Hemorrhagic fever symptoms. Crimean-Congo hemorrhagic fever Crimean hemorrhagic fever symptoms in children

The content of the article

Historical data on hemorrhagic fever

Etiology of hemorrhagic fever

Epidemiology of hemorrhagic fever

Pathogenesis and pathomorphology of hemorrhagic fever

Clinic of hemorrhagic fever

Diagnosis of hemorrhagic fever

Specific diagnosis of hemorrhagic fever

Differential diagnosis of hemorrhagic fever

Treatment of hemorrhagic fever

Crimean hemorrhagic fever Crimean hemorrhagic fever (CCHF, Crimean-Congo fever, Central Asian fever) is a viral natural focal human disease, the causative agent of which, the Crimean-Congo hemorrhagic fever virus, belongs to the RNA-containing viruses of the family Bunyaviridae kind Nairovirus and transmitted by ticks. The southern regions of Russia are endemic for CHF: Astrakhan, Rostov, Volgograd regions, Stavropol and Krasnodar regions, the republics of Kalmykia, Dagestan, Ingushetia, the virus also circulates in southern Europe (Greece, Bulgaria, Romania, Yugoslavia), in Central Asia (Turkmenistan, Uzbekistan , Tajikistan), in the countries of the Middle East (Turkey, Iran, Iraq, UAE), China and on the African continent.

The disease is characterized by an acute onset, a two-wave rise in body temperature, severe intoxication and hemorrhagic syndrome. From the first days of the disease, hyperemia of the skin of the face, neck and upper body, a sharp injection of the vessels of the sclera and conjunctiva are noted. Already in the first two days, nosebleeds, bleeding gums may occur, and a petechial rash on the skin of the body is determined. The second period (peak, hemorrhagic) of the disease begins with a repeated rise in temperature, which remains at high numbers for 3-4 days, then gradually decreases. The duration of the second period is from 3 to 9 days. During this period, the vast majority of patients develop hemorrhagic syndrome - from petechiae on the skin to massive bleeding. Often there are hematomas at the injection sites. Simultaneously with the rash, other manifestations of hemorrhagic syndrome develop: nasal, gastrointestinal and uterine bleeding, hemoptysis, bloody discharge from the eyes and ears, hematuria. The duration of the bleeding period varies, but is usually 3-4 days. The intensity and duration of the hemorrhagic syndrome determine the severity of the disease and often correlate with the concentration of the virus in the blood. During this period, pneumonia may develop due to the occurrence of hemo-aspiration atelectasis.

Anemia, leukopenia with lymphocytosis and severe thrombocytopenia are observed in the blood. The greatest diagnostic value is leukopenia with a predominance of neutrophils. The number of leukocytes drops to 800–1000, which, combined with the appearance of young forms (myelocytes, myeloblasts), gives grounds for differentiating CCHF from blood diseases with hemorrhagic syndrome. The number of platelets also drops rapidly and sharply, sometimes to zero. A rare exception is cases of transition of leukopenia to moderate leukocytosis, ending in death.

When compared with other hemorrhagic fevers registered on the territory of the Russian Federation (Omsk hemorrhagic fever, HFRS), in addition to epidemiological features, CHF is distinguished by a pronounced hemorrhagic syndrome against the background of severe intoxication, as well as the absence of kidney damage with the development of acute renal failure.

Indications for examination

• Staying in an enzootic territory for CHF (field trips, fishing, etc.) for 14 days prior to the disease;
• tick bite or contact with it (removal, crushing, crawling);
• the occurrence of the disease during the epidemic season (April–September);
• belonging to professional risk groups (agricultural and veterinary workers, persons involved in slaughtering, in field work, individual livestock owners, medical workers);
• carrying out instrumental manipulations in patients with suspected CHF, taking and examining biological material;
• care of patients with suspected CHF.

Differential Diagnosis

• Acute infectious diseases (in the first period): influenza, sepsis, typhus and other rickettsiosis, meningococcemia;
• hemorrhagic fevers (Omsk, fever with renal syndrome), thrombocytopenic purpura (Werlhof's disease); hemorrhagic vasculitis (Schonlein-Genoch disease);
• malignant blood diseases.

Material for research

• Blood plasma - detection of virus RNA;
• blood serum - detection of hypertension and specific antibodies;
• whole blood - virus isolation.

