience has been accumulated in the use of ribavirin in patients with viral hemorrhagic fevers. In Stavropol Krai, a ribavirin treatment regimen for patients with Crimean hemorrhagic fever has been introduced into clinical practice in accordance with the recommendations of the US Centers for Disease Control and Prevention. It is preferable to prescribe the drug in the first 4 days from the onset of the disease (the period of maximum viremia). When prescribing, contraindications for use are taken into account and the drug is used only for the treatment of patients with HFRS over 18 years of age, excluding pregnant women. Ribavirin is used in the form of capsules of 200 mg. The recommended "shock" dose of ribavirin is 2000 mg once (10 capsules) - 30 mg/kg for an average patient weight of 70 kg, followed by a transition to a dose of 1200 mg/day in 2 doses (if the patient's weight is more than 75 kg) or 1000 mg/day in 2 doses (if the patient's weight is less than 75 kg). Ribavirin is taken orally, without chewing and with water at the same time as meals.
Pathogenetic treatment of Crimean hemorrhagic fever includes:
- detoxification treatment (5-10% glucose solutions, isotonic sodium chloride solution with ascorbic acid and cocarboxylase are administered intravenously);
- prevention of DIC syndrome using angioprotectors (calcium gluconate, etamsylate, rutoside, calcium dobesylate), fresh frozen plasma, protease inhibitors (aprotinin);
- Antioxidant treatment (vitamin E, ubiquinone compositum). Treatment of disseminated intravascular coagulation syndrome:
- in case of hypercoagulation, sodium heparin is prescribed up to 10,000-15,000 U/day, in case of hypocoagulation - up to 5000 U/day intravenously (administration of sodium heparin without blood and plasma is contraindicated);
- infusion of fresh frozen blood plasma up to 600-800 ml/day intravenously by drip is used;
- protease inhibitors (aprotinin up to 1000 U/kg per day) and angioprotectors (etamsylate up to 6-8 ml/day) are used:
- regulate cellular membrane permeability (glucocorticoids 60-90 mg/day intravenously);
- In case of severe thrombocytopenia, platelet concentrate is prescribed.
The volume of circulating red blood cells is restored by administering red blood cell mass in case of a 25-30% loss of the circulating blood volume, a decrease in the hemoglobin content below 70-80 g/l and hematocrit below 25%, the occurrence of circulatory disorders, correction of the VIII factor of blood coagulation and fibrinogen by administering cryoprecipitate. Transfusion of preserved blood with a shelf life of more than 3 days is contraindicated. In case of gastrointestinal bleeding, oral administration of cooled aminocaproic acid, antacids (algedrate + magnesium hydroxide), and cimetidine is indicated. In the development of cardiovascular failure, oxygen therapy, cardiac glycosides, and cardiotonics (strophanthin-K, lily-of-the-valley herb glycoside, niketamide) are used intravenously. Treatment of infectious toxic shock is similar to the treatment of HFRS. In case of complications, antibacterial treatment of Crimean hemorrhagic fever is carried out. During the recovery period, general tonics, vitamins are prescribed, and anemia is corrected.
Regime and diet
Strict bed rest and 24-hour medical supervision are required.
A gentle diet is recommended. During the bleeding period, liquid cold food should be taken (soups-puree, jelly); meat broths, juices are contraindicated (introduced into the diet after the bleeding has stopped). During the recovery period, the use of protein-rich foods is recommended.
Approximate periods of incapacity for work
Discharge rules: patients are discharged no earlier than 21 days after the onset of the disease if the patient's condition is satisfactory, body temperature and laboratory parameters (hemogram, coagulogram, platelet count) are normalized, and there are no complications. Approximate periods of incapacity for work after discharge are: mild - 7-10 days; moderate - 10-14 days; severe - 15-30 days.
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Clinical examination
All convalescents of Crimean hemorrhagic fever are subject to dispensary observation. The observation period for those who have had a mild form of Crimean hemorrhagic fever is 3 months, moderate and severe - 12 months. Observation is carried out by an infectious disease specialist, and in his absence - by a local therapist. The first control examination with a clinical determination of the hemogram, urea level, creatinine, bilirubin, total protein and albumin. ALT and AST activity is carried out 1 month after discharge from the hospital; subsequent examinations - after 3, 6, 9 and 12 months.
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What should the patient know?
A balanced diet is recommended, excluding irritating spicy food and alcoholic beverages: drinking plenty of fluids (rosehip infusion, alkaline mineral waters, herbal decoctions with diuretic properties); maintaining a physical regimen (contraindicated: heavy physical work, hypothermia, visiting a bathhouse, sauna, playing sports for 6-12 months). General tonic medications, adaptogens, and multivitamins are prescribed.
Prevention of Crimean hemorrhagic fever
Formaldehyde-inactivated brain-purified protamine sulfate vaccine (full epidemiological evaluation of its effectiveness has not yet been obtained).
Destruction of ticks - carriers of the pathogen (disinsection); when going out into nature - wearing special protective clothing, clearing the areas around tents of bushes and grass; compliance with safety precautions (use of rubber gloves, protective glasses) by medical personnel when working with patients with Crimean hemorrhagic fever.
What is the prognosis for Crimean hemorrhagic fever?
Crimean hemorrhagic fever has a different prognosis, which depends on compliance with the principles of hospitalization, patient care, timely and comprehensive drug treatment, and prevention of complications. Late hospitalization and diagnosis, late treatment of Crimean hemorrhagic fever, incorrect or contraindicated transportation of patients during periods of severe bleeding can lead to death.