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Hemorrhagic fever with renal syndrome
Last reviewed: 18.10.2021
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Hemorrhagic fever with renal syndrome (synonyms: hemorrhagic nephrosonephritis, Tula fever, Scandinavian epidemic nephropathy, epidemic nephrosonephritis, Churilov's disease, Far Eastern, Korean, Manchu, Yaroslavl, Urals, Transcarpathian, Yugoslavian fever, etc.)
Hemorrhagic fever with renal syndrome is an acute viral zoonotic natural focal disease, characterized by a systemic lesion of small blood vessels, hemorrhagic diathesis. Hemodynamic disorders and kidney damage with the development of acute renal failure.
Hemorrhagic fevers are a polyethiologic group of acute viral zoonotic infections, united on the basis of regular development of hemorrhagic syndrome on the background of acute febrile state and characterized by intoxication and generalized vascular lesions of the microcirculatory bed with the development of thrombohemorrhagic syndrome.
Hemorrhagic fevers are dangerous or especially dangerous diseases with high mortality. This group includes at least 15 independent nosological forms. Venezuelan and Brazilian hemorrhagic fevers are variants of Argentine hemorrhagic fever.
ICD-10 code
A98.5. Hemorrhagic fever with kidney syndrome.
What causes hemorrhagic fever with kidney syndrome?
The causative agents of hemorrhagic fevers are classified as four families of viruses: Arenaviridae, Bunyaviridae, Filoviridae, Flaviviridae. Their genome is a single-stranded RNA.
Replication of the genome of these viruses occurs with low accuracy, which causes a high frequency of RNA mutations and the emergence of new versions of the virus with a modified antigenic structure and virulence.
Most hemorrhagic fevers are natural focal infections.
The reservoir of pathogens is various kinds of animals. In some cases, the source of the virus becomes a sick person and the infection becomes anthroponous.
Human infection with arbovirus hemorrhagic fevers occurs by transmissible way through the bite of infected blood-sucking arthropods (mites, mosquitoes).
Hemorrhagic fevers, caused by arenas, filoviruses and some bunyaviruses, spread by contact-household, aerogenic, parenteral routes.
The susceptibility of a person to hemorrhagic fevers varies widely and depends on the variability of the virus.
Pathogenesis of hemorrhagic fever
Replication of viruses - pathogens of hemorrhagic fevers occurs mainly in the endothelial cells of the vessels of the microcirculatory bed, which is accompanied by microcirculation disorders and development of hemorrhagic syndrome and infectious-toxic shock. It is these features that make it possible to treat hemorrhagic fevers in one group of diseases. Clinically, the generality of hemorrhagic fevers is determined by the presence of febrile-intoxication and hemorrhagic syndromes. Diagnosis of hemorrhagic fevers is carried out by virological and immunological methods. The basis of treatment is pathogenetic therapy. Specific prevention methods have not been developed. In connection with the severity of the course, high lethality, epidemiological uncontrollability, hemorrhagic fevers are classified as especially dangerous and dangerous infectious diseases.
What are the symptoms of hemorrhagic fever with kidney syndrome?
Hemorrhagic fever with renal syndrome has an incubation period that ranges from 4 to 49 (an average of 14-21) days. The disease is characterized by a clear cyclic flow and multiple symptoms, 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 phenomena in the form of malaise, cognition, fatigue, subfebrile, lasting 1-3 days, observe no more than 10% of patients.
Where does it hurt?
How is hemorrhagic fever diagnosed with kidney syndrome?
Hemorrhagic fever with renal syndrome is diagnosed on the basis of characteristic symptoms, a combination of acute onset of the disease with the appearance of fever and symptoms of intoxication, kidney damage with the development of acute hepatic insufficiency and hemorrhagic syndrome.
Stay in an endemic focus, the nature of professional activity.
The cyclicity of the course with a regular change in infectious-toxic symptoms of the initial period (fever, headache, weakness, hyperemia of the face, neck, upper third of the breast, mucous membranes, injection of scleral vessels) signs of increasing renal insufficiency of the oliguric period (pain in the loin, abdomen, vomiting, not associated with food intake, decreased visual acuity against a background of severe headache, dry mouth, thirst, severe hemorrhagic syndrome, decreased diuresis to less than 500 ml / day.
How is hemorrhagic fever treated with kidney syndrome?
Hemorrhagic fever with kidney syndrome requires strict bed rest until the termination of polyuria.
Recommend a full meal without limiting salt, a fractional, in a warm form. In the oligurical period, products rich in potassium (vegetables, fruits) and protein (beans, fish, meat) are excluded. In polyuria, on the contrary, the use of these products is indicated. The drinking regimen should be dosed, taking into account the amount of liquid allocated.
Hemorrhagic fever with renal syndrome is treated medically in the initial period, in the first 3-5 days: ribavirin 0.2 g 4 times a day for 5-7 days, iodophenazone - according to the scheme: 0.3 g 3 times a day for the first 2 days, 0.2 g 3 times a day for the next 2 days and 0.1 g 3 times a day for the next 5 days, Tyloron 0.25 mg 2 times a day on day 1, then 0.125 mg 2 days; donor specific immunoglobulin against HFRS 6 ml 2 times a day intramuscularly (course dose 12 ml), a complex immunoglobulin preparation, interferon preparations in suppositories (viferon) and parenterally (reaferon / leukinferon).
What prognosis is haemorrhagic fever with kidney syndrome?
Hemorrhagic fever with kidney syndrome has a different prognosis, which depends on the quality of care, the strain of the pathogen. Mortality is from 1 to 10% and higher. The kidney function is restored slowly, but chronic renal failure does not develop.