Etiological laboratory diagnostics includes isolation of the virus, detection of RNA and AG of the virus; detection of specific antibodies IgM and IgG.

Comparative characteristics of laboratory diagnostic methods

Virus isolation can be performed in Vero cell culture or using susceptible laboratory animals. Due to the duration and complexity of the study, these methods are not used in routine practice.

In the first week of the disease, studies should be carried out to detect virus RNA (PCR method, diagnostic sensitivity 95–100%). RNA detection is used in combination with the determination of IgM antibodies in the early period of the disease and confirmation of the diagnosis with an increase in the titer of IgG antibodies in blood samples taken in dynamics (paired sera). Ab IgM appear on the 3-4th day of illness, Ab IgG - on the 7-10th day. Detection of antibodies is carried out mainly by ELISA.

Features of interpretation of laboratory research results

According to MU3.1.3.2488-09, the detection of RNA and/or AG of the Crimean-Congo hemorrhagic fever virus in the blood of a patient taken in the early stages of the disease (up to 5–7 days) indicates that the patient is infected and, together with the data epidemiological history and clinical picture, can be considered the basis for the diagnosis. If IgM antibodies are detected in a titer of 1:800 or more and IgG antibodies in any titer, the diagnosis of CHF is considered confirmed.

Crimean-Congo hemorrhagic fever is a severe infectious disease characterized by high fever, intoxication syndrome and the obligatory presence of hemorrhagic syndrome. With untimely diagnosis of this dangerous pathology, the patient may develop severe complications. The purpose of this article is to acquaint you with the features of the course and treatment of this disease. Knowing about the manifestations of this disease, you can try to prevent its complicated course and seek help from a specialist in a timely manner.

Crimean-Congo hemorrhagic fever (or Central Asian, Congo-Crimea) was first identified in a Crimean haymaker in 1945. And already in 1956, the same pathogen was discovered in the Congo, and it caused an outbreak among the inhabitants.

Pathogen and routes of infection

The hemorrhagic fever discussed in this article is provoked by infection with an arbovirus, which is carried by ticks. For the first time, the pathogen was isolated by the Soviet epidemiologist Chumakov M.P. The doctor described the characteristics of the virus as follows:

• the shell is represented by fat-containing compounds;
• spherical structure;
• after introduction into the body, it penetrates into the cytoplasm of cells;
• after drying, it remains viable for 2 years;
• when boiled, it dies immediately, at a temperature of 37 ° C - after 20 hours, at 40 ° C - after 2 hours;
• the cells of embryonic kidneys of monkeys, hamsters and pigs are the most sensitive to infection;
• in nature, the virus persists in wild animals, livestock, birds and rodents and thus spreads among ticks.

The fever-causing virus is found in areas with a warm climate and more often affects people who are associated with agriculture or come into contact with nature.

• A higher probability of infection with it is observed in those seasons when ticks are most active (summer, spring and early autumn, or from April to September).
• Outbreaks of this disease occur annually in the Crimean regions of Russia, Ukraine, Pakistan, Bulgaria, Slovakia, Serbia, Tajikistan and other southern states of the post-Soviet space.

More often the disease affects young men and is less often found among children (only in isolated cases) and women. In childhood, due to the age-related characteristics of immunity (in children it is still weak), the disease is extremely difficult.

The virus enters the bloodstream in the following way:

• after a tick bite;
• after crushing an infected tick (for example, after removing it from a pet or livestock);
• poor-quality sterilization of medical instruments (in rare cases).

The most likely infection with the Crimean-Congo hemorrhagic fever virus is by sucking ticks, which usually live in forest belts or steppes. However, one should also remember the fact that these insects can easily make their way to personal plots or buildings.

After entering the bloodstream, the virus multiplies and begins to act on the walls of blood vessels with its toxins. The erythrocytes affected by the pathogen seep into the tissues, which causes hemorrhages. Infection leads to intoxication of the body up to a state of shock and disturbances in the functioning of the nervous system. Repeated waves of pathogen entry into the blood cause not only hemorrhagic lesions, but also provoke the development of intravascular thrombosis, which eventually becomes a thrombohemorrhagic syndrome. Such pathological processes always lead to oppression of hematopoiesis.

