What is hemorrhagic fever with renal syndrome? What are the clinical manifestations, complications, routes of transmission, examination and treatment of hemorrhagic fever with renal syndrome?

What is hemorrhagic fever with renal syndrome? What are the clinical manifestations, complications, routes of transmission, examination and treatment of hemorrhagic fever with renal syndrome?

What is hemorrhagic fever with renal syndrome? What are the clinical manifestations, complications, routes of transmission, examination and treatment of hemorrhagic fever with renal syndrome?

What is hemorrhagic fever with renal syndrome?
Hemorrhagic fever with renal syndrome, also known as epidemic hemorrhagic fever, is a natural epidemic disease caused by the epidemic hemorrhagic fever virus (also known as Hantavirus), which uses murine as the main source of infection. Mainly manifested as fever, hemorrhage, congestion, hypotension shock and kidney damage.

Why is the epidemic hemorrhagic fever renamed hemorrhagic fever with renal syndrome?
Epidemic hemorrhagic fever in different countries and regions, due to its different pathogens, epidemiology and clinical characteristics, there have been many names, such as "epidemic hemorrhagic fever" in China and Japan; North Korea called "North Korean hemorrhagic fever" The Soviet Union called it "hemorrhagic nephritis and kidney disease". In fact, all epidemic hemorrhagic fever has varying degrees of kidney damage, so in 1982 the World Health Organization (WHO) unified it as "renal syndrome hemorrhagic fever (HFRS)."

What is the incubation period? How long is the incubation period for hemorrhagic fever with renal syndrome?
The incubation period is the period from when the pathogen invades the human body to when clinical symptoms begin to appear. The incubation period for hemorrhagic fever with renal syndrome is usually 2 to 3 weeks.


What are the main clinical manifestations of hemorrhagic fever with renal syndrome?
The typical clinical course of hemorrhagic fever with renal syndrome is divided into the following five phases:

• Fever period: acute onset, fever, three pain (headache, back pain, eyelid pain) and nausea, vomiting, chest tightness, abdominal pain, diarrhea, general joint pain and other symptoms, skin and mucous membrane three red (face, neck and upper The chest is red), the conjunctiva is congested. Bleeding spots or ecchymoses of varying sizes appear in the oral mucosa, chest and back, under the armpits, or in the form of strips and scratches.
• Hypotensive shock period: more than 4 to 6 days of fever, when the body temperature begins to decline or shortly after fever, the patient has hypotension, and severe shock occurs.
• Oliguria: 24-hour urine volume is less than 400 ml, there is often no clear boundary between oliguria and hypotension.
• Polyuria: Renal tissue damage is gradually repaired, but the renal tubular function has not fully recovered, resulting in a significant increase in urine output. It is more common on the 8th to 12th day, lasting 7 to 14 days, and the urine volume is about 4000 to 6000 mL per day, which is easy to cause dehydration and electrolyte imbalance.
• Recovery period: With the gradual recovery of renal function, when the urine volume is reduced to less than 3000 ml, it will enter the recovery period. The amount of urine and symptoms gradually returned to normal.

Do all patients with hemorrhagic fever with renal syndrome go through the above five periods?
No. The typical five cases of hemorrhagic fever with renal syndrome will appear in the above five periods. Atypical cases and light cases may not occur in some periods and go directly to the next period. Severe cases may also have overlapping fever, shock, and oliguria.

What are the types of hemorrhagic fever with renal syndrome?
According to the difference of fever, the severity of poisoning symptoms and the severity of hemorrhage and renal function damage, it can be divided into the following five types:

• Light weight: body temperature below 39 °C, the symptoms of poisoning are light, kidney damage is light, no shock and oliguria, no bleeding other than bleeding point.
• Medium: body temperature 39 ~ 40 ° C, severe symptoms of poisoning, conjunctival edema, obvious bleeding and oliguria, urine protein, systolic blood pressure less than 12kPa (90 mmHg) or pulse pressure less than 3.5kPa (26 mmHg) ).
• Heavy: body temperature ≥ 40 ° C, severe symptoms of poisoning, may have mental symptoms and / or shock, skin ecchymosis and channel bleeding. Oliguria persists within 5 days or within 2 days without urine.
• Criticality: On one of the following conditions, one of the following conditions occurs: 1 central nervous system comorbidities such as cerebral edema, cerebral hemorrhage or cerebral palsy; 2 refractory shock; 3 major organ bleeding; 4 heart strength Failure, pulmonary edema; 5 severe secondary infection; 6 oliguria more than 5 days or no urine for more than 2 days, BUN>42.84 mmol / L.
• Atypical: fever below 38 °C, skin mucosa may have scattered bleeding points, urine protein (±), blood, urine specific antigen or antibody positive.

