Hlps symptoms treatment. Hemorrhagic fever

Acute viral zoonotic disease, viral etiology.

Characteristic of the causative agent of hemorrhagic fever with renal syndrome

The causative agent of HFRS is assigned to the family of Bunyaviridae (Bunyaviridae) and isolated in a separate genus Hantavirus, which includes several serovars: the virus Puumala, Dobrava, Seul, Hantaan. These are RNA-containing viruses up to 110 nm in size, die at a temperature of 50 ° C for 30 minutes, and at 0-4 ° C (temperature of a household refrigerator) 12 hours are stored. Tropen to endotheliocytes, macrophages, platelets, renal tubule epithelium. It binds to cells with specific receptors on the membranes (integrins).

Ways of infection:dusty air (inhalation of the virus with dried feces of rodents); fecal-oral (eating foods contaminated with rodent excrement); contact (contact of damaged skin with environmental objects contaminated by rodent secretions, such as hay, brushwood, straw, feed).

In humans, the absolute susceptibility to the pathogen. In most cases, autumn-winter seasonality is characteristic.

After the infection, a strong immunity is formed. Repeated diseases in one person do not occur.

Symptoms of HFRS The disease is cyclical!

1) the incubation period - 7-46 days (an average of 12-18 days), 2) the initial (febrile period) - 2-3 days, 3) the oligoanuric period - from 3 days of illness to 9-11 days of illness, 4) period early convalescence (polyuric period - after the 11th - up to 30 days of illness), 5) late convalescence - after 30 days of illness - up to 1-3 years.

Sometimes the initial period is preceded by   prodromal period: lethargy, increased fatigue, decreased performance, pain in the limbs, catarrhal phenomena. Duration no more than 2-3 days.

Initial periodcharacterized by the appearance of headaches, chills, myalgia, arthralgia, weakness.

The main symptom of the onset of HFRS is a sharp increase in body temperature, which in the first 1-2 days reaches high figures - 39.5-40.5 ° C. Fever can persist from 2x to 12 days, but most often it is 6 days. Feature - the maximum level is not in the evening, but in the daytime and even morning hours. Other intoxication symptoms immediately increase in patients - lack of appetite, thirst appears, patients are inhibited, sleep poorly. Headaches are spilled, intense, increased sensitivity to light stimuli, pain when moving eyeballs. In 20% of visual impairment - “fog before the eyes”, flickering flies, decreased visual acuity (swelling of the eye, blood stasis in the vessels). Upon examination of patients, “hood syndrome” (cranio-cervical syndrome) appears: hyperemia of the face, neck, upper chest, puffiness of the face and neck, injection of scleral vessels (there are hemorrhages in the sclera, sometimes affecting the entire sclera - a symptom of red cherry) and conjunctiva. The skin is dry, hot to the touch, the tongue is coated with a white coating. Already during this period, severe or dull lower back pain may occur. With high fever, the development of the development of toxic infectious encephalopathy (vomiting, severe headache, stiff neck, Kernig, Brudzinsky symptoms, loss of consciousness), as well as toxic toxic shock. Oliguric period. It is characterized by a practical decrease in fever for 4-7 days, no improvement occurs .. Constant back pain of various severity appears - from aching to sharp and debilitating. In severe HFRS, 2 days after the renal pain syndrome, vomiting and abdominal pain in the stomach and intestines of aching nature, oliguria join them. Laboratory - a decrease in the specific gravity of urine, protein, red blood cells, cylinders in the urine. In the blood, the content of urea, creatinine, potassium increases, the amount of sodium, calcium, and chlorides decreases.

At the same time, hemorrhagic syndrome also manifests itself. A small point hemorrhagic rash appears on the skin of the chest, in the armpits, on the inner surface of the shoulders. The rash bands may be in some lines, as from a “lash”. Hemorrhages in the sclera and conjunctiva of one or both eyes appear - the so-called symptom of “red cherry”. In 10% of patients, severe manifestations of hemorrhagic syndrome appear - from nosebleeds to gastrointestinal.

The peculiarity of this period of HFRS is a peculiar change in the function of the cardiovascular system: heart rate reduction, tendency to hypotension, muffling of heart sounds. On the ECG - sinus bradycardia or tachycardia, the appearance of extrasystoles is possible. Blood pressure during oliguria with initial hypotension can go into hypertension (due to sodium retention). Even within one day of illness, high blood pressure can turn into low and vice versa, which requires constant monitoring of such patients.

In 50-60% of patients in this period, nausea and vomiting are recorded even after a small sip of water. Often the pain in the stomach is painful. 10% of patients have loose stools, often with an admixture of blood.

During this period, symptoms of damage to the nervous system occupy a prominent place: patients have severe headache, stupor, delusional states, often fainting, hallucinations. The reason for such changes is hemorrhage in the substance of the brain.

It is during the oliguric period that one of the fatal complications should be wary of - acute renal failure and acute adrenal insufficiency.

The polyuric period (or early convalescence). It is characterized by a gradual restoration of diuresis. It becomes easier for patients, the symptoms of the disease regress. Patients excrete a large amount of urine (up to 10 liters per day), low specific gravity (1001-1006). After 1-2 days from the onset of polyuria, laboratory indicators of impaired renal function are also restored. By the 4th week of the disease, the amount of urine released is normal. A couple of months there is a slight weakness, a small polyuria, a decrease in the specific gravity of urine.

