Kgl clinic diagnostics treatment prevention. Crimean-Congo hemorrhagic fever. Symptoms of the virus at different stages

The disease was described by M.P. Chumakov in 1945-1947, who discovered its pathogen. In the period since 1945, cases of the disease were detected, in addition to the Crimea, in the Krasnodar and Stavropol Territories, Rostov and Volgograd Regions, Central Asia, a number of countries in Eastern Europe, Africa and Asia. A related virus was isolated in 1967-1969. in Congo, however, it rarely causes disease in humans, and it is not accompanied by hemorrhagic syndrome. Serological and virological studies have shown that natural foci exist for a long time, in which the virus circulates constantly, but clinically expressed cases of CHF are not recorded.

The virus enters the bloodstream - capillary toxicosis and DIC develops. The virus damages the walls of blood vessels. Blood supply to organs and metabolism are disrupted. At autopsy - hemorrhages of the mucous membrane of the stomach, intestines, skin, lungs (possibly pneumonia), serous-hemorrhagic impregnation of all organs and tissues.

Epidemiology of Crimean Hemorrhagic Fever (Crimean-Congo Hemorrhagic Fever)

Natural foci are formed in steppe, forest-steppe and semi-desert areas with a warm climate and developed cattle breeding. The reservoir of the virus is ixodid ticks of the genus Hualomma, as well as wild and domestic animals that feed the ticks. A person becomes infected through a tick bite. In laboratories, cases of airborne contamination have been reported. When infected from sick, the disease is more severe. The susceptibility to CHF is high. Repeated cases are not described.

Sources of infection: insectivores, wood mouse, hare, hedgehogs, small gopher.

Transmission routes: transmissive, through ixodid ticks.

Causes of Crimean Hemorrhagic Fever (Crimean-Congo Hemorrhagic Fever)

The causative agent is the arbovirus "Congo Virus".

The causative agent of CHF belongs to the genus Nairovirus of the Bunyavirus family, contains RNA, is resistant to freezing and drying. It is thermolabile, sensitive to chlorine-containing disinfectants.

From the site of the bite, the virus spreads hematogenously and is fixed by the cells of the endothelium of blood vessels, liver and kidneys, where it replicates, which is accompanied by cell damage and the development of generalized vasculitis. The vessels of the microvasculature suffer the most. The virus also multiplies in the epithelial cells of the liver and kidneys, causing damage.

Pathomorphology and causes of death. The stomach, small intestine, and large intestine contain liquid blood. In the liver, hemorrhages, dystrophy and necrosis of hepatocytes are detected; in the kidneys - dystrophy and necrosis of the tubular epithelium; in all organs - hemorrhages, microcirculation disorders. The walls of the vessels are edematous, the endothelial cells are swollen. There are dystrophic changes and foci of necrosis. The main cause of death is massive bleeding. Death can also occur as a result of ITSH, pulmonary edema, secondary bacterial complications.

Symptoms and signs of Crimean hemorrhagic fever (Crimean-Congo hemorrhagic fever)

There are three periods:

  • pre hemorrhagic;
  • hemorrhagic;
  • convalescent.

Pre-hemorrhagic (prodromal period) - 1-9 days.

The hemorrhagic period is 3-6 days, the temperature drops and rises again, the fever is up to 12 days. There may be a symmetrical localization of the rash. Bradycardia appears, blood pressure decreases. Lethargy, drowsiness increases, vomiting increases, and there may be loss of consciousness. Tachycardia. The abdomen is swollen, painful, the liver is enlarged, yellowness. Positive Pasternatsky's symptom, focal pneumonia, symptoms of meningo-encephalitis and collapse (lethargy).

The period of convalescence is a normal temperature, cessation of bleeding, blood pressure decreases for a long time, like asthenia.

The disease is cyclical. Depending on the presence of hemorrhagic syndrome and its severity, CHL is isolated without hemorrhagic syndrome and CHF with hemorrhagic syndrome. CHF without hemorrhagic syndrome can occur in mild to moderate forms. In mild cases of CHF with hemorrhagic syndrome, hemorrhages appear on the skin and mucous membranes. No bleeding. With a moderate form, in addition to hemorrhages, minor bleeding is noted. Most often, there is a severe course of the disease with profuse repeated bleeding.

