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03.03.2020

Crimea-Congo hemorrhagic fever is an infectious disease with a severe course, characterized by high fever, intoxication syndrome and the obligatory presence 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.

The causative agent 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 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.

It is more likely to become infected during the seasons when ticks are most active (summer, spring and early fall, or 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 age characteristics 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, one should also remember the fact that these insects can easily make their way to personal plots or buildings.

After entering the blood, the virus multiplies and begins to affect the walls of blood vessels with its toxins. The red blood cells 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 functional disorders 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 inhibition of hematopoiesis.

The virus of this fever also affects 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 Crimean-Congo hemorrhagic fever in acute form rises among people suffering from other chronic infections. In addition, experts note that the risk of death from this disease increases with age.

Symptoms

Characteristic feature diseases - 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 incubation period can be reduced to 1 day, and sometimes the first signs of the disease appear only after 10-14 days.

pre-hemorrhagic;
hemorrhagic.

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

an increase in temperature to significant indicators ("two-humped fever" - the temperature is kept 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 join the above symptoms:

local pain in the calf muscles;
catarrhal manifestations in the form of a runny nose, sore throat and redness of the conjunctiva;
non-food-related 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, already from day 2, the patient begins a hemorrhagic period, accompanied by heaviness 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 Pasternatsky's symptom 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 normalizes and any manifestations of bleeding or bleeding are eliminated. Full 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 is aimed at eliminating the symptoms that occur in a particular patient.

If 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 aminocaproic acid solution, 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 disease, help relieve pain.

If necessary, therapy can be supplemented by 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 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 pureed 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 way to prevent infection with the Crimean-Congo hemorrhagic fever virus is vaccination with the pathogen's genetic material. After the vaccination, a person develops protective antibodies. Such a measure is especially shown to the population of the southern territories and tourists who are going to visit these regions.

To prevent the spread of this viral infection, 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 recommended:

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.).
Wear clothing and hats that prevent mites from adhering to the skin.
At the first signs of the disease, consult a doctor without postponing his call or visit to him for later.
When ticks are detected, infected with the virus, be sure to decontaminate hazardous areas.
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.

There are diseases that normally only animals are sick. However, in some cases, such ailments can be transmitted to a person, bringing many unpleasant symptoms and sensations, and sometimes becoming the cause of death. Just such diseases can be attributed to the Crimean hemorrhagic fever, which most experts call the Crimean Congo. Such a pathological condition can 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 the methods of its correction and prevention.

Virus Crimean fever carried by various domestic animals, including sheep and goats, as well as cows, etc. The disease passes to humans, both through direct contact with the blood of an affected animal, and by a tick bite. Quite often, this ailment is recorded in people who are directly related to animal husbandry.

How does Crimean hemorrhagic fever manifest itself? Disease symptoms

After the virus enters the body, a rather short incubation period is observed, which can range from one day to a couple of weeks. The disease starts quite suddenly, the patient is faced with a severe chill, and his body temperature rises up to forty degrees. Despite this, the pulse does not accelerate, but rather slows down to almost forty beats, which is classified as bradycardia.

In the first few days of the development of the disease, the patient has manifestations of general intoxication of the body. Patients complain of headaches, a feeling of weakness and weakness, they are worried about painful sensations in the epigastric region, as well as aches in the joints and muscles.

In some cases, these symptoms are accompanied by catarrhal phenomena in the upper respiratory tract... A fairly frequent manifestation of hemorrhagic fever of this type at the initial stage of development is repeated vomiting, which greatly debilitates the patient. This symptom is not at all connected with food consumption, which doctors usually associate with peculiar lesions of the stomach, as well as the autonomic nervous system in the solar plexus region.

Before the disease enters the second phase (directly hemorrhagic), the body temperature decreases for a couple of days, after which it goes up again against the background of the formation of hemorrhagic rashes. At first, the rash is localized in the armpits, as well as on the surface of the elbow bends and on the inner side of the thigh. After such rashes spread throughout skin and mucous membranes, including the conjunctiva. The patient's face turns pale, becomes puffy, cyanosis, acrocyanosis, and also noticeable hemorrhages into the skin appear on it. The classic manifestation of this phase of hemorrhagic fever is bleeding itself different localization, there is bleeding of the gums and hemoptysis occurs. At this stage, bradycardia disappears, giving way to tachycardia, significantly decreases blood pressure, besides, oliguria appears.