Late convalescence.It can last from 1 to 3 years. Residual symptoms and their combinations are combined in 3 groups:

Asthenia - weakness, decreased performance, dizziness, decreased appetite. Violation of the function of the nervous and endocrine systems - sweating, thirst, skin itching, impotence, increased sensitivity in the lower extremities. Renal residual effects - heaviness in the lower back, increased diuresis up to 2.5-5.0 L, the prevalence of nocturnal diuresis over daytime, dry mouth, thirst. Duration about 3-6 months.

In the warm seasons, urban residents tend to spend weekends and holidays in nature - in the forest, in the country. At the same time, the summer season opens, agricultural work begins. During this period, there are many cases of hemorrhagic fever with renal syndrome (abbreviated as HFRS).

Causative agent of the disease

Hemorrhagic fever with renal syndrome (HFRS) is the collective name for several similar diseases caused by viruses of the genus Hantanaan of the Bunyaviridae family.

Synonyms: Manchu gastritis, hemorrhagic nephrosonephritis, Songo fever.

E.P. Shuvalova

Infectious Diseases, 2001

This disease is common among mouse rodents throughout the Russian Federation. The virus is found in large quantities in the feces of sick animals living on the banks of rivers, in forests, in suburban areas. All contaminated objects serve as a source of infection: plants stored in the winter in the country houses underwear, food, equipment. Agricultural workers, hunters, loggers, as well as urban residents traveling to summer houses, camp sites, and sanatoriums are at risk. In this regard, the disease is characterized by an increase in the incidence in the warm season of the year. This infectious pathology always proceeds in an acute form, the transition of the process to the chronic stage does not exist.

HFRS development mechanism

From rodents, the virus is transmitted to humans in the following ways:

• through inhaled air containing the components of the discharge of sick animals, when cleaning the premises after the end of the winter season (air-dust path);
• through eating foods and plants contaminated with urine, rodent saliva (nutritional route);
• in direct contact with sick animals (contact path);

The mechanism of the development of the disease - video

The transmission of the virus from person to person is excluded, so it does not pose a painful danger to others.

Symptoms and stages

During the course of the disease, several different stages can be distinguished.

Depending on the severity of symptoms, the severity of the disease is distinguished:

• a mild degree occurs with low fever, a small amount of hemorrhagic rash, short-term oliguria;
• moderate severity is characterized by all of the above phases without the development of life-threatening complications;
• with a severe form, fever is pronounced, the rash occupies large areas of the skin, nasal and stomach bleeding is possible as a result of coagulation dysfunction, the amount of urine decreases until it disappears completely;

Diagnostic Methods

Diagnosis methods include:

Differential diagnosis is carried out with other diseases accompanied by high fever, hemorrhagic rash and impaired renal function: influenza, tick-borne encephalitis, as well as a number of non-infectious pathologies: appendicitis, gastric ulcer.

Treatment of hemorrhagic fever with renal syndrome: methods and options

Treatment is carried out exclusively in a hospital setting with bed rest for the entire period of the disease (3-4 weeks). Self-medication can lead to the development of many formidable complications and death.

The following drugs are used:

In the case of complications, hardware-based blood purification from the decomposition products of proteins and other toxins is used - hemodialysis. With a pronounced violation of the coagulation function of the blood, its components are transfused.

Prognosis and complications

With timely treatment, the prognosis is favorable. In severe forms of the disease, terrible complications can lead to an unfavorable outcome:

Mortality in hemorrhagic fever reaches several percent. Immunity after the infection is persistent life-long.

Rehabilitation period

An discharge from the hospital is carried out after the disappearance of the clinical manifestations of the disease, restoration of renal function and blood coagulation. During the year after recovery, a doctor’s examination, blood pressure measurement, and urinalysis are performed once every three months.

• cereals;
• steamed meat and fish;
• yesterday's bread from bran and wholemeal flour;
• soups;
• fruit jelly;
• low-fat cottage cheese;

Permitted products for HFRS on the photo

Whenever possible, the following foods should be avoided:

• white bread;
• fresh bakery;
• spicy spices;
• fried meat and fish;
• chocolate;
• fat cottage cheese;
• smoked meats;
• carbonated drinks;
• alcohol;

Forbidden food in the photo

Prevention

Preventive measures in the foci of the spread of hemorrhagic fever of this type include:

Vaccine prophylaxis of HFRS in our country is not developed.

During the warm season, when you go on vacation, you must remember and follow the rules of hygiene in the places of the possible presence of rodents and their waste products. If fever symptoms appear, seek immediate medical attention to conduct appropriate treatment and prevent the development of serious complications.

Hemorrhagic fever with renal syndrome (HFRS) is a viral infection that has a certain territorial affection and is manifested by thrombohemorrhagic syndrome and specific kidney damage.

What is hemorrhagic fever with renal syndrome?

Pathology is caused by a virus, which, penetrating the body, accumulates in the endothelium (inner layer) of blood vessels and in the epithelium of internal organs (kidneys, myocardium, pancreas, liver). Then the virus spreads with blood throughout the body, provoking the onset of the disease, which is manifested by symptoms of general intoxication. The virus damages the vascular walls, violates the coagulation ability of the blood, causing the development of hemorrhagic syndrome. Thrombi form in different organs; in severe cases, extensive hemorrhages occur. Under the influence of toxins of the virus, the kidneys are most damaged.