Heart sounds are muffled. Reveal arterial hypotension and relative bradycardia, liver enlargement. This period is characterized by pallor of the skin, subicteric sclera, n cyanosis, tachycardia, severe arterial hypotension up to collapse. Lethargy, disturbances of consciousness, convulsions, meningeal syndrome are possible. The total duration of the fever is about 7 to 8 days. After a lytic decrease in body temperature, the condition of patients begins to slowly improve. The recovery period lasts 1-2 months or more.

A blood test reveals severe leukopenia up to 1.0x109 / l, thrombocytopenia, often azotemia, metabolic acidosis. The density of urine is reduced.

Diagnostics of the Crimean hemorrhagic fever (hemorrhagic fever Crimea-Congo)

Diagnostics is carried out on the basis of:

  • passport data (where he lives, profession);
  • complaints;
  • epidemiological anamnesis (contact with animals, tick bites);
  • clinical data;
  • biochemical blood tests;
  • coagulogram studies;
  • specific tests: operational test - detection of the RNA virus by PCR;
  • determination of JgM and JgG antibodies to CHF virus by ELISA; RSK, RIGA, RIA.

Differential diagnosis is carried out with leptospirosis, tick-borne encephalitis, tularemia, influenza, typhoid fever, meningococcal infection.

The diagnosis is established on the basis of epidemiological (tick bite, contact with a patient) and clinical (intoxication, leuko- and thrombocytopenia) data; PCR, ELISA, RIF are used to confirm the diagnosis.

Complications of Crimean hemorrhagic fever (Crimean-Congo hemorrhagic fever)

  • internal bleeding;
  • renal hepatic impairment;
  • pulmonary edema;
  • pleurisy;
  • peritonitis;
  • otitis;
  • mumps;
  • sepsis;
  • infiltrates;
  • abscesses;
  • massive stomach bleeding. Death is possible.

Treatment and prevention of Crimean hemorrhagic fever (Crimean-Congo hemorrhagic fever)

Patients are subject to emergency hospitalization. In the early stages of the disease, ribavirin is effective.

With significant blood loss, transfusion of blood, erythrocyte mass, blood substitutes, as well as platelet mass is indicated.

Forecast... With transmissible infection, the lethality is up to 25%, with infection from patients it reaches 50% or more.

Prophylaxis... The main directions are protection against tick bites and prevention of infection from sick people. Patients are subject to strict isolation. When caring for them, it is necessary to work in rubber gloves, a respirator or gauze mask, and goggles. Use only disposable needles, syringes, transfusion systems. Discharge of patients is disinfected.

Crimea-Congo hemorrhagic fever is an infectious disease with a severe course, characterized by high fever, intoxication syndrome and the obligatory presence of hemorrhagic syndrome. If this dangerous pathology is not diagnosed in time, the patient may develop severe complications. The purpose of this article is to acquaint you with the peculiarities of the course and treatment of this ailment. Knowing about the manifestations of this disease, you can try to prevent its complicated course and promptly seek help from a specialist.

Hemorrhagic fever Crimea-Congo (or Central Asian, Congo-Crimea) was first diagnosed in a Crimean worker engaged in haymaking in 1945. And already in 1956, the same causative agent of the disease was discovered in the Congo, and it caused an outbreak of the disease among the inhabitants.

Pathogen and ways of infection

The causative agent of hemorrhagic fever is arbovirus, which enters the human body through a tick bite.

The hemorrhagic fever discussed in this article is triggered by infection with a tick-borne arbovirus. 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 being introduced into the body, it enters 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 most sensitive to infection are cells of embryonic kidneys of monkeys, hamsters and pigs;
  • in nature, the virus persists in the body of wild animals, livestock, birds and rodents and thus spreads among ticks.

The fever-provoking virus is found in areas with warm climates and more often affects people who are associated with agriculture or in 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 as follows:

  • 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).

