What is dangerous Crimean hemorrhagic fever. Hemorrhagic fever Crimea Congo: features of flow and treatment

The Office of Rospotrebnadzor in the Astrakhan Region informs that favorable climatic conditions in the region contribute to the activation of insects, including ticks, which are the carriers of the Krym hemorrhagic fever (KGL) and Astrakhan Ricketsiomic Spotted Fever (ARPL).

In the region of the region, combined natural foci of kgl, arpl, fever of Western Nile (LZN) and other infections are registered.

As of July 06, 2018, 2050 victims of the ticks appealed to the medical organizations of the Astrakhan region, including the KGL-524 carrier. The following children under the age of 14 (867 people) are composed of 42.3%.

On July 06, 2018, 6 cases of the KGL were registered on the territory of the Astrakhan region: in the city of Astrakhan - 1 case and in 4 districts of the region: Narimanovsky - 1xl., Kharabalinsky - 2 words, Krasnoyarsky - 1 cl. And Volga - 1 cl. All patients They were infected when removing ticks from cattle and MRCs and crushing them, without using individual protection.

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

How can I get infected?

A person's contiguity of the KGL occurs mainly through the bite of the carrier, with the hands of the ticks taken from the pets, as well as in contact with the blood of patients of the CGL (through damage to the skin, microcracks, wounds), when driving ticks (dogs, cats) or people - on clothes, with flowers, branches, etc. (infection of people who do not attend the forest), when rubbing into the skin of the virus when crushing the tick or combing the bite space.

What are the main signs of the disease?

The disease begins acutely accompanied by chills, strong headache, sharp rise of temperature to 38-39 degrees, nausea, vomiting. Concerned muscle pain. The main manifestations of the KGL are hemorrhages in the skin, bleeding from gums, nose, ears, uterus, stomach and intestines, which, in case of late treatment of medical help, can lead to a fatal outcome. The first symptoms are begins as many virus infections from a sharp increase in temperature and heavy intoxication, accompanied by head and muscle pain.

Who is subject to infection?

All people are susceptible to the CGL infection, regardless of age and gender.

Persons whose activities are associated with staying in the forest are subject to the greatest risk - employees who are careful with agricultural animals and growing agricultural crops, geological exploration parties, builders of automotive and railways, oil and gas pipelines, power lines, topographers, hunters, tourists. Citizens are infected in suburban forests, forest parks, in gardening and garden areas.

How can I protect yourself from kgl?

CGA disease can be warned by individual prevention.

Individual prophylaxis Includes the use of special protective suits (for organized contingents) or fitted clothing, which should not be forged ticks through the collar and the collar. The shirt must have long sleeves that the wrists strengthen with a rubber band. Fill the shirt in the pants, the ends of the trousers - in socks and boots. Head and neck is closed by a golk.

To protect against ticks use scapors - repellents and insecticidal crayons, which are handled open areas of the body and clothing.

Before using drugs, you should read the instructions.

Each person, being in the natural focus of the CGA in the season of activity of insects, should periodically examine her clothes and the body on their own or with the help of other people, and remove the ticks to shoot. 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 discovered a sucking tick should be under the supervision of the medical network for 2 weeks. Daily thermometry and timely appeal to the doctor at the first signs of the disease will reduce the risk of severe forms of the disease to prevent the development of hemorrhagic syndrome, which is the main cause of death.

In everyday life, the population may affect the decrease in the number of ticks by active participation in the undercurrent territory of summer cottages from last year's grass, dry, garbage, as well as adjacent territory to cottage plot. With prophylactic purposes, anticipating processing of agricultural animals is recommended, contacting veterinary workers. It is advisable to prevent the grazing animals in the territory of country sites, summer health facilities, school sites, etc.

How to remove the tick?

In the case of a tick detection, it must be removed as quickly as possible. To do this, you can contact the medical and prophylactic institution at the place of residence (on weekends and holidays in the reception offices of the nearest hospitals and trauma).

It should be removed very carefully in order not to break the proboscis, which is deeply and strongly strengthened for the entire period of suction.

When the tick is removed, the following recommendations must be followed:

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

The place of bite to disinfect any means suitable for these purposes (70% of alcohol, 5% iodine, cologne),

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

If a black point remains (separating the head or trunk) to handle 5% iodine and leave up to natural elimination.