The virus of this fever also affects the internal organs:

• accumulation of bloody masses in the cavity of the stomach and intestinal lumen;
• hemorrhages on the membranes of the brain against the background of their general redness;
• small hemorrhagic foci in the brain tissues, leading to cell destruction;
• hemorrhagic foci in the tissues of the lungs, kidneys and liver, disrupting the functioning of organs.

Experts note that a larger structural lesion of the organ leads to a more significant violation of its functions. In turn, the severity of these pathological processes affects the nature of the course of the disease and the possibilities of rehabilitation.

There are cases when this disease proceeds easily and is not accompanied by severe fever and thrombohemorrhagic disorders. However, the most characteristic is the acute onset and course of this disease.

The risk of acute Crimean-Congo hemorrhagic fever is increased among people suffering from other chronic infections. In addition, experts note that the risk of death from this disease increases with age.

Symptoms

The first symptoms of Crimean-Congo hemorrhagic fever occur on average 3-9 days after infection. With weak immunity, the incubation period can be reduced to 1 day, and sometimes the first signs of the disease appear only after 10-14 days.

• prehemorrhagic;
• hemorrhagic.

In most cases, the pre-hemorrhagic period begins acutely:

• an increase in temperature to significant levels (“two-humped fever” - the temperature stays at high numbers for a week, then drops to subfebrile and jumps up again);
• chills;
• general weakness;
• redness of the face;
• pain in the joints and muscles;
• tendency to (less than 60 beats per minute).

In more rare cases, the following symptoms join the above symptoms:

• local pain in the calf muscles;
• catarrhal manifestations in the form of a runny nose, sore throat and redness of the conjunctiva;
• nausea and vomiting not associated with food;
• pain in the abdomen and lower back;
• (up to fainting);
• irritability and aggressiveness.

Prehemorrhagic period lasts from 1 to 7 days. Usually, already from the 2nd day, the patient begins a hemorrhagic period, accompanied by a worsening of the general condition:

• puffiness and pallor of the face;
• cyanosis of the fingers and lips;
• the appearance of small hemorrhagic rashes on the body, conjunctiva and mucous membranes;
• bleeding gums;
• bruising after injections;
• accompanied by pain in the abdomen and causing blood in the vomit and feces;
• the likelihood of, (in women) bleeding and hemoptysis;
• an increase in the size of the liver;
• disturbances of consciousness;
• bradycardia changing to tachycardia (the pulse becomes thready);
• positive symptom of Pasternatsky with percussion of the lower back.

The fever is usually present for about 12 days. It is against its background that the following complications are likely to develop:

• septic conditions;

At the beginning of recovery, the patient's temperature returns to normal and any manifestations of bleeding or bleeding are eliminated. Full rehabilitation after an illness, manifested in the gradual regression of all symptoms, takes about 60 days. For a longer time, the patient feels episodes of dizziness, a tendency to low blood pressure and increased heart rate.

Diagnostics

The diagnosis is made on the basis of examination of the patient and analysis of the epidemiological situation in the region. The following laboratory tests may be prescribed to the patient:

• - to assess the functions of those often suffering from kidney disease and timely detection of the possible presence of blood and protein in the urine;
• - to assess the erythrocyte sedimentation rate and detect sharply increasing anemia, thrombopenia and severe leukocytosis (characteristic of this disease);
• - with hemorrhages in this organ, an increase in the level of transaminases, violations of the level of coagulation factors and fibrinogen are detected;
• scraping of mucosal cells to perform PCR - performed to isolate the pathogen virus.

To exclude erroneous diagnosis, Crimea-Congo hemorrhagic fever is differentiated from the following diseases:

• other types;

Treatment

If Crimean-Congo hemorrhagic fever is suspected, the patient is urgently hospitalized and immediately begins diagnosis and treatment. Only such an approach to therapy can prevent complications and improve the further prognosis of the disease.