Infection with the Crimean-Congo hemorrhagic fever virus is most likely due to the suction of ticks, which usually live in forest belts or steppes. However, it should be remembered that these insects can easily make their way to personal plots or buildings.

After entering the bloodstream, the virus multiplies and begins to affect the walls of blood vessels with its toxins. The erythrocytes affected by the pathogen seep into the tissue, 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 the pathogen entering the blood cause not only hemorrhagic lesions, but also provoke the development of intravascular thrombosis, which eventually takes on the character of 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 stomach cavity and intestinal lumen;
  • hemorrhages on the membranes of the brain against the background of their general redness;
  • small hemorrhagic foci in the tissues of the brain, leading to the destruction of cells;
  • hemorrhagic foci in the tissues of the lungs, kidneys and liver, disrupting the functioning of organs.

Experts note that a larger-scale structural damage to an organ leads to a more significant disruption 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


A characteristic sign of the disease is a hemorrhagic rash on the skin and mucous membranes.

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 indicators ("two-humped fever" - the temperature remains at high numbers for a week, then drops to subfebrile and again jumps up);
  • chills;
  • general weakness;
  • redness of the face;
  • joint and muscle pain;
  • tendency to (less than 60 beats per minute).

In more rare cases, the following symptoms are added to 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;
  • non-food nausea and vomiting;
  • pain in the abdomen and lower back;
  • (up to fainting);
  • irritability and aggressiveness.

The pre-hemorrhagic period lasts from 1 to 7 days. Usually, from the 2nd day, the patient begins a hemorrhagic period, accompanied by an aggravation 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 abdominal pain and causing the appearance of 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 alternating with tachycardia (the pulse becomes threadlike);
  • positive symptom of Pasternatsky with lumbar percussion.

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 is normalized and any manifestations of bleeding or bleeding are eliminated. Complete rehabilitation after an illness, which manifests itself in a 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 patient may be assigned the following laboratory tests:

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

To exclude an erroneous diagnosis, differentiation of Crimean-Congo hemorrhagic fever with the following diseases is performed:

  • other types;

Treatment


Symptomatic treatment - aimed at eliminating the symptoms that occur in a particular patient.

If a hemorrhagic fever of Crimea-Congo is suspected, the patient is urgently hospitalized and immediately diagnosed and treated. Only this approach to therapy can prevent complications and improve the further prognosis of the disease.

Treatment for this type of hemorrhagic fever is always symptomatic:

  • antipyretic (Nurofen, Ibufen, Nise, etc.) - to lower the temperature;
  • (solution of immune serum: heterogeneous immunoglobulin, specific immunoglobulin, isolated from the blood of previously ill or vaccinated persons) - to increase resistance to the pathogen and improve the prognosis of the disease;
  • hemostatic (Etamsylate or vitamin C in combination with a solution of aminocaproic acid, etc.) - such drugs for intravenous administration prevent platelet adhesion (that is, the formation of blood clots) and prevent the development of bleeding;
  • detoxification agents (solutions of glucose and sodium chloride, Polyglukin, Gemodez, Albumin) - are used to accelerate the elimination of toxins from the blood and improve the rheological properties of blood;
  • cardiac glycosides (Strofantin-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 relieve pain.

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

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

Vaccination and prevention

The main method for the prevention of infection with the Crimean-Congo hemorrhagic fever virus is vaccination with the pathogen's genetic material. After being vaccinated, 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, epidemiological services are constantly monitoring the foci of ticks and carry out sanitary and educational work among the population. Residents and tourists from regions with hot climates are advised to:

  1. Regularly apply repellents to the body and clothing to repel ticks and inspect the skin (especially after visiting forests, planting, steppe areas, working with livestock, etc.).
  2. Wear clothing and hats that prevent mites from adhering 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 a virus are detected, it is imperative to decontaminate the dangerous area.
  5. Do not use mite-infested pastures or hay mowed in hazardous areas.


Forecast

When starting treatment for 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 increases the chance of a successful recovery several times.