How and how is the Crimean hemorrhagic fever eliminated? Treatment of the disease

All patients with suspected development of Crimean hemorrhagic fever are hospitalized without fail. First of all, they are given symptomatic treatment, which involves taking antipyretic drugs.

If temperature readings rise above 38.5 degrees, ibuprofen and paracetamol are the drugs of choice. With an increase in these data to forty degrees and above, doctors usually inject promethazine intravenously or intramuscularly, sometimes combining it with chlorpromazine.

In order to correct water and electrolyte balance and remove toxins from the body, it is practiced infusion therapy, while using a solution of albumin, dextran, sodium chloride, as well as hemodez, etc.

To stop and prevent bleeding, aminocaproic acid is administered in the form of a solution, as well as solutions ascorbic acid and etamzilata.

Treatment of Crimean hemorrhagic fever implies immunocorrective therapy. Such specific therapy involves the administration of immune serum, as well as hyperimmune gammaglobulin.

With a mild course of the disease, the use of loratadine and promethazine is practiced as hyposensitizing therapy, but if the disease is severe, then hydrocortisone, as well as prednisolone or dexamethasone, are used for this purpose. It is customary to use ouabain to correct heart failure. If necessary, methods of intensive therapy or resuscitation can also be used.

How is Crimean Hemorrhagic Fever Prevented? Disease prevention

The main measure for the prevention of 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 area of \u200b\u200bpossible infection should protect themselves from ticks and prevent their bites. When working with animals or their tissues, you should use a variety of protective clothing, including gloves. Before animals get to slaughterhouses, they should be quarantined or treated with pesticides.

When working with people with this ailment, you should avoid close contacts, wear protective clothing, and also observe personal hygiene - wash your hands, etc.

With proper treatment of Crimean hemorrhagic fever, the patient's chance of recovery is significantly increased.

Crimean hemorrhagic fever

Historical background .

The disease was first described by M. P. Chumakov and co-authors in 1944-1945. in the Crimea and later in the republics of Central Asia. In 1956-1969. foci of similar diseases were found in Bulgaria, Yugoslavia, Hungary, East and West Africa (Zaire, Nigeria, Uganda, Kenya and Senegal), Iran, Pakistan and India. Crimean hemorrhagic fever is widespread in the Crimea, Krasnodar and Stavropol regions, in the Astrakhan, Rostov, Donetsk, Kherson regions, in Kazakhstan, Uzbekistan, Turkmenistan and Azerbaijan.

Etiology, epidemiology, pathogenesis .

The causative agent is the CHF virus of the CHL-Congo-Khazar genus, family Bunyaviridae, antigenic group CHL-Congo-Khazar. Belongs to the group of arboviruses, unstable in the external environment.

The reservoir of viruses is wild (hares, African hedgehogs, etc.) and domestic (cows, sheep, goats) animals, as well as ticks of more than 20 species from 8 genera with transovarial transmission of pathogens.

The mechanism of infection is usually transmissible - through the bite of an infected tick Hyalommaplumbeum (in Crimea), Hyalommaanatolicum (in Central Asia, Africa) and biting midges ( Culicoides). Possible aerogenic infection (in laboratory conditions) and infection through contact with the blood of sick people (nosocomial infection). In endemic areas, the incidence is seasonal and increases during agricultural work (in July-August), often acquiring a professional character. The disease is characterized by a severe course; in non-immune individuals, the disease proceeds with a high mortality rate, reaching 5-40% in some years.

In the mechanism of development of the Crimean hemorrhagic fever, the main role belongs to the increase in the permeability of the vascular wall. Severe toxicosis is due to an increase in the number of circulating viruses. Its degree can reach the level of infectious-toxic shock with the development of disseminated intravascular coagulation and oppression of hematopoiesis, which in turn aggravates the manifestations of hemorrhagic syndrome.

Clinical picture .

The incubation period lasts from 2 to 14 (on average 3–5) days. The disease can proceed in an erased, light, moderate and severe forms.

