Hemorrhagic fever with renal syndrome - Symptoms

The incubation period of hemorrhagic fever with renal syndrome is from 4 to 49 (on average 14-21) days. Hemorrhagic fever with renal syndrome is characterized by a clear cyclical course and a variety of clinical variants, from abortive febrile forms to severe ones, with massive hemorrhagic syndrome and persistent renal failure. The following periods are distinguished: initial (febrile), oliguric, polyuric, convalescent (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, chills, fatigue, subfebrile condition, lasting 1-3 days, are observed in no more than 10% of patients.

The initial period of hemorrhagic fever with renal syndrome (1-3 days of illness) lasting from 3 to 10 days is characterized by an acute onset, an increase in body temperature to 38-40 °C and higher, severe headache, dry mouth, nausea, decreased appetite, weakness, and myalgia. Constipation is noted, although diarrhea is also possible up to 3-5 times a day. The characteristic symptoms of hemorrhagic fever with renal syndrome are: decreased visual acuity (spots before the eyes), pain in the eyeballs, which disappear within 1-5 days. Hyperemia of the face, neck, upper chest, injection of the sclera and conjunctiva, hyperemia of the pharynx, hemorrhagic enanthem on the mucous membrane of the soft palate, and moderate bradycardia are noted. Bloody discharge from the nose, vomiting, pain in the lower back and abdomen are possible; From the 3rd to the 5th day, a petechial rash appears in the area of the collarbones, armpits, and chest. In severe forms, symptoms of meningism are noted. On the 4th to 6th day of the disease, the risk of developing infectious toxic shock increases, especially if the therapeutic and protective regimen is violated (physical labor, visiting a bathhouse, drinking alcohol). Oliguric period (from the 3rd to the 6th to the 8th to the 14th day of the disease) - with normalization of body temperature, the patient's condition does not improve, more often it even worsens; symptoms of hemorrhagic fever with renal syndrome worsen (headache intensifies, vomiting not associated with food intake, hiccups, dry mouth, anorexia appears), and daily diuresis decreases, the degree of oliguria correlates with the severity of the disease. Characteristic features are pronounced adynamia, pain in the lumbar region of varying intensity, hemorrhagic syndrome (hemorrhages in the sclera, at injection sites; nasal, gastrointestinal, uterine bleeding). Hemorrhages in vital organs (CNS, adrenal glands, pituitary gland) can cause death. Objectively, patients have pale face, pasty eyelids, puffiness of the face; bradycardia, hypotension, replaced by hypertension by the end of the period; symptoms of bronchitis (in smokers) appear. Palpation of the abdomen reveals pain in the projection of the kidneys, hepatomegaly, a positive symptom of percussion in the lumbar region. If the latter symptom is detected, special care should be taken due to the possibility of rupture of the renal capsule.

The polyuric period (from the 9th to the 13th day of illness) is characterized by the development of polyuria (up to 5 l/day and more), nocturia with hypoisosthenuria; cessation of vomiting, disappearance of back pain, restoration of sleep and appetite. At the same time, such symptoms of hemorrhagic fever with renal syndrome as weakness, dry mouth, and increased thirst persist. Sometimes in the first days of polyuria, azotemia increases, dehydration, hyponatremia, and hypokalemia may develop.

During the convalescence period, daily diuresis is restored, urea and creatinine levels return to normal, and the patient's general condition improves. The duration of recovery depends on the rate of recovery of renal function and lasts from 3 weeks to 2-3 years. The severity of the disease is assessed according to the severity of the main clinical syndromes, primarily acute renal failure, and the development of complications.

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Complications of hemorrhagic fever with renal syndrome

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

• Specific:
  • infectious toxic shock:
  • DIC syndrome;
  • azotemic uremia;
  • pulmonary and cerebral edema;
  • hemorrhages in the pituitary gland, adrenal glands, myocardium, brain;
  • eclampsia:
  • acute cardiovascular failure;
  • profuse bleeding;
  • rupture or tear of the renal capsule;
  • infectious myocarditis;
  • hemorrhagic meningoencephalitis,
  • intestinal paresis;
  • viral pneumonia, etc.
• Non-specific:
  • pyelonephritis;
  • ascending pyelitis;
  • purulent otitis;
  • abscesses;
  • phlegmon;
  • pneumonia;
  • mumps;
  • sepsis, etc.

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Mortality and causes of death

Hemorrhagic fever with renal syndrome has a mortality rate of 0.7-3.5% and occurs from the development of infectious toxic shock, acute renal failure, hemorrhages in vital organs, and kidney rupture.