Crimean hemorrhagic fever Crimean hemorrhagic fever (CHF, 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 is 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 half of the body, a sharp injection of the vessels of the sclera and conjunctiva are noted. Already in the first two days, nosebleeds, bleeding of the gums may occur, and a small-point petechial rash on the skin of the trunk is determined. The second period (peak, hemorrhagic) of the disease begins with a repeated rise in temperature, which is kept 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. Hematomas at injection sites are common. 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, the development of pneumonia due to the occurrence of hemo-aspiration atelectasis is possible.

In the blood, anemia, leukopenia with lymphocytosis and severe thrombocytopenia are observed. The greatest diagnostic value is leukopenia with a predominance of neutrophils. The number of leukocytes drops to 800–1000, which, in combination with the appearance of young forms (myelocytes, myeloblasts), gives rise to the differentiation of CHF from blood diseases with hemorrhagic syndrome. The platelet count also drops rapidly and sharply, sometimes to zero. A rare exception are cases of transition of leukopenia to moderate leukocytosis, ending in a lethal outcome.

When compared with other hemorrhagic fevers recorded 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 a background of severe intoxication, as well as the absence of kidney damage with the development of acute renal failure.

Indications for examination

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

Differential diagnosis

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

Research material

  • Blood plasma - detection of RNA virus;
  • 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; identification of specific IgM and IgG antibodies.

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 laboriousness 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 the RNA of the virus (PCR method, diagnostic sensitivity 95-100%). RNA detection is used in combination with the determination of IgM AT in the early period of the disease and confirmation of the diagnosis with an increase in the IgG AT titer in blood samples taken over time (paired sera). IgM antibodies appear on the 3-4th day of illness, IgG antibodies - on the 7-10th day. The detection of antibodies is performed mainly by the ELISA method.

Features of the interpretation of laboratory test results

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

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

What provokes / Causes of Crimean hemorrhagic fever:

The causative agent of the Crimean hemorrhagic fever is a virus from the Bunyaviridae family, genus Nairovirus. Refers to arboviruses (Arboviridae). Discovered in 1945 by M.P. Chumakov in the Crimea, when examining the blood of sick soldiers and migrants who fell ill during hay harvesting. In 1956, a virus similar in antigenic composition was isolated from the blood of a sick boy in 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 are cultures of kidney cells of the embryo of pigs, Syrian hamsters and monkeys. Poorly stable 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 the pathogen- rodents, cattle and small ruminants, birds, wild species of mammals, as well as the ticks themselves, capable of transmitting the virus to their 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 tick bites or medical procedures involving injections or blood sampling. The main vectors are mites Hyalomma marginatus, Dermacentor marginatus, Ixodes ricinus. Outbreaks of the disease on the territory of Russia occur annually in the Krasnodar and Stavropol Territories, the Astrakhan, Volgograd and Rostov Regions, in the republics of Dagestan, Kalmykia and Karachay-Cherkessia. The disease also occurs in southern Ukraine and Crimea, Central Asia, China, Bulgaria, Yugoslavia, Pakistan, Central, East and South Africa (Congo, Kenya, Uganda, Nigeria, etc.). In 80% of cases, people between the ages of 20 and 60 get sick.

Pathogenesis (what happens?) During Crimean hemorrhagic fever:

At the heart of pathogenesis of hemorrhagic Crimean fever there is an increase in the permeability of the vascular wall. The increasing viremia causes the development of severe toxicosis, up to infectious-toxic shock with disseminated intravascular coagulation, inhibition of hematopoiesis, which aggravates the manifestations of hemorrhagic syndrome.

The gateway of infection is the skin at the site of a tick bite or minor injuries in contact with the blood of sick people (with nosocomial infection). At the site of the gate of infection, no pronounced changes are observed. The virus enters the bloodstream and accumulates in the cells of the reticuloendothelial system. With 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, hemorrhages with a diameter of 1-1.5 cm with destruction of the medulla are found in them. Small hemorrhages are detected throughout the brain matter. Hemorrhages are also observed in the lungs, kidneys, etc. Many questions of the pathogenesis of Crimean-Congo fever remain unexplored.