Shot tick must be delivered to the study inRemote tick must be placed in a tightly closing bottle and deliver to laboratory Especially dangerous infections FBUZ "Center for Hygiene and Epidemiology in the Astrakhan Region" at the address: ul. N. Ostrovsky, d 138, tel. 33-64-66, Monday-Friday from 9 to 16 hours - For species.

It is very important to carry out anticipating events in a timely manner, because your health depends on it, and even life.

Crimean hemorrhagic fever in the English-language literature is called the Congo-Crimean, Central Asian. This is due to the first identification of the pathogen in 1945 in the Crimea among workers who were engaged in the cleaning of the hay. And in 1956, a completely similar virus was allocated in the Congo during the outbreak of the disease.

The Congo-Crimean hemorrhagic fever, for any territory to develop, is included in a group of acute infectious diseases characterized by a severe course with intoxication, high temperature and mandatory hemorrhagic syndrome.

Description of the pathogen, properties

The causative agent of the Crimean hemorrhagic fever is a virus from the Arbovirus family. Allocated from the blood of the diseased and first studied by the Soviet epidemiologist M. P. Bogmakov. By the way, it is the courage and organizational talents of this person that we are obliged to victory over polio, creating a vaccine and the preservation of millions of children's lives (at present it is named by the Institute of Poliomyelitis and Viral Encephalitis in Moscow).

• has a spherical structure;
• the shell consists of fat-containing biochemical compounds;
• it is considered weakly resistant in the environment (it dies when boiling immediately, withstands the temperature of 37 degrees 20 hours, and 45 degrees - two hours);
• when drying, viability and contagiousness persists for about two years;
• when damaged, the cells are included in the cytoplasm space;
• the most sensitive cell cultures are fetal kidney pigs, monkeys and hamsters;
• in natural conditions, it lives in the body of rodents, birds, large and petty cattle, wild animals.

Lifeline Virosteners are ticks, they are able to transmit it to their offspring through eggs

How is infection?

Man gets infection through:

• tick bite;
• consumption of sick animal meat;
• with direct contact with animals;
• procedures related to the blood of already infected people (injections, a fence for analyzes, assistance in open wounds).

The outbreaks of the Crimean hemorrhagic fever occur annually in the southern republics and regions of Russia, in Ukraine, Central Asia, Bulgaria, Serbia, Slovakia, Pakistan, African countries. Most often adult people are sick after 20 years.

The mechanism of development of pathology

The virus enters the blood through damaged skin or when injected, tick bite. There are no inflammatory changes in the place of "entrance gate". In the blood, fast reproduction occurs (virusemia). Toxic action is expressed in damage to the virus of the vessel walls. At the same time, red blood cells have the opportunity to leak through them in the tissue and cause hemorrhage.

The body responds to the introduction of a virus with severe toxicosis to the development of a shock state with impaired functions nervous system and hearts. The pathogen accumulates in reticullendothelial cells.

Repeated waves of receipt of viruses in blood against the background of hemorrhagic manifestations cause intravascular thrombosis. The disease acquires the nature of thrombohemorgic syndrome. It is oppressed by own bleeding.

What changes in the organs cause a virus?

The affecting effect of the virus applies to different human organs.

1. Blood masses without signs of inflammation accumulate in the stomach and intestines.
2. In the shells of the brain, hemorrhages are detected, reaching in diameter up to 15 mm against the background of general hyperemia. The brain substance also contains small hemorrhagic hemorrhage foci, the fabric with neurons is destroyed.
3. Similar changes are observed in the tissues of the lungs, liver, kidneys.

The more broken the structure of the body, the stronger the functions are damaged. This is expressed in the severity of the flow, the possibilities of the recovery period.

Clinical manifestations and flow

The symptoms of the Crimean hemorrhagic fever have cyclicality characteristic of all infectious diseases. It is caused by the peculiarities of virus development and protective abilities. immune system man.

Light cases of disease occurring without significant fever and thrombohemorgic manifestations. Perhaps they are more, but the diagnosis is impossible due to the lack of appeals for medical help.

There is no prospective period. Incubation of the pathogen lasts up to two weeks. With a weak immunich, the clinic is manifested in a day after the introduction. The disease always begins suddenly, sharply.