Hemorrhagic fever with renal syndrome is the most likely cause of damage to that organ?
Hemorrhagic fever with renal syndrome is most likely to cause kidney damage. Renal damage is often the most prominent manifestation of hemorrhagic fever with renal syndrome, with 50-60% of patients presenting with acute renal failure and becoming the leading cause of death. Although kidney damage is dangerous, if it is detected early and given effective treatment, even in extremely serious cases, most of the kidney damage can be cured after successful treatment.

Why is hemorrhagic fever with renal syndrome easily associated with kidney damage?
In the past, renal ischemia caused by hypotension and hypovolemic shock was the main cause of renal damage caused by hemorrhagic fever with renal syndrome. Many studies today show that immune complexes formed by immune responses are also one of the causes of kidney damage caused by hemorrhagic fever with renal syndrome.

What diseases can cause hemorrhagic fever with renal syndrome?
The complications of hemorrhagic fever with renal syndrome are:

• Channel bleeding (such as abdominal bleeding, nasal cavity, digestive tract and vaginal bleeding).
• Central nervous system complications such as encephalitis, meningitis, cerebral edema, hypertensive encephalopathy and intracranial hemorrhage.
• Pulmonary edema;
• Pleural effusion and atelectasis;
• Secondary infection;
• Spontaneous renal rupture;
• Heart damage and heart failure;
• Liver damage;
• Hyperosmolar nonketotic coma, a very small number of patients.

What are the sequelae of hemorrhagic fever with renal syndrome?
Hemorrhagic fever with renal syndrome can generally be fully restored, and only a few patients may have symptoms such as hypertension, renal dysfunction, myocardial strain and hypopituitarism.

Is hemorrhagic fever with renal syndrome an infectious disease? Can people infect people?
Hemorrhagic fever with renal syndrome is an infectious disease. Although some people have reported people, it is not the main route of transmission.

What are the sources of infection for hemorrhagic fever with renal syndrome?
The main source of infection of hemorrhagic fever with renal syndrome is rodents (Anopheles sinensis, brown rat, etc.).

What are the routes of transmission of hemorrhagic fever with renal syndrome?
It is currently believed that the following pathways can cause hemorrhagic heat to spread:

• Respiratory tract: aerosol particles formed by virus-containing mouse excretions contaminated by dust are inhaled and infected through the respiratory tract;
• Digestive tract: Infected with food and water contaminated with virus-containing rat waste;
• Contact transmission: infection by rat bites, rodent excretions, and secretions directly in contact with damaged skin or mucous membranes;
• Mother-to-child transmission: pregnant women may be infected with the fetus through the placenta after illness;
• Insect-borne transmission: The parasitic mites on the surface of the mouse sucked the blood of the virus-bearing mouse and inhaled blood to cause infection.

What are the prevalence areas of hemorrhagic fever with renal syndrome?
Hemorrhagic fever with renal syndrome is mainly distributed in Asian countries, followed by Europe and Africa.

Who is prone to hemorrhagic fever with renal syndrome?
The population is generally susceptible, with the majority of male and female peasants and workers, and other people may also be ill, which may be related to the chance of contact with the source of infection.

Is it necessary to have hemorrhagic fever with renal syndrome when infected with Hantavirus?
Not necessarily, only a small number of people are infected after the infection, and most people are latent infections.

Is there a seasonal onset of hemorrhagic fever with renal syndrome?
Yes. The disease is periodically prevalent and peaks in a certain month each year, and sporadic cases can be observed. The peak incidence of hemorrhagic fever with renal syndrome in the rat-type syndrome is between spring and summer (March-May), and the peak of hemorrhagic fever with renal syndrome in Apodemus type is between autumn and winter (November-January).