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, hemorrhages with a diameter of 1-1.5 cm with destruction of the medulla are found in them. Small hemorrhages are detected throughout the brain matter. Hemorrhages are also observed in the lungs, kidneys, liver, etc.

Symptoms of Crimean Hemorrhagic Fever:

Incubation period from one to 14 days. Most often 3-5 days. There is no prodromal period. The disease develops sharply.

In the initial (pre-hemorrhagic) period there are only signs of general intoxication, characteristic of many infectious diseases. The initial period usually lasts 3-4 days (from 1 to 7 days). During this period, against the background of high fever, weakness, fatigue, headache, aches throughout 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 of this disease appear
symptoms - repeated vomiting, not associated with food intake, 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, with the appearance of hemorrhagic syndrome, a decrease in body temperature to subfebrile is noted, after 1-2 days the body temperature rises again, which determines the "two-humped" temperature curve characteristic of this disease.

Hemorrhagic period corresponds to the height of the disease. The severity of the 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 (stomach, intestinal, etc.). The patient's condition deteriorates sharply. Facial hyperemia 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 the enanthema appears on the mucous membranes of the oropharynx, there may be larger hemorrhages in the skin. Possible nasal, uterine bleeding, hemoptysis, bleeding of the gums, tongue, conjunctiva. The appearance of massive gastric and intestinal bleeding is prognostically unfavorable. The condition of the patients becomes even more difficult, 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 builds up. In peripheral blood - leukopenia, hypochromic anemia, thrombocytopenia, ESR without significant changes. The fever lasts 10-12 days. The normalization of body temperature and the cessation of bleeding characterizes the transition to the recovery period. Asthenization persists for a long time (up to 1-2 months). Some patients may have mild forms of the disease, occurring without pronounced thrombohemorrhagic syndrome, but they, as a rule, remain undetected.

As complications, sepsis, pulmonary edema, focal pneumonia, acute renal failure, otitis media, thrombophlebitis can be observed. 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 zone of natural foci, attack of ticks, contact with patients with Crimean hemorrhagic fever), the results of laboratory tests. In the blood, there is a reduced number of erythrocytes, leukopenia (up to 1x109-2x109 / l), neutropenia, thrombocytopenia. To confirm the diagnosis, the isolation of the virus from the patient's blood is used, from the 6-10th day of the disease, an increase in the titer of antibodies in repeated samples of the patient's blood serum in the CSC, the reaction of diffuse precipitation in agar, the reaction of passive hemagglutination is determined.

Differential diagnosis is carried out with other viral diseases manifested by 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. Eliminate the use of drugs that increase kidney damage, for example, sulfonamides. Antiviral drugs (ribavirin, reaferon) are also prescribed. In the first 3 days, heterogeneous specific equine immunoglobulin, immune serum, plasma or specific immunoglobulin obtained from the blood serum of recovered or vaccinated persons are injected. Specific immunoglobulin is used for emergency prophylaxis in persons who come into contact with the patient's blood.

Prevention of Crimean hemorrhagic fever:

To prevent infection, the main focus is on vector control. They carry out disinfestation of premises for keeping livestock, prevent grazing on pastures located on the territory of the natural hearth. Individuals should wear protective clothing on an individual basis. Treat clothing, sleeping bags, and tents with repellents. In case of tick bites in the habitat, immediately contact a medical institution for help. For persons who are going to enter the territory of the South of Russia, preventive vaccination is recommended. In hospitals, it is necessary to take into account the high contagiousness of the virus, as well as its high concentration in the blood of patients. Therefore, patients should be placed in a separate box, and service should be trusted only by specially trained personnel.

Which doctors should be consulted if you have Crimean hemorrhagic fever:

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Crimean hemorrhagic fever is a viral disease characterized by impaired blood circulation and the development of multiple bleeding. Infection occurs from a tick bite. The disease develops rapidly. Without timely assistance, the likelihood of death is high.

general information

Crimean hemorrhagic fever is a natural focal disease of a viral nature, the source of which is ticks. This pathology is characterized by an acute onset with two-humped waves of fever, which is necessarily accompanied by headaches and muscle pains, multiple bleeding. The mortality rate is 10-40%. Treatment includes detoxification, the use of antiviral and hemostatic drugs, and the introduction of specific immunoglobulin.