Treatment of this type of hemorrhagic fever is always symptomatic:

• antipyretic (Nurofen, Ibufen, Nise, etc.) - to reduce the temperature;
• (immune serum solution: heterogeneous immunoglobulin, specific immunoglobulin isolated from the blood of previously ill or vaccinated persons) - to increase resistance to the pathogen and improve disease prognosis;
• hemostatic (Etamzilat or vitamin C in combination with a solution of aminocaproic acid, etc.) - such drugs for intravenous administration prevent platelets from sticking together (that is, the formation of blood clots) and prevent the development of bleeding;
• means for detoxification (solutions of glucose and sodium chloride, Polyglukin, Hemodez, Albumin) - are used to accelerate the removal of toxins from the blood and improve the rheological properties of blood;
• cardiac glycosides (Strophantin-G, Digoxin) - are used to prevent insufficient contractility of the heart muscle and eliminate congestion in organs (lungs, etc.);
• glucocorticosteroids (Hydrocortisone, Dexamethasone) - are used in severe cases of the disease, help to relieve pain.

If necessary, therapy can be supplemented with the introduction of vitamin preparations to maintain the liver and intravenous infusions of platelet and erythrocyte mass. Sometimes hemodialysis is recommended to eliminate the consequences of kidney tissue damage.

Patients with Crimean-Congo hemorrhagic fever are advised to follow a special diet, which involves the intake of semi-liquid food, low-fat broths, cereals cooked in water and pureed fruits. As the general condition improves, the diet is gradually expanded, introducing boiled meat, fish, sour-milk products and fruits into it.

Vaccination and prevention

The main way to prevent infection with the Crimean-Congo hemorrhagic fever virus is vaccination with the genetic material of the pathogen. After vaccination, a person develops protective antibodies. Such a measure is especially shown to the population of the southern territories and tourists who are going to visit these regions.

To prevent the spread of this viral infection, the epidemiological services constantly monitor tick habitats and carry out sanitary and educational work among the population. Residents and tourists of regions with a hot climate are recommended:

1. Regularly apply repellents to the body and clothing to repel ticks and inspect the skin (especially after visiting forests, plantings, steppe areas, working with livestock, etc.).
2. Wear clothing and hats that prevent ticks from sticking to the skin.
3. At the first signs of the disease, consult a doctor without postponing his call or visit to him for later.
4. If ticks infected with the virus are detected, it is imperative to decontaminate the dangerous area.
5. Do not use mite-infested pastures or mowed hay in hazardous areas.

Forecast

At the beginning of the treatment of hemorrhagic fever in the first three days, in most cases, it is possible to achieve good results with the introduction of a specific immunoglobulin. Such a measure several times increases the chance of a successful recovery.

The Office of Rospotrebnadzor for the Astrakhan region informs that favorable climatic conditions in the region contribute to the activation of insects, including ticks that are carriers of Crimean hemorrhagic fever (CHF) and Astrakhan rickettsial spotted fever (ARPL).

Combined natural foci of CHF, ARPL, West Nile fever (WNF) and other infections have been registered in the region.

As of July 06, 2018, 2,050 tick bite victims, including the carrier of KHF-524, turned to medical organizations in the Astrakhan region. Of all those who applied, 42.3% are children under the age of 14 years (867 people).

As of July 06, 2018, 6 cases of CHF disease were registered in the Astrakhan region: in Astrakhan - 1 case and in 4 districts of the region: Narimanovskiy - 1 case, Kharabalinsky - 2 cases, Krasnoyarsk - 1 case. and Privolzhsky - 1 cl. All patients were infected when removing ticks from cattle and small cattle and crushing them, without the use of personal protective equipment.

Crimean hemorrhagic fever is a viral natural focal disease with a transmissible mechanism of infection. Translated from the Latin "hemorrhage" means bleeding.

How can you get infected?

Infection of a person with CHF occurs mainly through the bite of a carrier, by crushing ticks taken from domestic animals, as well as by contact with the blood of patients with CHF (through skin lesions, microcracks, wounds), when ticks are introduced by animals (dogs, cats) or people - on clothes, with flowers, branches, etc. (infection of people who do not visit the forest), when rubbing the virus into the skin when crushing a tick or scratching the bite site.

What are the main signs of the disease?

The disease begins acutely, accompanied by chills, severe headache, a sharp rise in temperature to 38-39 degrees, nausea, and vomiting. Relieve muscle pain. The main manifestations of CHF are hemorrhages into the skin, bleeding from the gums, nose, ears, uterus, stomach and intestines, which, if not promptly sought medical help, can lead to death. The first symptoms of the disease begin, like many viral infections, with a sharp increase in temperature and severe intoxication, accompanied by headache and muscle pain.