The initial period of Crimean hemorrhagic fever lasts 3–6 days and is characterized by sudden chills, a rapid rise in body temperature to 39–4 ° C, widespread myalgias and arthralgias, severe headache, and often pain in the abdomen and lumbar region. A positive Pasternatsky symptom can be determined. Frequent symptoms are dry mouth, dizziness, and repeated vomiting. Patients are usually agitated, the face, mucous membranes, neck and upper chest are hyperemic, and the lips are dry. Often noted herpeslabialis... Hematological changes during this period are manifested by leukopenia with neutrophilic shift to the left, thrombocytopenia, increased ESR.

The duration of the height of the disease is from 2 to 6 days. It often begins after a short-term (1–2 days) drop in temperature. At this stage of the disease, a pronounced hemorrhagic syndrome is revealed in the form of a petechial rash on the lateral parts of the body, in the area of \u200b\u200blarge folds and limbs. In severe forms of Crimean hemorrhagic fever purpura, ecchymosis are observed, bleeding from the gums, nose, stomach, uterus, intestines and lungs is possible. Patients are depressed, pale. Acrocyanosis, tachycardia and hypotension are determined. In 10-25% of cases, meningeal symptoms are noted, delirium and excitement of patients, convulsions with the subsequent development of coma are possible. The liver is usually enlarged. Some patients have signs of acute liver failure... Oliguria, microhematuria, hypostenuria, pneumonia, pulmonary edema, thrombophlebitis, acute renal failure, shock.

The duration of the fever is 4 to 8 days. The convalescence period is long (1-2 months or more), characterized by an asthenic symptom complex. In endemic areas, abortive forms of Crimean hemorrhagic fever without pronounced hemorrhagic syndrome are often observed.

When laboratory research, in addition to characteristic hematological changes, an increase in hematocrit, residual nitrogen, aminotransferase activity, signs of metabolic acidosis is revealed. Significant thrombocytopenia and high hematocrit values \u200b\u200bmay indicate a poor prognosis. Mortality reaches 10–40%.

Diagnostics and differential diagnostics .

Specific diagnostics involves isolating the virus and staging serological reactions... Retrospective diagnosis of Crimean hemorrhagic fever is possible with the use of CSCs.

Differentiation of the Crimean hemorrhagic fever follows from meningococcal infection, influenza, leptospirosis, typhus, thrombocytopenic purpura and Schönlein-Henoch disease, in the inhabitants of tropical countries - from yellow fever and other African and American hemorrhagic fevers.

Treatment and prevention .

Treatment of patients with Crimean hemorrhagic fever is carried out in a hospital setting. In the acute period of the disease, bed rest and a sparing diet with restriction of proteins and table salt are shown.

In the initial period, the introduction of colloidal preparations (hemodez, rheopolyglucin, polyglucin, macrodex, peristone, serum albumin, etc.) is shown. They help to stabilize the volume of circulating blood, improve blood circulation, restore tissue blood supply, normalize renal blood flow and promote the elimination of toxins. Crystalloid solutions (isotonic sodium chloride solution, 5% glucose solution, Ringer's solution, etc.) promote the accelerated excretion of toxic substances through the kidneys. The drugs are prescribed at a dose of 10–20 to 30–50 ml / kg. The daily dose of the injected fluid is from 1.5-2 to 3-4 liters, sometimes more. The injection rate is 10-15 ml / min, an indwelling catheter is used. The introduction of saluretic (lasix, uregit) and osmotic (mannitol, urea) diuretic drugs is shown.

For the prevention and termination of shock reactions, glucocorticosteroids are used (prednisone at a dose of 90-120 mg, hydrocortisone - 250-300 mg). Contrakal and trasilol are also used in doses up to 80,000-100,000 units. The positive effect of early use of heparin (10,000-15,000 units) has been noted. The complex of therapeutic agents includes large doses of ascorbic acid, vitamin P, prescribes cardiac glycosides, and carries out oxygen therapy. In cases of massive hemorrhagic syndrome, hemorrhagic replacement therapy is performed mainly with fresh heparinized or citrated blood. Marked positive effect from the use of immune serum (60-100 ml) and hyperimmune gamma globulin.

Dispensary observation of convalescents is carried out for 6 months from the date of recovery.

Hospitalization of patients with Crimean hemorrhagic fever requires prophylaxis of nosocomial infection, including by intravenous route. In the foci of the disease, a set of measures is carried out aimed at preventing the attack of ticks on a person: the use of protective clothing, protective nets, the treatment of clothes with repellents, self- and mutual examinations of workers in hazardous conditions every 1.5-2 hours and at the end of the working day to remove ticks from clothes. The specific immunoprophylaxis of the disease has been developed. Vaccination is carried out according to epidemiological indications.