A bit of history

The first cases of the disease were recorded in the steppe regions of the Crimean region in 1944. The patients were soldiers and displaced persons engaged in haymaking and harvesting.

Later, M.P. Chumakov began to study the virus. He studied the clinic and epidemiology of the disease.

In 1956, a virus of a similar antigenic nature was found in the blood of an infected boy in Congo. The causative agent was later officially named the Congo virus.

In the medical literature today, you can find several variations of the name of the Crimean hemorrhagic fever (CHF, Central Asian fever, Crimea-Congo disease, etc.).

The reasons for the development of the disease

Human infection is possible in several ways:

  • Most often, the virus enters the body through a transmissible route, that is, through a tick bite. The latter, in turn, become infected when fed on cattle.
  • After consuming raw milk from a sick animal, it is also possible to develop such an ailment as Crimean hemorrhagic fever. Symptoms in this case begin to appear within a few hours.
  • Another infection option is contact. When mites are crushed, their particles can enter the human body through micro-cuts and wounds on the skin.

This disease is exclusively professional in nature. People involved in agriculture (shepherds, milkmaids, livestock breeders), medical workers, and veterinarians are more susceptible to infection.

Crimean hemorrhagic fever is seasonal. Outbreaks are recorded between May and August. In 80% of cases, the diagnosis is confirmed in people between the ages of 20 and approximately 60 years.

CHF pathogenesis

How does Crimean hemorrhagic fever develop? The symptoms of this disease are described later in this article, first you need to consider the mechanism of its origin.

The virus enters the human body through the skin when bitten by an infected tick. At the site of the "entrance gate", pronounced changes are usually not observed. The virus enters the bloodstream and gradually accumulates in the cells of the so-called reticuloendothelial system. In the case of secondary viremia, symptoms of general intoxication occur, and thrombohemorrhagic syndrome develops.

As for the pathological changes, they are characterized by the presence of blood in the lumen of the stomach and intestines, multiple bleeding on the mucous membranes of these organs, but there are no inflammatory processes. The brain is hyperemic. On closer examination, punctate hemorrhages with destruction of the medulla are usually visible.

Currently, many questions of the pathogenesis of the disease remain unexplored.

What symptoms indicate pathology?

The incubation period can last from 1 to 14 days. The first signs of Crimean hemorrhagic fever appear suddenly. The disease begins with a temperature rise of up to 40 degrees.

In the pre-hemorrhagic period, patients have symptoms of general intoxication of the body, which are characteristic of many ailments of an infectious nature. Against the background of severe fever, patients develop weakness and aches throughout the body. More rare manifestations of the initial stage of CHF include discomfort in the calf muscles, signs of inflammation in the upper respiratory tract, impaired consciousness and dizziness.

Some infected people, before the onset of the development of the hemorrhagic period, develop symptoms characteristic of this pathology (vomiting, pain in the lower back and abdomen). Fever is considered a constant sign of the disease, which usually lasts 7-8 days. For CHL, a decrease in temperature to subfebrile values ​​is typical. After two days, this figure increases again. This causes the characteristic “two-humped” temperature curve for the disease.

The so-called hemorrhagic period can be compared with the height of pathology. Its severity determines the severity of the disease. In many patients, on the second day after infection, a characteristic rash appears on the skin and mucous membranes, bleeding of internal organs, hematomas at the injection sites.

The patient's condition is rapidly deteriorating. The clinical picture takes on new variations. So, hyperemia on the face is quickly replaced by pallor, the lips turn blue, the head becomes puffy. Nasal, intestinal and uterine bleeding is possible. Some have impaired consciousness. Patients complain of severe pain in the abdominal area, diarrhea, low blood pressure.

Fever usually lasts no more than 12 days. Normalization of temperature and cessation of bleeding is a clear sign of recovery.

Forms of the disease

  1. True Crimean hemorrhagic fever. With this form of pathology, a characteristic clinical picture is observed with rashes on the skin, bleeding of varying degrees of intensity.
  2. Sometimes doctors diagnose a disease without hemorrhagic syndrome. In this case, there is no second wave of temperature rise and bleeding.