AT clinical flow distinguish periods:

• pre-amorry
• hemorrhagic.

In the pre-generagic (initial) state, the Crimean hemorrhagic fever is expressed in signs of intoxication and is not different from other infectious diseases. The patient has:

• total weakness;
• headaches;
• muscular pain and lubrication;
• artralgia.

When studying the heart draws attention to the tendency to bradycardia to 60 and below.

Rarely patient complains of:

• local soreness of the ion muscles;
• dizziness with loss of consciousness;
• catarrhal phenomena in the nasopharynx (runny nose, throat pain when swallowing);
• nausea and vomiting without communication with meals;
• pain in the stomach, lower back.

The duration of the period from one day to a week is accompanied by a high fever. It is called "dugorby", because a week before the manifestation of hemorrhage, the temperature decreases to 37 degrees, then again the splash. On the graph of the temperature curve, this symptom looks like two waves and is considered one of the characteristic features.

Point rash can merge and form larger stains

Hemorrhagic or period of right begins in most cases from the second day, but can manifest itself at the end of the week. The patient's condition is dragging:

• the face becomes pale, fined;
• lips and shini fingers;
• on the skin and mucous membranes are fine hemorrhagic rashes;
• in places of injection, hematoma (bruises) are visible;
• bleeding from the stomach and intestines give symptoms of bloody vomiting and chair, accompanied by strong pains throughout the abdomen, more often in the field of epigastria;
• possibly hemoptal, nasal bleeding, uterine - in women;
• gums sharply bleed;
• hemorrhages are manifested in the conjunctival shell of the eye, language.

When examined, it is noted:

• disturbed consciousness;
• increase liver, its pain;
• positive symptom when tapping at the lower back (Pasternatsky);
• bradycardia is replaced by frequent heart cuts with a filamental pulse;
• arterial pressure Reduced.

The total period of fever lasts up to 12 days.

At this time, severe complications are possible:

• septic condition;
• thrombophlebitis;
• inflammation of the middle ear;
• acute renal failure.

For the recovery period indicates the normalization of temperature and the cessation of any bleeding. Recovery continues up to two months. All symptoms undergo reverse development, gradually disappear. For a long time weakness remains, a tendency to hypotension, tachycardia, dizziness.

Diagnostics

To form a diagnosis, infectious doctors work together with epidemiologists. It is important to take into account the combination of hemorrhagic symptoms of the patient with the data of epidemiological surveillance of the terrain, the prevalence of ticks, the incidence of animals in natural foci.

Investigation of contact cases with a possible bridge of infection from other territories

Common laboratory tests of blood and urine show:

• increasing anemia with a drop in the number of erythrocytes and hemoglobin;
• platelets are spent on hemorrhagic manifestations, therefore thrombocytopenia is formed;
• significant leukopenia with a moderate shift of the formula to the left;
• in the urine, there are signs of bleeding and disturbed filtration - red blood cells, protein;
• in case of hemorrhage into the liver, it is possible to raise the level of transaminase, changing the content of fibrinogen and coagulation factors.

The virus under the microscope is not detected, therefore immunological analyzes are carried out in bacteriological laboratories to identify the pathogen. They are based on the detection of typical serum antibodies (reaction of binding complement, precipitation, passive hemaglutination, polymerase chain reaction).

Differential diagnosis is carried out with other types of hemorrhagic fever.

Treatment

Hemorrhagic fever Crimea Congo is treated with:

• antiviral agents (etiotropic therapy);
• disintellation;
• symptomatic therapy.

To combat the virus, the causative agent is used:

• antiviral agent Ribaverin;
• heterogeneous immunoglobulin, cooked from horse serum;
• specific immunoglobulin, obtained from the blood of passing or grafted persons.

The action is enhanced by simultaneously receiving interferon

In order to remove intoxication and hemorrhagic phenomena, patients are administered:

• glucose solutions, physiological for breeding circulating virus in the blood;
• Hemodez, polyglyukin - to maintain rheological properties;
• in pronounced anemia, it may take the transfusion of erythrocyte and platelet mass;
• with damage to the renal tissue and increase in the analysis of the decay of nitrogen substances, hemodialysis will need.

At the same time, the volume of circulating blood in hematocrit is maintained, if necessary, hearty glycosides, diuretics are introduced.