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Fever

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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 territories, 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, spotting 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 is possible due to the occurrence of hemo-aspiration atelectasis.

Anemia, leukopenia with lymphocytosis, and severe thrombocytopenia are observed in the blood. The greatest diagnostic value has leukopenia with a predominance of neutrophils. The number of leukocytes drops to 800–1000, which, combined with the appearance of young forms (myelocytes, myeloblasts), gives 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

Sharp infectious diseases (in the first period): influenza, sepsis, typhus and other rickettsioses, meningococcemia;
hemorrhagic fevers (Omsk, fever with renal syndrome), thrombocytopenic purpura (Werlhof'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 virus isolation, detection of RNA and virus AG; 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 antibodies in early period diseases and confirmation of the diagnosis with an increase in the titer of AT IgG in blood samples taken in dynamics (paired sera). IgM antibodies appear on the 3-4th day of illness, IgG antibodies - on the 7-10th day. The detection of AT is performed mainly by ELISA.

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 on early dates disease (up to the 5-7th day), indicates the infection of the patient and, in conjunction with the data of the epidemiological history and clinical picturemay be considered the basis for a 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.

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 carriers of the Crimean hemorrhagic fever (CHF) and the Astrakhan rickettsial spotted fever (ARPF).

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

On 06 July 2018 in medical organizations In the Astrakhan region, 2,050 victims of tick bites, including the KGL-524 vector, applied. Of all those who applied, 42.3% are children under the age of 14 (867 people).

As of July 6, 2018, 6 cases of CHF were registered in the Astrakhan region: in the city of Astrakhan - 1 case and in 4 districts of the region: Narimanovsky - 1 case, Kharabalinsky - 2 cases, Krasnoyarsk - 1 case. and Privolzhsky - 1 word. All sick were infected when removing ticks from cattle and small cattle and crushing them, without using personal protective equipment.

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

How can you get infected?

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

What are the main signs of the disease?

The disease begins acutely, accompanied by chills, severe headache, a sharp rise in temperature to 38-39 degrees, nausea, vomiting. Worried muscle pain... The main manifestations of CHF are hemorrhages in the skin, bleeding from the gums, nose, ears, uterus, stomach and intestines, which, in case of untimely treatment for medical help can be fatal. The very first symptoms of the disease begin, like in many viral infections, with a sharp rise in temperature and severe intoxication, accompanied by headache and muscle pain.

Who is susceptible to infection?

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

The most at risk are persons whose activities are related to their stay in the forest - workers caring for farm animals and growing crops, exploration parties, builders of roads and railways, oil and gas pipelines, power lines, surveyors, hunters, tourists. Townspeople become infected in suburban forests, forest parks, and garden plots.

How can you protect yourself from CHF?

CHF disease can be prevented with individual prevention.

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

To protect against ticks, repellants are used - repellents and insecticidal crayons, with which exposed areas of the body and clothing are treated.

Before using drugs, read the instructions.

Each person, being in the natural focus of CHF during the season of insect activity, should periodically inspect their clothes and body on their own or with the help of other people, and remove the identified ticks. Children under the age of 14 must be examined every 5 minutes, adolescents every 10 minutes, adults every 15 minutes.

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

In everyday life, the population can affect the decrease in the number of ticks by actively participating in the cleaning of the territory of summer cottages from last year's grass, dead wood, garbage, as well as the adjacent territory to summer cottage... For prophylactic purposes, it is recommended to carry out anti-mite treatments of farm animals, seeking help from veterinary workers. It is advisable not to allow grazing of farm animals on the territory of summer cottages, summer recreation facilities, school grounds, etc.

How to remove a tick?

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

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

When removing a tick, the following recommendations must be observed:

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

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

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

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

The removed tick must be taken for examination inThe removed tick must be placed in a tight-fitting bottle and delivered to laboratory of especially dangerous infections FBUZ "Center for hygiene and epidemiology in the Astrakhan region" at the address: st. N. Ostrovsky, 138, tel. 33-64-66, Monday-Friday from 9 am to 4 pm - for species identification.

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