Diagnostic measures

Diagnostics of the Crimean hemorrhagic fever includes:

  • Analysis of anamnesis from an epidemiological point of view (establishing the fact of a tick bite).
  • Evaluation of patient complaints (detection of tick bites on the skin, fever for no apparent reason, hemorrhagic rash, multiple bleeding).
  • Virological diagnostics (the doctor isolates a virus from the patient's saliva, and then introduces it into the body of laboratory animals for the purpose of follow-up).
  • Serological examination (determination of the amount of antibodies in the blood of an infected person to the pathogen).
  • Consultation with an infectious disease specialist.

It is important to differentiate the disease with hemorrhagic fevers of a different etiology, influenza, typhus and other pathologies.

Based on the results of a comprehensive examination of the patient, the doctor can confirm the diagnosis of Crimean hemorrhagic fever. Photos of patients with such a diagnosis are presented in the materials of this article.

Necessary treatment

All patients are subject to immediate hospitalization. In some cases, antiviral drugs are prescribed ("Reaferon", "Ribavirin"). However, most often, therapy is limited to reducing the manifestation of symptoms.

Patients are advised to strictly adhere to bed rest and avoid physical activity. Diet is an important part of therapy. Food should be easily digestible, preference should be given to simple soups, cereals.

Patients are prescribed the introduction of immune plasma and transfusion of donor platelets. The latter is necessary to normalize the function of natural blood coagulation. In the case of severe intoxication of the body and dehydration, vitamin therapy, the introduction of saline solutions are indicated. To lower the temperature, antipyretics are prescribed. If CHF is accompanied by a bacterial infection, broad-spectrum antibiotics are recommended.

Complications and consequences

What complications can the Crimean hemorrhagic fever lead to? Treatment of this disease should be prescribed in a timely manner, otherwise the likelihood of severe gastrointestinal bleeding and edematous processes increases. Sometimes patients are diagnosed with infectious toxic shock. This is a condition in which, against the background of poisoning the body with toxins, a decrease in blood pressure occurs, as a result, the death of a person.

If the disease is accompanied by a bacterial infection, the likelihood of developing pneumonia or sepsis increases.

Doctors prognosis

A positive outcome of the disease depends on compliance with a number of factors (timeliness of hospitalization and treatment started, adherence to the principles of patient care, prevention of complications). Late diagnosis and, accordingly, therapy, improper transportation during the period of severe bleeding can be fatal.

Crimean hemorrhagic fever: disease prevention

When pathologists are in a natural hearth, going to the park or to the dacha, it is recommended to wear closed clothes, trousers must be tucked into boots and by all means take a headdress with you. If necessary, you can use aerosols and sprays specially designed to repel ticks. The application procedure should be repeated every three hours.

Upon returning from a forest or park, first of all, you need to examine yourself for the detection of insects. It is recommended to pay special attention to the scalp, as well as the so-called natural folds on the skin (armpit, area behind the ears).

After detecting a tick bite, you must immediately seek qualified medical help. Do not wait until the signs of Crimean hemorrhagic fever appear.

In medical institutions, patients with such a diagnosis are subject to isolation in a box specially designed for this purpose. Only trained personnel are allowed to work with patients.

Instead of a conclusion

  1. This pathology develops as a result of the penetration of a virus of the arbovirus family into the body.
  2. The main vectors and sources of fever are domestic and wild animals and ticks.
  3. On the territory of our country, outbreaks of fever are annually recorded in certain areas (Krasnodar Territory, Astrakhan and Volgograd Regions, the Republic of Dagestan, Kalmykia).
  4. In Russia, the incidence is seasonal, with the peak observed in the period from May to August.
  5. In the past few years, there has been a sharp increase in patients diagnosed with Crimean hemorrhagic fever. Anti-epidemic measures and treatment of livestock from ticks are not carried out properly, therefore, there is a surge in the incidence.

We hope that all the information presented in this article will be really useful to you. Be healthy!

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