Who is susceptible to infection?

All people are susceptible to infection with CHF, regardless of age and gender.

Persons whose activities are associated with being in the forest are most at risk - workers caring for farm animals and growing crops, exploration parties, builders of roads and railways, oil and gas pipelines, power lines, topographers, hunters, tourists. Citizens become infected in suburban forests, forest parks, garden plots.

How can you protect yourself from CHF?

CHF can be prevented by individual prevention.

Individual prevention includes the use of special protective suits (for organized contingents) or adapted clothing that should not allow ticks to crawl through the collar and cuffs. The shirt should have long sleeves, which are reinforced at the wrists with an elastic band. They tuck the shirt into trousers, the ends of the trousers into socks and boots. The head and neck are covered with a scarf.

To protect against ticks, repellents are used - repellents and insecticidal crayons, which treat open areas of the body and clothing.

Before using the drugs, you should read the instructions.

Each person, being in the natural focus of KHF during the season of insect activity, should periodically inspect his clothes and body on his own or with the help of other people, and remove the identified ticks. Inspection of children under the age of 14 should be carried out every 5 minutes, adolescents - every 10 minutes, adults - every 15 minutes.

Persons who have discovered a sucked tick should be under the supervision of medical network specialists for 2 weeks. Daily thermometry and timely access to a doctor at the first sign of illness will reduce the risk of severe forms of the disease and prevent the development of hemorrhagic syndrome, which is the main cause of death.

In everyday life, the population can influence the reduction in the number of ticks by actively participating in the cleaning of the territories of summer cottages from last year's grass, dead wood, debris, as well as the adjacent territory to the summer cottage. As a preventive measure, it is recommended to carry out anti-tick treatments of farm animals by contacting veterinarians for help. It is advisable not to allow grazing of farm animals on the territory of summer cottages, summer health facilities, school grounds, etc.

How to remove a tick?

If a tick is found, it must be removed as soon as possible. To do this, you can contact the medical institution at the place of residence (on weekends and holidays, to the emergency departments of the nearest hospitals and emergency room).

It should be removed very carefully so as not to cut off the proboscis, which is deeply and strongly strengthened for the entire period of suction.

When removing a tick, the following guidelines should be followed:

Grab the tick with tweezers or fingers wrapped in clean gauze (cellophane) as close as possible to its mouth apparatus and holding it strictly perpendicular to the bite surface, turn the body of the tick around the axis, remove it from the skin,

Disinfect the bite site with any means suitable for this purpose (70% alcohol, 5% iodine, cologne),

After removing the tick, wash your hands thoroughly with soap,

If a black dot remains (separation of the head or proboscis), treat with 5% iodine and leave until natural elimination.

The removed tick must be delivered for examination toThe removed tick must be placed in a tightly closed vial and delivered to laboratory of especially dangerous infections of the FBUZ "Center for Hygiene and Epidemiology in the Astrakhan Region" at the address: st. N. Ostrovsky, 138, tel. 33-64-66, Monday-Friday from 9 a.m. to 4 p.m. - for species definition.

It is very important to carry out anti-tick measures in a timely manner, because your health, and even life, depends on it.

Crimean-Congo hemorrhagic fever(Latin febris haemorrhagica crimiana, synonym: Crimean hemorrhagic fever, Crimean Congo hemorrhagic fever, Central Asian hemorrhagic fever) is an acute human infectious disease transmitted through tick bites, characterized by fever, severe intoxication and hemorrhages on the skin and internal organs. First identified in 1944 in the Crimea. The causative agent was identified in 1945. In 1956, a similar disease was identified in the Congo. Investigations of the virus have established its complete identity with the virus found in the Crimea.

What provokes / Causes of the Crimean hemorrhagic fever:

The causative agent of the Crimean hemorrhagic fever is a virus from the family Bunyaviridae, genus Nairovirus. Refers to arboviruses (Arboviridae). Opened in 1945 by M.P. Chumakov in the Crimea, when examining the blood of sick soldiers and settlers who fell ill during hay harvesting. In 1956, a virus similar in antigenic composition was isolated from the blood of a sick boy in the Congo. The causative agent is called the Congo virus. Virions are spherical, 92-96 nm in diameter, surrounded by a lipid-containing envelope. The most sensitive to the virus cultures are the kidney cells of the embryo of pigs, Syrian hamsters and monkeys. Poor stability in the environment. When boiled, the virus dies instantly, at 37 `C - after 20 hours, at 45 `C - after 2 hours. In the dried state, the virus remains viable for over 2 years. In the affected cells, it is localized mainly in the cytoplasm.