The patient shows vitamins that normalize the function of the liver, stimulating blood formation.

Power supply to acute stage is limited by semi-liquid food, rubbed fruit, low-fat broths, porridge on the water. As recovery, they are expanding due to coarse meat, fermented milk products, fish, fruit.

Prevention measures

For the prevention of infection and dissemination of infection with an epidemic service, a constant supervision in natural foci of tick residence is carried out.

On farms, which contains a bird and cattle, disinfection is held on schedule annually

In case of detection of cases of the disease, extraordinary additional disinfection of the terrain and premises, the destruction of the patient's cattle is required.

Specific immunoglobulin uses specific immunoglobulin for preventive vaccination of farms.

Immunoglobulin is also introduced to contact persons in cases of emergency prevention when identifying a patient with Crimean hemorrhagic fever

Treatment of patients is carried out in the bauxated chambers of infectious offices. The service personnel must use protective gloves, masks, change the bathrobe at the entrance to the box.

All materials of laboratory studies, separation from patients with hemorrhagic fever are treated with a disinfectant solution. The health of the world population depends on the honest work of responsible employees.

Since the virus is activated in the warm season, travelers are recommended to carry closed clothes and shoes to prevent tick bites.

Accessibility of medical care and sanitary literacy of the population are different in different countries World. Therefore, lethal outcomes from the hemorrhagic fever of Crimea Congo range from 2 to 50%.

It is important not to engage in self-treatment at any temperature rise. Some anti-inflammatory drugs (antibiotics, sulfonamides) are not only useless when viral infection, but also have an additional destructive effect on the liver. An inspection of the doctor is necessary when detecting a rash on the body. The fellow man should be isolated before the decision of the doctor about hospitalization.

Crimean hemorrhagic fever is a very dangerous pathology. Timely diagnosis is extremely important for the start of treatment. Launched processes are fraught with very serious consequences. The disease has an acute beginning and proceeds with pronounced manifestations.

What is a disease

Crimean hemorrhagic fever is a viral disease. The pathogen belongs to the nature of the arboviruses. The main carrier of infection is a tick. This pathology has a high percentage of deaths. The disease is distributed in territories with a warm climate. Persons engaged in agriculture more than others are subject to this type of fever. According to statistics, such a viral disease is striking mostly young men, it is less common in women. In children, the disease is found in isolated cases and is extremely difficult due to the weak immune system. The risk of getting sick falls on the spring and summer, when the ticks are especially active.

The disease is differently called the hemorrhagic fever of the Congo - Crimea, the Congo-Crimean fever, the Central Asian hemorrhagic fever.

What is the Congo-Crimean Fever - Video

Transmission paths and development factors

The main cause of the disease is the hitting of the Bougainerus, which is transmitted during the creation of a tick. The temperature favorable for the vital activity of the infectious agent is from 20 to 40 degrees, which allows it to be quite comfortable to dwell both in the body of an insect and animal and a person. There is also a contact transmission method when crushing the tick and getting into the wound surfaces of the biological material of infected animals.

Bunavirus - Cauditator of the Crimean Hemorrhagic Fever

The organism of most people is very susceptible to the virus. You can get infected by both poor-quality sterilization of medical instruments. The weaker immune response, the hardest there will be the course of the disease. The virus is resistant to unfavorable environmental conditions and can be destroyed only by boiling.

Crimean hemorrhagic fever distributed in many countries of the globe

The presence of chronic infections is one of the provoking factors of the acute flow of the disease. With age, the risk of death is increasing.

Symptoms of hemorrhagic fever

The incubation period (from infection before the appearance of the first signs) of the Crimean hemorrhagic fever is from three to nine days. After the tick bite, the picture of the disease is developing much faster than with a different transmission method. Among the first signs of the disease, the following are distinguished:

• an increase in body temperature to high digits;
• severe weakness;
• dizziness;
• chills.

Then the articular, muscle and muscular and the clinical picture is joined. headache. There is nausea, vomiting and inflammation of conjunctiva. In the future, irritability and aggression is joined, letting let letness and apathy come to replace. During this period, the body temperature is often reduced to normal indicators, and then increases sharply again.

