Hemorrhagic fever with renal syndrome: symptoms

The incubation period of hemorrhagic fever with renal syndrome is from 4 to 49 (an average of 14-21) days. For hemorrhagic fever with renal syndrome is characterized by a clear cyclic flow and a variety of clinical options, from abortive fever to severe forms, with massive hemorrhagic syndrome and persistent renal insufficiency. The following periods are distinguished: initial (febrile), oliguric, polyuric, reconvalescent (early - up to 2 months and late - up to 2-3 years). Prodromal symptoms of hemorrhagic fever with renal syndrome in the form of malaise, cognition, fatigue, subfebrile, lasting 1-3 days, observe no more than 10% of patients.

The initial period of hemorrhagic fever with renal syndrome (1-3 days of the disease) lasting from 3 to 10 days is characterized by an acute onset, an increase in body temperature to 38-40 ° C or more, severe headache, dry mouth, nausea, loss of appetite , weakness, myalgia. They note constipation, although diarrhea is possible up to 3-5 times a day. Characterized by symptoms of hemorrhagic fever with kidney syndrome: decreased visual acuity ("flies" before the eyes), pain in the eyeballs, which disappear within 1-5 days. Mark hyperemia of the face, neck, upper chest, injection of sclera and conjunctiva, hyperemia of the throat, hemorrhagic enanthem on the mucous membrane of the soft palate, moderate bradycardia. There may be bloody discharge from the nose, vomiting, pain in the lower back, abdomen; from the 3rd-5th day a petechial rash appears in the area of the clavicles, axillae, chest. In severe forms, meningism symptoms are noted. On the 4th-6th day of the disease, the risk of developing an infectious-toxic shock increases, especially if the treatment-and-protective regime is violated (physical labor, bath visits, alcohol consumption). Oliguric period (from 3-6 to 8-14th day of the disease) - when the body temperature is normalized, the patient's condition does not improve, more often it worsens; symptoms of hemorrhagic fever with renal syndrome are aggravated (headache, vomiting, unrelated to eating, hiccough, dry mouth, anorexia), and diuresis is reduced, the severity of oliguria correlates with the severity of the disease. Characterized by pronounced adynamia, pain in the lumbar region of varying intensity, hemorrhagic syndrome (hemorrhages in sclera, at the injection sites, nasal, gastrointestinal, uterine bleeding). Hemorrhages in vital organs (CNS, adrenal glands, pituitary gland) can cause death. Objectively, the patients note the pallor of the face, the pastosity of the eyelids, the puffiness of the face; bradycardia, hypotension, replaced by the end of the period with hypertension; symptoms of bronchitis appear (in smokers). When palpation of the abdomen is determined by soreness in the projection of the kidneys, hepatomegaly, a positive symptom of effleurage in the lumbar region. When the last symptom is detected, care should be taken due to the possibility of rupturing the capsule of the kidney.

The polyuric period (from the 9th to 13th day of the disease) is characterized by the development of polyuria (up to 5 liters / day or more), nocturia with hypoisostenuria; the cessation of vomiting, the disappearance of pain in the lower back, the restoration of sleep and appetite. At the same time, such symptoms of hemorrhagic fever with renal syndrome, such as: weakness, dry mouth. Thirst is increasing. Sometimes, in the first days of polyuria, azotemia is still growing, possibly the development of dehydration, hyponatremia, hypokalemia.

In the period of convalescence daily diuresis is restored, urea and creatinine values are normal, the general condition of the patient improves. The duration of recovery depends on the rate of recovery of renal function and lasts from 3 weeks to 2-3 years. Assessment of the severity of the disease corresponds to the severity of the main clinical syndromes, especially acute renal failure, and the development of complications.

[1], [2], [3], [4]

Complications of hemorrhagic fever with renal syndrome

Complications of hemorrhagic fever with renal syndrome are divided into specific and nonspecific.

• Specific:
  • infectious-toxic shock:
  • DIC-syndrome;
  • azotemic uremia;
  • edema of the lungs and brain;
  • hemorrhages in the pituitary gland, adrenal glands, myocardium, brain;
  • eclampsia:
  • acute cardiovascular insufficiency;
  • profuse bleeding;
  • tearing or rupturing the capsule of the kidney;
  • infectious myocarditis;
  • hemorrhagic meningoencephalitis,
  • paresis of the intestine;
  • viral pneumonia, and others.
• Nonspecific:
  • pyelonephritis;
  • ascending pyelite;
  • purulent otitis media;
  • abscesses;
  • phlegmon;
  • pneumonia;
  • parotitis;
  • sepsis, and others.

[5], [6], [7], [8], [9], [10],

Mortality and causes of death

Hemorrhagic fever with renal syndrome has a lethality, which is 0.7-3.5% and comes from the development of infectious-toxic shock, acute kidney failure, hemorrhages to vital organs, rupture of the kidneys.