Natural reservoir of pathogen- rodents, large and small cattle, birds, wild species of mammals, as well as ticks themselves, capable of transmitting the virus to offspring through eggs, and being virus carriers for life. The source of the pathogen is a sick person or an infected animal. The virus is transmitted by a tick bite, or by medical procedures involving injections or blood sampling. The main carriers are ticks Hyalomma marginatus, Dermacentor marginatus, Ixodes ricinus. Outbreaks of the disease in Russia occur annually in the Krasnodar and Stavropol Territories, Astrakhan, Volgograd and Rostov regions, in the republics of Dagestan, Kalmykia and Karachay-Cherkessia. The disease also occurs in the south of Ukraine and in the Crimea, Central Asia, China, Bulgaria, Yugoslavia, Pakistan, Central, East and South Africa (Congo, Kenya, Uganda, Nigeria, etc.). In 80% of cases, people aged 20 to 60 get sick.

Pathogenesis (what happens?) during the Crimean hemorrhagic fever:

At the core pathogenesis of hemorrhagic Crimean fever is an increase in the permeability of the vascular wall. Increasing viremia causes the development of severe toxicosis, up to infectious-toxic shock with disseminated intravascular coagulation, hematopoiesis suppression, which exacerbates the manifestations of hemorrhagic syndrome.

The gate of infection is the skin at the site of a tick bite or minor injuries upon contact with the blood of sick people (with nosocomial infection). There are no pronounced changes at the site of the infection gate. The virus enters the blood and accumulates in the cells of the reticuloendothelial system. With a secondary more massive viremia, signs of general intoxication appear, damage to the vascular endothelium, and thrombohemorrhagic syndrome of varying severity develops. Pathological changes are characterized by multiple hemorrhages in the mucous membranes of the stomach and intestines, the presence of blood in the lumen, but there are no inflammatory changes. The brain and its membranes are hyperemic, they show hemorrhages with a diameter of 1-1.5 cm with the destruction of the medulla. Throughout the substance of the brain, small hemorrhages are detected. Hemorrhages are also observed in the lungs, kidneys, etc. Many questions of the pathogenesis of Crimean-Congo fever remain unexplored.

An autopsy reveals multiple hemorrhages in the mucous membranes of the gastrointestinal tract, blood in its lumen, but there are no inflammatory changes. The brain and its membranes are hyperemic, they show hemorrhages with a diameter of 1-1.5 cm with the destruction of the medulla. Throughout the substance of the brain, small hemorrhages are detected. Hemorrhages are also observed in the lungs, kidneys, liver, etc.

Symptoms of the Crimean hemorrhagic fever:

Incubation period from one to 14 days. More often 3-5 days. There is no prodrome. The disease develops rapidly.

In the initial (pre-hemorrhagic) period only signs of general intoxication characteristic of many infectious diseases are noted. The initial period lasts more often than 3-4 days (from 1 to 7 days). During this period, against the background of high fever, weakness, weakness, headache, aches all over the body, severe headache, pain in muscles and joints are noted.

More rare manifestations of the initial period include dizziness, impaired consciousness, severe pain in the calf muscles, signs of inflammation of the upper respiratory tract. Only in some patients, even before the development of the hemorrhagic period, characteristic for this disease appear
symptoms - repeated vomiting, not associated with eating, lower back pain, abdominal pain, mainly in the epigastric region.

A constant symptom is fever, which lasts an average of 7-8 days, the temperature curve is especially typical for the Crimean hemorrhagic fever. In particular, when a hemorrhagic syndrome appears, a decrease in body temperature to subfebrile is noted, after 1-2 days the body temperature rises again, which causes a "two-humped" temperature curve characteristic of this disease.