How is hemorrhagic fever with renal syndrome?
The pathogenesis of this disease is still not fully understood, and the main pathogenesis is related to the role of the virus and the involvement of the body's immune response. After infection with Hantavirus, on the one hand, viral infection can cause damage to the function and structure of infected cells; on the other hand, viral infection induces immune response and various cytokines (interleukin, tumor necrosis factor, prostaglandin E2, endothelin) The release of the drug, both to remove the virus, protect the body, but also participate in endothelial cell damage, aggravating vascular damage.

What is hemorrhagic fever with pulmonary syndrome (HPS)? What is the difference between hemorrhagic fever with renal syndrome?
Hantavirus pulmonary syndrome (HPS), also known as hemorrhagic fever with pulmonary syndrome, is a major manifestation of acute respiratory failure caused by a novel Hantavirus infection. The pathogen was first confirmed in 1993, the pathogenic mechanism. It is possible that the virus mediates an increase in vascular permeability through cytokines. The disease is dangerous and the mortality rate is high.
Hemorrhagic fever with renal syndrome (HFRS) and Hantavirus pulmonary syndrome (HPS) are acute infectious diseases caused by Hantavirus. The pathogens of HFRS (Hantavirus, Seoul virus, Pumara virus and Dobrava virus) are mainly distributed in Eurasia, which has a history of thousands of years of civilization, and is called the Old World Hantavirus in the world. The pathogens of HPS such as Sinopharm and Anders virus are mainly distributed in the New World of North and South America, which has only a few hundred years of civilization history, so it is also called New World Hantavirus. Although the two types of diseases differ in pathogens, lesions, clinical manifestations, and methods of diagnosis and treatment, the pathogens belong to the Hantavirus genus. The basic pathological changes are small blood vessels and capillary leaks. A small number of HFRS patients can behave as Respiratory failure is predominant, and a small number of HPS cases can be associated with significant renal failure.

What are the tests for hemorrhagic fever with renal syndrome?
Patients with hemorrhagic fever with renal syndrome generally perform the following tests:

• Blood-related routine examinations: such as blood routine, liver and kidney function, electrolytes, blood gas analysis, coagulation function, etc.
• Specific antigens, antibodies and pathogens: In the early stage, specific antigens can be detected in the patient's serum or urine sediment cells, serum can be searched for specific antibodies, and viral RNA can also be detected in serum.
• Others: electrocardiogram, X-ray, ultrasound, etc. The doctor will perform relevant tests according to the patient's condition. Some tests may be repeated to determine the cause or monitor the treatment effect.

Will white blood cells rise in patients with hemorrhagic fever with renal syndrome?
Although hemorrhagic fever with renal syndrome is caused by viral infection, its white blood cell count will gradually increase after the third disease day, up to (15 ~ 30) × 10 ^ 9 / L, a small number of critically ill patients can reach (50 ~ 100) × 10^9/L. In the early stage of the disease, neutrophils increased, the left side of the nucleus moved, and there were poisonous granules. In severe cases, the immature cells showed leukemia-like reactions. After the 4th to 5th disease days, lymphocytes increased and more atypical lymphocytes appeared.

Is it so high in white blood cells in patients with hemorrhagic fever with renal syndrome?
Hemorrhagic fever with renal syndrome is often accompanied by a significant increase in white blood cells, a small number of critically ill patients can reach (50 ~ 100) × 10 ^ 9 / L, sometimes visible immature cells, and the symptoms of leukemia are very similar, but the blast cells in the bone marrow of patients with hemorrhagic fever with renal syndrome The increase is not obvious and can be identified.

How is hemorrhagic fever with renal syndrome diagnosed?
The diagnosis of this disease is based on epidemiological history, clinical manifestations and laboratory tests. Diagnosis depends on antigen detection (IgM antibody is positive at 1:20, can be detected on the second day of onset. IgG antibody is positive at 1:40, titer is increased by 4 times after 1 week), virus isolation, virus nucleic acid detection, etc. .

How long can hemorrhagic fever with renal syndrome be cured?
Hemorrhagic fever with renal syndrome is dangerous and the course of disease will be delayed for more than a month. Even if it is cured, it needs to be strictly rested for at least 1-3 months, in order to facilitate the gradual recovery of the body.