In Russia, the inhabitants of Siberia, the Far East, Kazakhstan, Transbaikalia are susceptible to the disease, therefore the name of this virus infection is linked to the locality - Far Eastern, Omsk, Korean, Ural, Tula hemorrhagic fever, etc. The disease is also widespread in the world, they are sick residents of the Scandinavian countries (Norway, Finland), Europe (France, Czech Republic, Bulgaria), China, North and South Korea. Synonyms for the name of the pathology are hemorrhagic or epidemic nephrosonephritis, Churilov’s disease, mouse fever.

Every year in our country from 5 to 20 thousand cases of the disease are recorded. Mostly sick men of active age - from 16 to 50 years old (70–90%).  Hemorrhagic nephrosonephritis is mainly sporadic, that is, isolated cases are recorded, but there are also small outbreaks - 10–20, less often up to 100 people.

The highest incidence is observed in the summer and until mid-autumn; in winter, pathology is rarely diagnosed. This is because the carriers of the virus are rodents - a field mouse and a red vole, which are active in the warm season. In urban settings, house rats can be carriers of infection.

Until the age of three, hemorrhagic fever with renal syndrome is practically not registered, until seven years, children are extremely ill. This is due to the fact that the kids have little contact with wildlife, do not take part in agricultural work. Children can get sick only if their parents violate hygiene standards (for example, they fed a child unwashed vegetables contaminated with feces of the mouse). Among children, small outbreaks of the disease in pioneer camps, sanatoriums, kindergartens are possible if the institutions are located near a forest or field.

In young children, especially newborns and infants, the disease is very difficult, since the virus affects the blood vessels, and in children they are characterized by increased permeability. In babies, as a rule, multiple bleeding develops in the internal organs with disruption of the functioning of entire systems.

Hemorrhagic nephrosonephritis is always acute, a chronic course does not exist.  After the disease, lifelong immunity remains.

Doctor in detail about infection - video

Causes, development factors and transmission routes of infection

The causative agents of the disease are RNA viruses belonging to the bunyavirus family, of which four serotypes are pathogenic for the human body: Hantaan, Puumala, Dubrava and Seoul. Each of these viruses is spread over a specific area. Hantaviruses have the shape of a sphere or spiral, reach sizes from 80 to 120 nm, are stable in the environment, lose stability at a temperature of 37 ° C, at 0–4 ° C they remain viable for up to 12 hours, and at 50 ° C they die within half an hour. A person is absolutely susceptible to these viruses.

Infectious agents can penetrate the human body in different ways:

• aspirated (through air) - when inhaling the smallest particles of dried rodent feces;
• contact - penetration through damaged skin of a person when interacting with contaminated objects (agricultural feed, cereals, straw, hay, brushwood);
• alimentary (fecal-oral) - through products infected with rodents.

The risk group for morbidity includes agricultural workers (farmers, tractor drivers), workers of enterprises producing feed and other food products, drivers, that is, everyone who is actively in contact with the environment. The possibility of human infection is directly related to the number of rodents in a particular area. The patient is not dangerous for the environment - the virus is not transmitted from person to person.

Symptoms of HFRS

Depending on the strength of the manifestations, the severity of intoxication, renal and thrombohemorrhagic syndromes, mild, moderate and severe forms of pathology are distinguished. The course of hemorrhagic nephrosonephritis can be typical, erased and subclinical.

A cyclical course is characteristic of the disease, during which several periods change:

• incubation (can last from a week to 50 days, most often 3 weeks);
• prodromal (short, lasts only a couple of days);
• febrile (lasts from 3 days to a week);
• oliguric (only 5–8 days);
• polyuric (begins on 10-14 days of illness);
• convalescence (from 20 days to 2 months - the early period and up to 2-3 years - the late).

After incubation, a short period of the prodrome begins, which may be absent. At this time, the patient feels weakness, malaise, he is worried about muscle, joint, headaches, the temperature may increase slightly (up to 37 ° C).

The febrile stage begins rapidly: the temperature rises to 39–41 ° C, signs of intoxication appear: nausea, vomiting, body aches, severe headache, lethargy, pain in the eyes, muscles, joints. The patient’s vision is blurred, “flies” flicker before his eyes, color perception is disturbed (everything around is seen in a crimson color). This period is characterized by the appearance of a petechial (small hemorrhagic) rash on the neck, chest, armpit skin, and oral mucosa. The patient’s face and neck are hyperemic, the sclera is red, the heartbeat is slowed down (bradycardia), the pressure is lowered (it can decrease up to a collapse - critically low numbers with the development of acute heart failure, loss of consciousness and death).

The next period, oliguric, is characterized by a decrease in temperature to low or normal numbers, but this does not improve the well-being of the patient. Signs of general intoxication are even more aggravated, symptoms from the side of the kidneys join: severe pain in the lower back, the amount of urine decreases, the pressure rises sharply. Blood and protein appear in the excreted urine, the number of cylinders increases (protein imprints of the renal tubules - one of the structural elements of nephrons). Azotemia is increasing (a high level in the blood of nitrogenous metabolic products, which are normally excreted by the kidneys), a serious violation of the functional abilities of the kidneys (acute renal failure) is possible, and there is a threat of uremic coma. Most patients at this stage suffer from diarrhea and excruciating vomiting.