Body temperature increase - the main symptom of the Congo-Crimean fever

As the process progressing from the third day, the infection affects the vascular channel. In this case, skin and other types of hemorrhage occur. The data of manifestations are dangerous fatal. The source of bleeding can be like a mucous membrane of the nose and internal organs. The skin appears characteristic rashes.

Then, as a rule, confidence of consciousness and low blood pressure joins. The man can go to whom. If the disease has a favorable course, then recovery occurs on 7 days with a gradual decrease in the severity of the main manifestations.

Diagnostic events

The diagnosis is important. It is necessary to differentiate the disease from meningococcal infection, typhoid and influenza. For this, the blood test is carried out to identify certain protective proteins antibodies against the virus of the Crimean hemorrhagic fever. In addition, there are many studies:

In addition to the listed, the doctor examines the patient and already on the basis of the aggregate clinical signs can make a diagnosis.

Major Treatment Methods: Hospitalization, Medicinal preparations

In the presence of Crimean hemorrhagic fever, urgent hospitalization of the patient is required to prevent life-threatening consequences. Treatment of the disease is symptomatic, as there is no means that could destroy the virus. At the same time, the following groups of drugs are often used:

1. Antipyretic. Used to reduce high temperature indicators. Most often used non-steroidal anti-inflammatory agents, which not only get rid of the heat, but also remove unpleasant pain symptoms. These drugs include ibuprofen and nurofen.
2. Hemostatic. Aminocaproic acid is used to prevent serious complications. Additionally, ascorbic acid and ethalate are used to prevent bleeding. These tools strengthen the vascular wall and accelerate the gluing platelets. Everything medicinal substances Enter intravenously.
3. Immunostimulants. This group of drugs is needed to speed up the process of recovery and get rid of complications. The patient is injected with a solution of immune serum, which increases the body's resistance to the virus.
4. Glucocorticoids. With a serious course of the main process, dexamethasone and hydrocortisone are used. These rapid effects contribute to the elimination of heavy symptoms, reduced pain syndrome.
5. Heart glycosides. Used to prevent insufficient myocardial contractility. Most often, digoxin and stanfantine are used, allowing to regulate the activities of the heart muscle. These drugs are prevention of stagnant phenomena in lungs and other internal organs.

To prevent dehydration and removal of toxins, intravenous infusion of albumin solution and sodium chloride solutions that replenish fluid deficiency are used.

Preparations used for therapy, photo

Ascorbic acid strengthens the wall of the vessels
Stroofantin is used to prevent heart failure
Dexamethasone removes severe pain and skin manifestations
Ibuprofen eliminates heat and pain
Aminocaproic acid warns bleeding

Forecast of treatment and complications

With a timely approach to the treatment and normal functioning of the immune system, the disease prediction is favorable. However, the virus causes human sensitivity in humans, therefore, in most cases, the disease proceeds extremely difficult. Treatment should be carried out only in the hospital, since the frequency of death is at least 40% of all cases.

Early start of therapy in the first 3 days after infection allows you to achieve good results. A person is introduced specific immunoglobulin. As a result, the probability of recovery increases several times. Each patient has a disease with varying degrees of severity. clinical manifestations.

After the suffered fever, a long immunity is produced. One of hazardous consequences Diseases becomes infectious-toxic shock, in which the patient falls into someone.

Vaccine and other preventive measures

To combat the Crimean hemorrhagic fever, it is necessary to defend against the attack of ticks

A person going to rest to the country with a warm climate is recommended to conduct preventive vaccination that will allow specific immunity in the body.

Crimean hemorrhagic fever is a complex disease, which at the initial stage can be confused with the flu. However, symptoms increase very quickly and becomes extremely heavy. At the very first signs of the presence of a disease, it is urgent to consult a doctor.

There are diseases that are irrevocable exclusively animals. However, in some cases, such ailments are able to be transferred to a person, bringing many unpleasant symptoms and sensations, and sometimes becoming the cause of death. Just as such diseases include the Crimean Herororgic Type Fever, which most experts refer to the Congo-Crimea. Such a pathological condition may occur not only in the Crimea, but also in the Caucasus, as well as in the Stavropol Territory and in the Astrakhan region. Let's talk about the manifestations of this ailment, as well as on the methods of its correction and prevention.