Hemorrhagic period corresponds to the peak of the disease. The severity of thrombohemorrhagic syndrome determines the severity and outcome of the disease. In most patients, on the 2-4th day of illness (less often on the 5-7th day), a hemorrhagic rash appears on the skin and mucous membranes, hematomas at the injection sites, there may be bleeding (gastric, intestinal, etc.). The patient's condition deteriorates sharply. Hyperemia of the face is replaced by pallor, the face becomes puffy, cyanosis of the lips, acrocyanosis appear. The rash on the skin is initially petechial, at this time an enanthema appears on the mucous membranes of the oropharynx, there may be larger hemorrhages in the skin. Possible nasal, uterine bleeding, hemoptysis, bleeding gums, tongue, conjunctiva. The appearance of massive gastric and intestinal bleeding is unfavorable prognostically. The condition of patients becomes even more severe, disturbances of consciousness are noted. Characterized by abdominal pain, vomiting, diarrhea; the liver is enlarged, painful on palpation, Pasternatsky's symptom is positive. Bradycardia is replaced by tachycardia, blood pressure is reduced. Some patients have oliguria, residual nitrogen increases. In the peripheral blood - leukopenia, hypochromic anemia, thrombocytopenia, ESR without significant changes. The fever lasts 10-12 days. Normalization of body temperature and cessation of bleeding characterizes the transition to a period of recovery. Asthenization persists for a long time (up to 1-2 months). Some patients may have mild forms of the disease that occur without a pronounced thrombohemorrhagic syndrome, but they, as a rule, remain undetected.

Sepsis, pulmonary edema, focal pneumonia, acute renal failure, otitis media, thrombophlebitis can be observed as complications. Mortality ranges from 2 to 50%.

Diagnostics of the Crimean hemorrhagic fever:

Diagnostics of the Crimean hemorrhagic fever based on the clinical picture, epidemiological history data (stay in the area of ​​natural foci, tick attack, contact with patients with Crimean hemorrhagic fever), laboratory results. In the blood there is a reduced number of erythrocytes, leukopenia (up to 1x109-2x109/l), neutropenia, thrombocytopenia. To confirm the diagnosis, isolation of the virus from the patient's blood is used, from the 6th-10th day of illness, an increase in antibody titer is determined in repeated samples of the patient's blood serum in the CSC, diffuse precipitation reactions in agar, passive hemagglutination reactions.

Differential diagnosis is carried out with other viral diseases that manifest hemorrhagic syndrome, especially if the patient in the last days before the development of clinical manifestations of the disease was in countries with a tropical and subtropical climate, with leptospirosis, hemorrhagic fever with renal syndrome, hemorrhagic vasculitis, sepsis, etc.

Treatment of Crimean hemorrhagic fever:

Patients must be isolated in the infectious diseases department of the hospital. Treatment is symptomatic and etiotropic. Prescribe anti-inflammatory drugs, diuretics. Exclude the use of drugs that increase kidney damage, for example, sulfonamides. Antiviral drugs (ribavirin, reaferon) are also prescribed. In the first 3 days, a heterogeneous specific equine immunoglobulin, immune serum, plasma or specific immunoglobulin obtained from the blood serum of recovered or vaccinated individuals is administered. Specific immunoglobulin is used for emergency prophylaxis in persons in contact with the patient's blood.

Prevention of Crimean hemorrhagic fever:

To prevent infection, the main efforts are directed to the fight against the carrier of the disease. Conduct disinfestation of premises for keeping livestock, prevent grazing on pastures located on the territory of the natural focus. Individuals should wear protective clothing. Treat clothes, sleeping bags and tents with insect repellent. In case of tick bites in the habitat, immediately contact a medical facility for help. For persons who are going to enter the territory of the South of Russia, preventive vaccination is recommended. In medical institutions, one should take into account the high contagiousness of the virus, as well as its high concentration in the blood of patients. Therefore, patients must be placed in a separate box, and service should be trusted only by specially trained personnel.

Which doctors should you contact if you have Crimean hemorrhagic fever:

Are you worried about something? Do you want to know more detailed information about the Crimean hemorrhagic fever, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can book an appointment with a doctor– clinic Eurolaboratory always at your service! The best doctors will examine you, study the external signs and help identify the disease by symptoms, advise you and provide the necessary assistance and make a diagnosis. you also can call a doctor at home. Clinic Eurolaboratory open for you around the clock.

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