Hemorrhagic syndrome manifests itself as macrohematuria (blood clots in the urine, which are visible to the naked eye), intense bleeding - nasal, from injection sites, as well as from internal organs. Hemorrhagic syndrome is dangerous with serious complications: stroke, extensive hemorrhages in vital organs - the pituitary, adrenal glands.

The onset of the polyuric stage is characterized by an improvement in the general condition of the patient. Sleep and appetite are gradually normalizing, nausea and lower back pain go away. The volume of urine increases significantly: up to 3-5 liters can be excreted per day. Polyuria is a specific sign of this stage. The patient complains of thirst and dryness of the mucous membranes.

The stage of recovery can be significantly delayed - from several months to several years. Those who underwent hemorrhagic fever experience post-infectious asthenia for a long time: weakness, increased fatigue, emotional instability. At the convalescence, symptoms of VVD (vegetative-vascular dystonia) are observed: decreased pressure, excessive sweating, shortness of breath even with a slight load, sleep disturbances.

Diagnostics

When collecting an epidemiological history, the patient must be taken into account in the area where there were cases of hemorrhagic nephrosonephritis, possible contact with rodents or objects contaminated with the waste products of these animals. Clinical diagnosis is based on the cyclical course of the disease, a characteristic change in symptoms in successive periods, as well as laboratory data.

General and biochemical blood and urine tests, a coagulogram (blood coagulation test) are performed. Analyzes are carried out in dynamics, since the disease is characterized by a constant change in indicators.

In the blood at the initial stage of the disease, leukopenia (a decrease in the level of leukocytes) is observed, followed by a sharp leukocytosis (an increase in leukocytes), thrombocytopenia (a decrease in the number of platelets), and a high ESR (up to 40-60 mm per hour). In the oliguric stage, the amount of residual nitrogen, magnesium and potassium in the blood increases significantly, the level of chlorides, calcium and sodium decreases. Hemoglobin and red blood cells increase due to blood clotting due to plasma leakage through the walls of blood vessels damaged by the virus. The coagulogram shows a decrease in blood coagulation.
Blood biochemistry determines a change in key indicators, which indicates a deep violation of metabolic processes in the patient’s body.

In the analysis of urine, red blood cells, protein, and cylinders are determined. Albuminuria (a high protein in the urine) appears a few days after the onset of the disease and reaches its highest levels by about 10 days, and then abruptly decreases. Such a sharp change in protein indices (even within a few hours) is characteristic of mouse fever and does not occur in any other disease.

Hypoisostenuria (low specific gravity of urine) is observed from the very beginning of the disease, is significantly enhanced at the oliguric stage and does not recover for a long time. This symptom, along with albuminuria, has valuable diagnostic value.

Specific diagnostics consists in the detection of antibodies to the pathogen in the blood serum through serological methods - ELISA (enzyme-linked immunosorbent assay) or RNIF (indirect immunofluorescence reaction). Blood is taken for examination at the earliest possible period of the disease and again after 5-7 days. In the repeated analysis, an increase in antibody titers of at least 4 times was detected. Antibodies persist in the blood of patients who have been ill for many years (5–7).

To assess the severity of kidney damage, an ultrasound scan is used, the patient is given an ECG, chest x-ray, fibrogastroscopy according to indications.

Differential diagnosis

The disease should be distinguished from pathologies with similar symptoms: other types of hemorrhagic fevers, leptospirosis, enterovirus infection, typhus, sepsis, renal diseases - acute pyelonephritis, glomerulonephritis, nephrosis.

Treatment

The patient is treated only in a hospital.  Hospitalization in the early stages by adapted medical transport, with the observance of precautions due to the danger of rupture of the kidney capsule, significantly reduces the percentage of complications and deaths.

Therapy is aimed at combating intoxication, maintaining the functionality of the kidneys, and preventing complications. A strict bed rest is prescribed, up to the first days of the polyuric stage. The patient is shown a diet table No. 4, with a restriction of protein (meat products) and potassium (due to the development of hyperkalemia), salt is not limited, they recommend drinking plenty of fluids, mainly mineral water without gas - Essentuki No. 4, Borjomi.

Doctors conduct continuous monitoring of the patient's condition - control of water balance, hemodynamics, functional indicators of the kidneys and cardiovascular system. The patient needs thorough hygienic care.

Etiotropic therapy in the form of antiviral drugs is effective in the first few days of the disease (up to 5 days). The patient is injected with donor immunoglobulin, interferon preparations, chemical antiviral agents - Ribavirin (Ribamidil, Virazole) or Amiksin, Cycloferon.

At the febrile stage, detoxification measures are carried out: intravenous infusion of physiological saline with ascorbic acid, 5% glucose solution, in case of heart failure - Hemodez, Reopoliglyukin. The prevention of DIC-syndrome (desimenated intravascular coagulation or thrombohemorrhagic syndrome - the formation of blood clots in small vessels) is to prescribe:

• angioprotectors:
  • Calcium Gluconate, Rutin, Prodectin;
• disaggregants:
  • Pentoxifylline (Trental), Complamin, Curantyl;
• drugs to improve microcirculation:
  • Heparin, Fraxiparin, Clexane.