The Crimean fever virus is transferred to different pets, including sheep and goats, as well as cows, etc. To man, the disease passes, as with direct contact with the blood of the affected animal, and when the tick bite. Quite often, this ailment is fixed in people who are directly related to animal husbandry.

How does the Crimean hemorrhagic fever manifest? Symptoms of Disease

After the penetration of the virus in the body there is rather short incubation periodwhich can be from one day and up to the pair of weeks. The ailment starts quite suddenly, the patient faces the strongest chills, and its body temperature increases to forty degrees. Despite this, the pulse is not accelerated, but on the contrary slow down almost to forty shocks, which is classified as bradycardia.

In the first few days of the development of the disease, the patient observes the manifestations of general intoxication of the body. Patients complain of headaches, a sense of breakdown and weakness, they are bothering painful sensations in the field of epigastria, as well as lubrication in the joints and muscles.

In some cases, these symptoms are joined by catarrhal phenomena in the upper respiratory tract. A rather frequent manifestation of hemorrhagic fever of this type at the initial stage of development becomes repeated vomiting, which greatly extends the patient. Such a symptom is not at all associated with food intake that the doctors are usually associated with peculiar lesions of the stomach, as well as the vegetative nervous system in the field of solar plexus.

Before the disease passes into the second phase (directly hemorrhagic), the body temperature decreases for a couple of days, after which it comes up on the background of the formation of hemorrhagic rashes. At the beginning, rash is localized in the area of \u200b\u200bthe axillary depression, as well as on the surface of the elbow folds and from the inside of the hip. After such rashes apply throughout skin Pokrov and mucous membranes, including conjunctiva. The patient's face pale, acquires an outdatedness, cyanosis arises on it, acricyanosis, as well as noticeable hemorrhages in the skin. The classical manifestation of this phase of hemorrhagic fever is the bleeding of the most different localization, there is a bleeding of the gums and hearding occurs. At this stage, bradycardia disappears, alternating tachycardia, blood pressure is significantly reduced, in addition, Oliguria appears.

How and how eliminates the Crimean hemorrhagic fever? Treatment of disease

All patients with suspicion of the development of the Crimean hemorrhagic fever are hospitalized at mandatory. First of all they spend symptomatic treatmentwhich implies the reception of antipyretic drugs.

If the temperature indicators increase above 38.5 degrees, the drugs of the choice are ibuprofen and paracetamol. With increasing this data to forty degrees and above, the doctors are usually administered intravenously or intramuscularly promethazine, sometimes combining it with chlorpromazine.

In order to adjust water-electrolyte balance and remove toxins from the body practiced infusion therapyAt the same time, the solution of albumin, dextran, sodium chloride, as well as hemodez, etc. is used.

To stop and preventing bleeding, aminocaproic acid is introduced as a solution, as well as solutions ascorbic acid and etchilage.

The treatment of Crimean hemorrhagic fever implies immox-corrective therapy. Such specific therapy implies the introduction of immune serum, as well as a hyperimmune gammaglobulin.

With a light course of the disease, the use of Loratadine and Promethazine is practiced as hyposensitizing therapy, but if the disease proceeds in severe form, then for this purpose hydrocortisone is used, as well as prednisone or dexamethasone. To correlate heart failure, it is customary to use Wabain. If necessary, intensive therapy techniques or resuscitation can also be used.

How is the Crimean hemorrhagic fever warn? Prevention of disease

The basic measure of the prevention of the Crimean hemorrhagic fever is the fight against ticks - carriers of the causative agent of the disease. For this purpose, special chemical elements are used - acaricides.

All people who live in the zone are possible infection worth protecting against ticks, and warn their bites. When working with animals or their tissues, it is worth using different protective clothing, including gloves. Before the animals fall on the slaughterhouse, they should be withstanding in quarantis or process pesticides.

When working with patients with infant people should avoid close contacts, wearing protective clothing, as well as observe personal hygiene - flush hands, etc.

With competent therapy of the Crimean hemorrhagic fever, the chance of a patient for recovery is significantly increasing.