What should I do if I have hemorrhagic fever with renal syndrome?
There is no specific treatment for hemorrhagic fever with renal syndrome, so it is currently based on comprehensive therapy. Early antiviral drugs, such as ribavirin, can be used for antiviral therapy; in the advanced stage, appropriate treatments for patients' symptoms, such as fluid replacement, body temperature control, prevention of coagulopathy, anti-shock, maintenance of kidney function, dialysis, maintenance Water and electrolyte balance, prevention and treatment of infections and various complications. Hemorrhagic fever with renal syndrome should follow the "three mornings and one time" principle, namely "early detection, early rest, early treatment and local isolation treatment." Patients should stay in bed during treatment, eat liquid or semi-liquid food, drink plenty of water.

Can hemorrhagic fever with renal syndrome be cured?
The mortality rate of the disease is related to the severity of the disease, the sooner or later treatment, and the correctness of the measures. In recent years, through the improvement of early diagnosis and treatment measures, the current mortality rate has dropped to less than 5%. Therefore, once there are symptoms and signs related to hemorrhagic fever with renal syndrome, you should go to the hospital in time to avoid delay in treatment.

Do patients with hemorrhagic fever with renal syndrome need blood transfusion?
Patients with hemorrhagic fever with renal syndrome do not need blood transfusion. However, patients with obvious bleeding should be transfused to provide normal function of platelets and clotting factors and other blood components; those with significantly reduced platelets should be transfused with platelets.

Patients with hemorrhagic fever with renal syndrome have high white blood cells. Do you need to use antibiotics?
Patients with hemorrhagic fever with renal syndrome are viral infectious diseases and generally do not need to use antibiotics. However, during the entire treatment process, it is necessary to pay attention to prevent the occurrence of infection, closely monitor, and once the infection is found, it is necessary to use antibiotics for treatment.

Does hemorrhagic fever with renal syndrome need dialysis? How many times do you need to do it?
All patients with hemorrhagic fever with renal syndrome have kidney damage, but the degree of damage is different. HFRS oliguria is a period of severe kidney damage, and is also a period of complication and high mortality. The rescue and treatment of HFRS oliguria is the key to reducing mortality. Some patients may have obvious azotemia, hyperkalemia or hypervolemia syndrome during oliguria. Hemodialysis may be applied to remove metabolic waste, maintain electrolyte and acid-base balance, and remove excess water from the body. Conducive to kidney recovery. The specific number of times to be done depends on the recovery of the patient's kidneys.

Will hemorrhagic fever with renal syndrome be repeated after healed?
will not. Hemorrhagic fever with renal syndrome will gain immunity after recovery, and generally will not get hemorrhagic fever with renal syndrome.

What is good for patients with hemorrhagic nephritis?
Patients with high fever period have high body temperature, sweating and metabolic enhancement. Therefore, they should be given a high-calorie, high-vitamin, excellent protein and other nutritious and digestible whole-flow diet or semi-flow diet, such as milk and soy milk. Rice porridge, natural juice, lotus root starch, egg soup, noodles, etc.; use small meals to avoid increasing the burden of gastrointestinal; drink as much water and eat as much as possible. Patients with polyuria should eat more potassium-containing foods. In addition, the patient's immune function is reduced, more rest to avoid cold, more ventilation, pay attention to personal hygiene, prevent secondary respiratory and urinary infections.

How to prevent hemorrhagic fever with renal syndrome?

• Control of infectious source: Anti-mouse and rodent control are one of the important measures to prevent and control hemorrhagic fever with renal syndrome.
• Vaccination: Inoculation of epidemic hemorrhagic fever vaccine. After three needles were inoculated, the antibody positive conversion rate was 96%, and the protection rate was about 90%.
• Strengthen personal protection: Try to avoid contact with rodents and their excreta or secretions, work in the wild or in infected areas to reduce exposure and prevent contact with infection. Do a good job in food hygiene, utensil disinfection, food preservation, etc.

Who needs to get an epidemic hemorrhagic fever vaccine?
Hemorrhagic fever epidemic areas 10-70 years old are all vaccinated. Forestry workers in general epidemic areas, water conservancy site migrant workers, wilderness