In the oliguric period, infusion infusions of saline solutions are canceled, the daily amount of parenteral (intravenous) solutions is calculated based on the amount of urine released per day. Diuresis is stimulated with diuretics - Eufillin intravenously, Furosemide in shock doses.

The fight against acidosis is carried out by administering to the patient a 4% sodium bicarbonate solution. Prevention of bleeding is carried out by the introduction of Dicinon, Aminocaproic acid, with severe bleeding, blood substitutes are prescribed. In acute renal impairment, the patient is transferred to hemodialysis (contraindicated in case of kidney rupture, massive bleeding, hemorrhagic stroke).

With increasing renal failure, the patient with mouse fever is transferred to hemodialysis - a method of purifying blood using the "artificial kidney" apparatus

In severe cases and complications appoint:

• hormonal drugs:
  • Prednisolone, Hydrocortisone, Doxu;
  • protease inhibitors:
• Kontrikal, Trasilol, Gordoks;
• transfusion of fresh plasma;
• oxygen therapy.

Severe pains are relieved by analgesics (Spazmalgon, Baralgin, Trigan) along with antihistamines (Suprastin, Tavegil, Diphenhydramine), if they are ineffective - with drugs, for example, Promedol, Fentanyl, Tromadol. With nausea and vomiting, Raglan, Cerucal, Perinorm are used, with indomitable vomiting, Aminazine, Droperidol, Atropine are indicated. The development of cardiovascular failure requires the use of cardiac glycosides and cardiotonics to normalize the work of the heart - Strophanthin, Korglikon, Cordiamin.

In anuria (lack of urine), uremic intoxication is treated by washing the stomach and intestines with 2% sodium bicarbonate solution.
After diuresis has recovered, for the prevention of secondary infection of the urinary tract is prescribed:

• nitrofurans:
  • Furogin, Furodonin;
• sulfonamides:
  • Groseptol, Biseptol.

Bacterial complications are treated with antibiotics, mainly the cephalosporin and penicillin series.In the polyuric period, therapy is aimed at optimal rehydration (restoration of water balance): injected saline solutions - Acesol, Quintasol, Lactosol, the patient should take alkaline mineral waters, Regidron, Citroglucosolan inside. The patient is prescribed general strengthening drugs: multivitamins, Riboxin, ATP, Cocarboxylase.

A recovering person is prescribed after normalizing diuresis, laboratory parameters of urine and blood:

• with a mild form - not earlier than 17-19 days of illness;
• in severe cases, not earlier than 25–28 days.

The sick leave after discharge is continued by the clinic doctor for at least 2 weeks. The therapist is observed by a therapist (children - pediatrician) and an infectious disease specialist. The patient is released from hard physical labor, sports (children - from physical education lessons) for 6-12 months. Children should not receive routine vaccinations during the year.

In the recovery period, a full, fortified diet and drink are recommended: rosehip infusion, herbs with a diuretic effect, multivitamin preparations are recommended. Exercise therapy, massage, physiotherapy (electrophoresis, diathermy) are important measures for the speedy recovery of the patient.

Diet implies the exclusion of fatty, fried, salty, spicy, spicy dishes. Smoked foods, marinades, canned goods, spices, all products that can irritate the kidneys must be removed from the diet of the patient. Nutrition should be complete, fortified, balanced in protein, fat and carbohydrate content.

• dried fruits:
  • raisins, dried apricots;
• berries:
  • blackberries, strawberries;
• beverages:
  • rosehip broth;
  • cranberry, cranberry juice;
  • natural juices;
• fruits and vegetables:
  • bananas, pears, pumpkin, cabbage;
• dairy products;
• jelly, fruit and milk jellies;
• cereal cereals;
• low-fat varieties of meat and fish.

For drinking, it is best to choose mineral water without gas with antispastic and diuretic effects - Borjomi, Essentuki, Kurgazak, Krasnousolskaya. Herbs in the form of teas and infusions for normalizing diuresis are recommended: bearberry (bear’s ear), lingonberry leaves, cornflower flowers, strawberry leaves, dill seeds with a succession, meadow clover. The person who underwent the disease is categorically contraindicated in any form of alcohol.

Photo gallery - products recommended for convalescents of hemorrhagic nephrosonephritis

  Fresh vegetables and fruits are especially beneficial for hemorrhagic fever with renal syndrome.
  In the recovery period, you need to include lean meats and fish in the diet
  Cranberry juice is recommended for all kidney diseases.
  Decoctions of raisins and dried apricots are very rich in potassium
  Porridge is useful in high micronutrients
  Dairy and dairy products are necessary for recovery from illness
  Blackberries, strawberries, strawberries contain many vitamins, minerals and have a diuretic effect
  Bearberry leaf is useful for kidney diseases, as it has a diuretic effect.

Treatment prognosis and complications

Mild and moderate forms of the disease usually end in recovery. Residual effects, signs of vascular dystonia, weakness, lumbar pain, cardiopathy, polyneuropathy (a decrease in muscle strength and tendon reflexes) persist for a long time in half of those who underwent pathology. Dispensary observation is indicated for 12 months with an infectious disease specialist and a nephrologist.

