Crimean hemorrhagic fever: treatment

Medical treatment of Crimean hemorrhagic fever includes specific, pathogenetic and symptomatic treatment. It is necessary to avoid unreasonable prescribing of medical manipulations, accompanied by traumatization of cutaneous and mucous membranes. Treatment of Crimean hemorrhagic fever should be carried out under daily control of the coagulogram and the number of platelets (2 times per day).

The etiotropic treatment of Crimean hemorrhagic fever previously consisted in the use of hyperimmune specific horse y-globulin. At present, a certain experience of using ribavirin in patients with viral hemorrhagic fevers has been accumulated. In Stavropol Krai, the scheme of ribavirin treatment of patients with Crimean hemorrhagic fever was 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). At appointment contraindications to application take into account and use a preparation only for treatment of patients HFRS more senior 18 years, excepting pregnant women. Ribavirin is used in the form of 200 mg capsules. The recommended "shock" dose of ribavirin is 2000 mg once (10 capsules) - 30 mg / kg per average weight of the patient 70 kg, followed by a dose of 1200 mg / day in 2 doses (if the patient weighs 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 washing with water while eating.

Pathogenetic treatment of Crimean hemorrhagic fever includes:

• detoxication treatment (intravenously administered 5-10% glucose solutions, isotonic sodium chloride solution with ascorbic acid and cocarboxylase);
• prevention of DIC-syndrome with the use of angioprotectors (calcium gluconate, etamzilate, rutoside calcium dobezilate), fresh-frozen plasma, protease inhibitors (aprotinin);
• antioxidant treatment (vitamin E, ubiquinone compositum). Treatment of disseminated intravascular coagulation syndrome:
• with hypercoagulability prescribe heparin sodium to 10 000-15 000 units / day, with hypocoagulation - up to 5000 units / day intravenously (contraindicated the administration of sodium heparin without blood and plasma);
• apply infusion of fresh-frozen blood plasma to 600-800 ml / day intravenously drip;
• use of protease inhibitors (aprotinin up to 1000 U / kg / day) and angioprotectors (etamzilate up to 6-8 ml / day):
• regulate cell membrane permeability (glucocorticoids 60-90 mg / day intravenously);
• with severe thrombocytopenia, a platelet concentrate is prescribed.

The volume of circulating red blood cells is restored by the introduction of erythrocyte mass with a loss of 25-30% of the volume of circulating blood, a decrease in the hemoglobin content below 70-80 g / l and a hematocrit below 25%, the occurrence of circulatory disorders, correction of the VIII factor of blood coagulation and fibrinogen by the introduction of cryoprecipitate. Contraindicated transfusion of canned blood with a shelf life of more than 3 days. In gastrointestinal bleeding, ingestion of chilled aminocaproic acid, antacids (algeldate + magnesium hydroxide), cimetidine is indicated. With the development of cardiovascular insufficiency, oxygene therapy, cardiac glycosides and cardiotonics (strophanthin-K, lily-of-the-valley glycoside, niketamide) are administered intravenously. Treatment of infectious-toxic shock is similar to treatment of HFRS. In case of complications, antibiotic treatment of Crimean hemorrhagic fever is carried out. In the period of convalescence, tonic fortifying preparations, vitamins, and correction of anemia are prescribed.

[1], [2], [3], [4], [5], [6], [7], [8], [9],

Diet and diet

Strict bed rest is necessary; round-the-clock medical supervision.

It is recommended that you have a gentle diet. In the period of bleeding, you should take liquid cold food (soups, mashed potatoes, kissels); meat decoctions, juices are contraindicated (enter into the diet after cessation of bleeding). In the period of convalescence, the use of foods rich in protein is indicated.

[10], [11],

Approximate terms of incapacity for work

The discharge rules: the discharge of patients is performed no earlier than 21 days from the onset of the disease with a satisfactory patient condition, normalization of body temperature and laboratory parameters (hemograms, coagulograms, platelet counts), and absence of complications. Approximate terms of incapacity for work after discharge are: with a light form - 7-10 days; moderate - 10-14 days; heavy - 15-30 days.

[12], [13], [14], [15],

Clinical examination

All convalescents of the Crimean hemorrhagic fever are subject to dispensary observation. The observation period for those who had recovered from an easy form of Crimean hemorrhagic fever was 3 months. Medium and heavy - 12 months. Supervision is conducted by an infectious disease specialist, and in his absence - a district therapist. The first control examination with clinical definition of hemogram, urea level, creatinine. Bilirubin, total protein and albumin. ALT and ACT activity is carried out 1 month after discharge from the hospital; follow-up examinations - after 3, 6, 9 and 12 months.

[16], [17], [18], [19], [20], [21]

What should the patient know?

Recommended nutrition with the exception of irritating spicy foods, alcoholic beverages: plentiful drink (infusion of dogrose, alkaline mineral water, broths of herbs with diuretic properties); compliance with the physical regime (contraindicated: heavy physical work, hypothermia, bath, sauna, sports for 6-12 months). Prescribe a general health-improving drug, adaptogens. Multivitamins.

Prevention of Crimean hemorrhagic fever

Formalin-inactivated brain protivansulfate-purified vaccine (a full epidemiological assessment of its efficacy has not yet been obtained).

Destruction of mites - carriers of the pathogen (pest control); when leaving for nature - wearing special protective clothing, cleaning the area around the tents from the bush and grass; compliance with the precautionary rules (use of rubber gloves, goggles) by medical personnel when working with patients with Crimean hemorrhagic fever.

What is the prognosis of the Crimean hemorrhagic fever?

Crimean hemorrhagic fever has a different prognosis, which depends on adherence to the principles of hospitalization, patient care, timely and comprehensive medication, prevention of complications. Late hospitalization and diagnosis, late treatment of Crimean hemorrhagic fever, incorrect or contraindicated transportation of patients during the period of severe bleeding can lead to death.