What is the Crimean hemorrhagic fever

Hemorrhagic fever Crimea Congo (Lat. Febris Haemorrhagica Crimiana, Sin.: Crimean hemorrhagic fever, Congo-Crimean hemorrhagic fever, Central Asian hemorrhagic fever) - acute infectious disease of the person transmitted through tick bites, characterized by fever, pronounced intoxication and hemorrhages on the skin and internal organs. First revealed in 1944 in the Crimea. The pathogen was detected in 1945. In 1956, a similar disease was revealed to the Congo. Virus studies have established its complete identity with the virus discovered in the Crimea.

What provokes the Crimean Hemorrhagic Fever

The causative agent of the Crimean hemorrhagic fever It is a virus from the BunyaViridae family, the genus Nairovirus. Refers to Arbovirusam (Arboviridae). Opened in 1945 by M. P. Chumakov in the Crimea, in the study of the blood of patients with soldiers and immigrants, sick when carrying out work on the cleaning of the hay. In 1956, a virus was allocated in the Congo from the blood of a diseased boy. The causative agent called the Congo virus. Spherical virions, diameter 92-96 nm, surrounded by a lipid-containing shell. The most sensitive to the virus of the culture of kidney cells of the embryo pigs, Syrian hamsters and monkeys. Poorly resistant in the environment. When boiling, the virus dies instantly, at 37 `C - after 20 hours, at 45` C - after 2 hours. In the dried state, the virus remains viable over 2 years. In the affected cells localized mainly in the cytoplasm.

Natural causative agent tank - rodents, large and finely horned cattle, birds, wild species of mammals, also mites themselves, capable of transmitting the virus with offspring through eggs, and being virus carriers for life. The source of the causative agent is a sick person or an infected animal. The virus is transmitted in the bite of a tick, or conduct medical procedures associated with injections or blood intake. Major carriers - Magnifier Hyalomma Marginatus, Dermacentor Marginatus, Ixodes Ricinus. Outbreaks of the disease in Russia every year are in the Krasnodar and Stavropol Territory, Astrakhan, Volgograd and Rostov regions, in the republics of Dagestan, Kalmykia and Karachay-Cherkessia. The disease is also found in the south of Ukraine and in Crimea, Central Asia, China, Bulgaria, Yugoslavia, Pakistan, Central, Eastern and South Africa (Congo, Kenya, Uganda, Nigeria, etc.). In 80% of cases, persons face aged 20 to 60 years.

Pathogenesis (what happens?) During the Crimean hemorrhagic fever

Based on pathogenesis of Hemorrhagic Crimean Fever It is an increase in the permeability of the vascular wall. The growing virus causes the development of heavy toxicosis, up to infectious-toxic shock with disseminated intravascular coagulation of blood, the inhibition of blood formation, which aggravates the manifestations of hemorrhagic syndrome.

The gates of the infection is the skin at the site of the tick bite or minor injuries when contacting the blood of patients (with nosocoonic infection). At the site of the gate of infection of pronounced changes is not observed. The virus penetrates into the blood and accumulates in the cells of the reticuloendothelial system. In secondary more massive virusemia, signs of general intoxication appear, the defeat of the endothelium of blood vessels and develops a different severity of thrombohemorrhagic syndrome. Pathologic 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 shell are hyperemic, in them detects hemorrhages with a diameter of 1-1.5 cm with the destruction of the brainstant. Throughout the brain substance, small hemorrhages are detected. The hemorrhages are also observed in the lungs, kidneys, etc. Many questions of the pathogenesis of the roast of Crimea-Congo remain unexplored.

When opening, multiple hemorrhages in the mucous membranes of the gastrointestinal tract are found, the blood in it will be asked, but there are no inflammatory changes. The brain and its shell are hyperemic, in them detects hemorrhages with a diameter of 1-1.5 cm with the destruction of the brainstant. Throughout the brain substance, small hemorrhages are detected. Hemorrhages are also observed in the lungs, kidneys, liver, etc.

Symptoms of Crimean Hemorrhagic Fever

Incubation period From one to 14 days. More often 3-5 days. Promotional period is absent. The disease develops sharply.

In the initial (pre-generagic) 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, on the background of high fever, weakness, driers, headache, lubrication in the whole body, strong headache, pain in muscles and joints are noted.

More rare manifestations of the initial period include dizziness, violation of consciousness, strong pain In the ion muscles, signs of inflammation of the upper respiratory tract. Only some patients before the development of the hemorrhagic period, characteristic of this disease appear
symptoms - re-vomiting, not related to meals, pain in the lower back, abdominal pain, mainly in the epigastric area.