The severe course of the disease can cause complications:

• infectious toxic shock - the development of uremic coma is possible;
• DIC, leading to multiple organ failure;
• pulmonary edema (acute respiratory failure);
• stroke, hemorrhage in the heart muscle, pituitary, adrenal glands with the formation of areas of necrosis (one of the main causes of death);
• acute heart failure;
• damage (rupture) of the renal capsule;
• the imposition of a bacterial infection threatening sepsis, peritonitis, severe pneumonia, otitis media, pyelonephritis.

Mortality from hemorrhagic nephrosonephritis is 7–10%.

Video - How to protect yourself from the virus?

Preventative measures

Specific prophylaxis does not exist today.  To prevent infection by the following measures:

• extermination of rodents, especially in endemic areas;
• storage of products, grain, feed in warehouses and barns, reliably protected from the penetration of rats and mice;
• work at agricultural facilities in overalls and respirators;
• observance of sanitary and hygienic standards when arranging the territory of summer camps, sanatoriums, open recreation complexes, household plots (cutting down and destroying weed thickets, wild shrubs, moving garbage and latrine pits to considerable distances from residential facilities, protecting grocery storage facilities);
• regular deratization of residential and industrial premises;
• compliance with the rules of personal hygiene (washing hands, using disinfectant disposable wipes) in the countryside, in the country, during outdoor recreation.

Hemorrhagic fever with renal syndrome is a disease that threatens with serious complications and death. With timely diagnosis and proper treatment of these effects can be avoided. Do not forget about prevention, which can protect against infection and maintain health.

The virus is transmitted to humans from rodents: field mice, field voles, lemmings, etc. Infection occurs during direct contact with the animal, through the mouth (dirty hands, unwashed berries), when inhaling dust containing residual excrement.

Hemorrhagic with renal syndrome occurs in the form of outbreaks, most often from June to October, since at this time people most often go to nature. Isolated cases occur throughout the year. Villagers are most at risk. It is known that the disease is caused by a virus, but scientists have not yet been able to obtain it in its pure form in the laboratory and study it well.

Manifestations of hemorrhagic fever with renal syndrome

Disease is preceded by an incubation period. It can last from 4 to 48 days, in most patients - 2-3 weeks. There are no symptoms at this time. Only mild malaise and a slight increase in body temperature can be noted.

In the first 1-6 days of the disease, body temperature rises to 38-40⁰C. There is severe, chills, pain in the lower back and muscles. Bright light causes severe pain to the eyes. The objects seem vague, before the eyes as if “a grid appears”. The skin of the face, neck and upper chest turns red. The tongue is coated in white. Blood pressure drops. Infection can manifest as pneumonia. The liver and spleen increase in size, due to which the abdomen may increase outwardly.

On the 3-4th day of the disease, hemorrhages occur on the skin, first in the armpits, then on the sides of the body. The whole body of the patient may be covered by hemorrhages in the form of a rash. This is due to the fact that the virus affects the blood vessels. At this time, the patient's condition worsens.

On the 6th-9th day of illness, body temperature normalizes, the condition temporarily improves. But there is a pallor of the skin, blueness of the feet and hands, severe lower back pain. If the patient is given injections, hemorrhages remain in their places. During the blood comes out with sputum, vomiting with blood occurs. The chair turns black, reminiscent of tar. The amount of urine is greatly reduced. This condition is the most dangerous. It is caused by impaired renal function. If treatment is absent or is carried out incorrectly, then they develop that can lead to the death of the patient.

On 10-16 days of illness, the patient's condition begins to recover. The amount of urine increases. All symptoms gradually disappear.

What can you do?

Hemorrhagic fever with renal syndrome needs urgent treatment. If, after going to nature or contact with rodents, symptoms resembling a cold occur, you should consult a doctor. Usually, when a disease outbreak occurs in a particular area, the public is informed about this in the media.

What can a doctor do?

Treatment of hemorrhagic fever with renal syndrome is carried out in a hospital. The disease is not transmitted from person to person, so the patient does not need to be isolated. A strict bed rest is prescribed, the amount of food containing a large amount of protein and potassium is limited. The patient is recommended to drink mineral water. The main treatment for the disease is the appointment

Hemorrhagic fever with renal syndrome (HFRS) or mouse fever should be familiar to every resident of Russia.

The disease is dangerous with the possibility of serious complications. The number of deaths among patients in Russia reaches 8%.

Is there any problem? Type in the "Symptom" or "Name of the disease" form, press Enter and you will find out all the treatments for this problem or disease.

The site provides background information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor. Any drugs have contraindications. Specialist consultation is required, as well as a detailed study of the instructions! .

What are the causes of HFRS?

This is a viral disease that affects the vessels and kidneys. The causative agent of the disease is the Hantaan virus, which belongs to the bunyavirus family.

Between animals, this virus spreads through the bites of fleas or ticks. Rodents are latent carriers of the virus and excrete it into the environment with feces, urine and saliva.

The virus is characterized by resistance to freezing temperatures and dies within half an hour at temperatures from 50 degrees. The peculiarity of the virus is that it infects the inner lining of the blood vessels (endothelium).

There are 2 types of virus:

1. Eastern type. The type prevails in the Far East, the carriers of infection are Manchurian field mice.
2. The western type is common in the European part of Russia. The peddler is a red and red vole.

It was noted that the first type is more dangerous and causes from 10 to 20% of cases of deaths, the second - up to 2%. There are several ways to get this disease.

Infection occurs when a person comes in contact with secretions of infected rodents by inhalation, eating, or when they get on damaged skin. The disease is autumn-winter seasonal in nature.

Symptoms of this disease

The course of HFRS is divided into several periods.

Depending on the stage of the disease, the patient manifests symptoms of the disease.

1. The incubation period. This stage lasts about 20 days. At this stage, the disease does not manifest itself. The patient may not suspect infection.
2. The initial (febrile) period lasts 3 days.
3. Oligoanuric lasts about a week.
4. Polyuric (early convalescence) - from 2 to 3 weeks.
5. Late convalescence begins from about the second month of the course of the disease and lasts up to 3 years.

The initial stage of the disease is characterized by a significant jump in body temperature in the morning and afternoon. The patient is accompanied by insomnia, aches throughout the body, fatigue, lack of appetite.

There is a headache, a painful reaction to light stimuli, conjunctivitis. A white coating forms on the tongue. Redness of the upper body is observed.

In the third stage of the disease, the temperature decreases slightly, but other pronounced symptoms appear.

Characteristic for this period are pain in the lower back, which with a severe form of the disease can be accompanied by nausea, vomiting, aching pain in the abdominal part.

Urine output is reduced. Due to this, the level of potassium and urea in the blood increases, and the level of calcium and chlorides decreases.

A small rash (hemorrhagic syndrome) appears on the patient’s skin. More often the area of \u200b\u200bthe chest, armpits and shoulders is affected. This is accompanied by nasal and gastrointestinal bleeding.

The patient’s cardiovascular system malfunctions: the pulse becomes less frequent, blood pressure in a short period grows from low to high and back.


  A characteristic symptom of hemorrhagic fever with renal syndrome is damage to the nervous system. Hemorrhages in the patient’s brain can cause hallucinations, deafness, and fainting. At the stage of oliguria, the patient has complications - acute renal and adrenal insufficiency.

At the stage of early convalescence, the patient feels relief. At first, abundant urine is observed (up to 10 liters per day), then diuresis gradually returns to normal.

Late convalescence is characterized by residual symptoms. The patient feels a general malaise - dizziness, weakness, increased sensitivity in the legs, the need for fluid, increased sweating.

Features of the development of HFRS

The development of HFRS begins in a patient with an incubation period in the first 2-3 weeks from the moment of infection. Infection enters the body through the mucous membrane of the respiratory tract or digestive system, less commonly through open wounds on the skin.

If a person has persistent immunity, the virus dies. It begins to breed.

Then the infection enters the bloodstream and the patient begins to manifest an infectious-toxic syndrome. Once in the blood, the virus settles on the endothelium.

The vessels of the kidneys are more affected. An infection leaves the patient's body with urine.

At this time, the patient may experience acute renal failure. There is regression, and body functions are restored. The recovery process is complex and proceeds slowly, this period can take up to 3 years.

Pathology diagnostics

The first symptoms of the disease are similar to acute respiratory viral infections, so the patient often hesitates with seeking help from a medical institution. Consider the features in the symptoms of HFRS in the early stages of the development of the disease.

Firstly, with SARS, the patient's temperature rises in the evening, while with HFRS it occurs mainly in the morning. Another feature of the disease is redness of the skin of the upper body, eyeballs.

At later stages of the development of the disease, clearer symptoms appear. This is a hemorrhagic rash, a decrease in the amount of urine released, pain in the lumbar region.

At the first suspicion of the development of hemorrhagic fever, you need to see a doctor. When making a diagnosis, the seasonal factor, the likelihood of the patient staying in endemic foci, and other epidemiological characteristics are taken into account.

For an accurate diagnosis, differential and laboratory diagnostics are used. During differential research methods, specialists exclude other diseases, SARS, influenza, tonsillitis, pyelonephritis.

The patient is constantly monitored to identify new symptoms of the disease.

Laboratory diagnostic methods include urine tests, a general and biochemical analysis of the patient’s blood. With HFRS, fresh red blood cells are found in the patient’s urine, and the protein level is significantly reduced.

The blood level increases urea and creatine, and the level of hemoglobin and red blood cells decreases. In the blood serum, the concentration of fats increases and the level of albumin decreases.

The diagnosis of HFRS is confirmed by the detection of antibodies of the IgM and G class in the body. For this, an enzyme-linked immunosorbent assay is used.

An important feature of the diagnosis of this disease is not the fact of the ongoing research, but their frequency.

The patient should be under constant monitoring, and the diagnosis is made on the basis of changes that are observed in the results of studies during the course of the disease.

Instrumental diagnostic methods (x-ray, computed tomography and others) are carried out to identify the degree of damage to internal organs.

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Effective treatment of the disease

When a disease is detected, the patient is strictly shown hospitalization as quickly as possible. Due to the fact that the disease is not transmitted from person to person, treatment of hemorrhagic fever with renal syndrome is carried out in infectious hospitals, in surgical, therapeutic.

Transportation of the patient in the late stages of development is carried out with extreme caution, fearing hemorrhage and rupture of the kidneys.

The patient needs compliance with bed rest, diet. During the patient’s stay in the hospital, preventive measures are taken to prevent complications.