A permanent symptom is a fever that lasts an average of 7-8 days, especially typical of the Crimean hemorrhagic fever. In particular, with the appearance of hemorrhagic syndrome, there is a decrease in body temperature to subfebrile, after 1-2 days the body temperature rises again, which causes the temperature curve characteristic of this disease.

Hemorrhagic period corresponds to the peride of the disease of the disease. The severity of thrombohemorrhagic syndrome determines the severity and outcome of the disease. Most patients with the 2-4th day of the disease (less often on the 5-7th day), hemorrhagic rash appears on the skin and mucous membranes, hematoma in the field of injection, there may be bleeding (gastric, intestinal, etc.). The patient's condition deteriorates sharply. Facial hyperemia is replaced by a pallor, the face becomes fined, the cyanosis of the lips, acricyanosis appears. A rash on the skin first phetechial, at that time ananhenthae appears on the mucous membranes of the oral chill, there may be larger hemorrhages in the skin. Possible nasal, uterine bleeding, hemoptal, bleeding gum, language, conjunctiva. Prognostically unfavorable appearance of massive gastric and intestinal bleeding. The patient's condition becomes even more severe, disturbances are noted. Characteristic abdominal pain, vomiting, diarrhea; The liver is enlarged, painful when palpation, the symptom of Pasternatsky positive. Bradycardia is replaced by Tachycardia, blood pressure is reduced. In some patients, Oliguria is noted, residual nitrogen is growing. In peripheral blood - leukopenia, hypochromic anemia, thrombocytopenia, ESRs without significant changes. Fever lasts 10-12 days. Normalization of body temperature and cessation of bleeding characterizes the transition to the period of recovery. Asthenization (up to 1-2 months) remains for a long time. In individual patients there may be light forms of the disease flowing without a pronounced thrombohemorgic syndrome, but they, as a rule, are not identified.

As complications can be observed sepsis, email swelling, heat pneumonia, acute renal failure, otitis, thrombophlebitis. Mortality is from 2 to 50%.

Diagnosis of Crimean Hemorrhagic Fever

Diagnosis of Crimean Hemorrhagic Fever based on a clinical picture, epidemiological history data (stay in the zone natural foci, attack ticks, contact with sick Crimean hemorrhagic fever), results of laboratory studies. There is a reduced amount of erythrocytes, leukopenia (up to 1x109-2x109 / l), neutropenia, thrombocytopenia. To confirm the diagnosis, the selection of the patient's blood virus is used, from the 6-10th day of the disease, an increase in antibodies in repeated serum samples of the patient in RSK, the reaction of diffuse precipitation and agar, passive hemagglutination reaction is determined.

Differential diagnostics are carried out with others viral diseasesmanifested by hemorrhagic syndrome, especially if the patient in last days Before the development of clinical manifestations of the disease was in countries with tropical and subtropical climates, with leptospirosis, hemorrhagic fever with renal syndrome, hemorrhagic vasculitis, sepsis, etc.

Treatment of Crimean Hemorrhagic Fever

Patients are necessarily isolated in the infectious department of the hospital. Treatment is symptomatic and etiotropic. Anti-inflammatory drugs are prescribed, diuretic. Exclude the use of drugs that increase the kidney damage, for example, sulfonamides. Also prescribe antiviral drugs (Ribavirin, Refaferon). In the first 3 days heterogeneous specific horsepower immunoglobulin, immune serum, plasma, or specific immunoglobulin, obtained from the serum of the blood of passing or grafted persons. Specific immunoglobulin is used for emergency prevention in individuals in contact with the blood of the patient.

Prevention of Crimean Hemorrhagic Fever

To prevent infection, the main efforts are directed to the struggle with the carrier of the disease. The disinsection of space for livestock is carried out, prevent grazing on pastures located on the territory of the natural focus. People individually use protective clothing. Processing clothes, sleeping bags and tents with repellents. When tick bite in the habitat, immediately contact medical institution for help. For persons who are going to enter the territory of the South of Russia, preventive vaccination is recommended. AT medical institutions It 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 the service is to trust only specially trained personnel.

What doctors should contact if you have a Crimean hemorrhagic fever

Infectious

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