Drug treatment for the disease includes the use of antibacterial drugs. To save energy, glucose solutions with insulin are prescribed.

Curantyl and aminophylline normalizes microcirculation. To relieve the symptoms of the disease, antipyretic and analgesic drugs are used.

Features of a therapeutic diet

For recovery, a strict diet is required. For patients with HFRS, diet No. 4 of 15 medical nutrition systems developed by the Soviet doctor M.I. is recommended. Pevzner.

You need to eat often and in small portions. Food should be of medium temperature. Fermentation products (cabbage, plum, sour cream, cheese) should be completely excluded from the diet.

Diet number 4 is aimed at limiting the amount of fats and carbohydrates. Hardly digestible foods that increase gastric secretion are also excluded from it.


  These include:

• Fatty varieties of fish and meat;
• Smoked meats;
• Pickles;
• Sausages;
• Sauces;
• Canned food;
• Bakery products;
• Dried fruits;
• Carbonated drinks;
• Sweets.

Dishes should not be sharp or spicy.

Allowed to eat low-fat boiled meat and fish, low-fat cottage cheese, wheat crackers. From cereals, you need oats, rice, buckwheat, semolina, jelly decoctions from these cereals are useful.

Raw fruits and vegetables are not allowed. Compote, jelly, jelly are prepared from fruits, vegetables are used in the form of mashed potatoes.

Help folk remedies

Effective treatment of the disease is impossible without medical assistance.

Self-medication of this disease leads to serious consequences and death. Before taking one or another folk remedy, you should consult your doctor.

Doctors advise taking various decoctions aimed at normalizing the work of the kidneys. In herbal medicine, many medicinal plants are known, the use of which has a diuretic and anti-inflammatory effect.

The most common decoctions used for HFRS disease:

1. 1 teaspoon of flax seeds and 200 ml of water must be brought to a boil. You need to drink a decoction of 100 ml every 2 hours.
2. 50 g of young birch leaves need to be insisted for 5 hours in 200 ml of warm water, take 100 ml 2 times a day.
3. Add 2 tablespoons of lingonberry leaves to 200 ml of hot water. Insist the broth in a water bath for half an hour, you need to take 100 ml 2 times a day.
4. Add 3 g of dry leaves of orthosiphon (kidney tea) to a glass of boiling water and boil for another 5 minutes. The broth is insisted for 4 hours and drink 100 ml before meals.

The most effective are collections from medicinal herbs; they are already in ready-made proportions in pharmacies.

In most of these collections bearberry leaves are used, they can be separately brewed as tea.

The composition of the fees with bearberry:

• Bearberry leaves, licorice root, cornflower inflorescences in proportions 3: 1: 1;
• Bearberry leaves, licorice root, juniper fruits in proportions of 2: 1: 2;
• Bearberry leaves, orthosiphon leaves, lingonberry leaves in proportions of 5: 3: 2.

A tablespoon of the collection is brewed in a glass of water. You need to take a decoction for half a glass 3 times a day. To normalize the work of the cardiovascular system, currant juice and a decoction of the roots of fragrant geranium are used.

Currant juice is taken in 100 ml 3 times a day. Geranium roots (about 4 pieces) are poured into 1 liter of water and boiled for 20 minutes. You need to drink this broth in a warm form every 20 minutes.

The use of folk remedies is also possible to relieve symptoms of the disease. To lower body temperature, take baths with cool water (about 30 degrees) and drink decoctions of raspberries, honeysuckle and wild strawberries.

Possible complications of the disease

It is proved that the most dangerous in terms of complications is the oligoanuric stage of the disease. The period runs from 6 to 14 days of illness.

The complications that hemorrhagic fever can cause are specific and not specific.

Various complications include:

• Infectious toxic shock;
• DIC-syndrome (disseminated vascular coagulation);
• Edema of the brain and lungs;
• Acute cardiovascular failure;
• Various hemorrhages (in the brain, adrenal glands and others) and bleeding;
• Kidney rupture.

Infectious toxic shock is characterized by acute circulatory failure. The patient's blood pressure drops, internal organs failure develops.

This complication of the disease is the most common cause of death in HFRS.

With DIC, there is a violation of normal blood circulation in the patient's body. This leads to the development of serious dystrophic changes.

Hypocoagulation develops - the patient's blood clotting ability decreases, thrombocytopenia - the platelet level in the blood decreases. The patient has bleeding.


  Among non-specific complications, there are diseases - pyelonephritis, purulent otitis media, abscesses, pneumonia. Complications of HFRS are dangerous and can often lead to death of the patient.

Patients who have had this disease develop a stable immunity to the virus. This statement is justified by the fact that there were no cases of reinfection in patients after HFRS.

Timely diagnosis of the disease is important, which will provide effective and qualified treatment.

Disease prevention

In order to prevent hemorrhagic fever with renal syndrome, you must follow the rules of personal hygiene.

You need to thoroughly wash your hands and consumed fruits and vegetables, do not leave food in the reach of rodents.

Use a gauze bandage to protect the respiratory tract from dust that can carry the infection.

The main measures for the general prevention of the disease is the destruction of the population of mouse rodents in the foci of HFRS.

It is necessary to ensure the improvement of the territories adjacent to residential buildings, crowded places, food warehouses and the like. The spread of weeds and thickets should not be allowed.

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