Hemorrhagic fever with renal syndrome (HFRS)

Hemorrhagic fever with renal syndrome (HFRS) is an acute interstitial nephropathy occurring mainly in Europe and Asia, it is caused by hantaviruses from the family Bunyaviridae and characterized by high fever and varying degrees of renal failure.

Pathogen – RNA virus genus Hantaan (Hantavirus).

Epidemiology

The source of infection – Rodents

Mechanism of transmission – alimentary, aerogenic, by means of contact. infection occurs most often by means of respiration of contaminated air-dust particles, in food and/or by contact with objects that have contaminated particles on their surface (from the rodents).

Clinical picture

Incubation period from 1-7 weeks. Start acute.

Intoxication syndrome, rise in temperature to reach 38 – 41 C in a week period, severe headache, chills, thirst, myalgia.

The Face is hyperemic, swelled, red eyes (vascular injection of the sclera and conjunctiva), the emergence of “visual disturbance” in the eyes.

Hemorrhagic syndrome starting from the 3rd day of illness, punctulated rash, petechial, in deep places, sometimes the rash presents in the form of chains and bands.

Hemorrhagic enanthema on the mucosa of the soft palate (2-4 days of illness), There may be bleeding in the sclera, nasal bleeding, uterine bleeding, gastric, or intestinal bleeding.

Renal syndrome:

Oliguric period from 3-4 till 8-11th days of disease: it is characterized by pain in the flanks, decreased urine output up-till anuria, increased intoxication when the temperature drops.

Polyuric phase (Полиурический период ) presenting in the period between 9-13th day of illness – characterized by reduced intoxication, increased urine output up to 6 – 8 liters per day, nocturia, Hyposthenuria (гипоизостенурия, urine with an osmolality less than that of plasma).

Complications: toxic shock, pulmonary edema, uremic coma, eclampsia, bleeding in the internal organs, bleeding, kidney rupture, bacterial infections.

Differential diagnosis

The differential diagnosis is carried out with the flu, typhoid and typhus, leptospirosis, pyelonephritis, acute glomerulonephritis, hemorrhagic vasculitis.

Laboratory diagnosis

In the analysis of blood leukopenia followed by neutrophilic leukocytosis, thrombocytopenia, increased erythrocyte sedimentation rate.

In urinalysis proteinuria, microscopic hematuria, iso-hyposthenuria, cylindruria, blood clots.

In the biochemical analysis signs of acute renal failure are present.

Serological diagnosis – ELISA, IFA.

Treatment

Causal treatment is not carried out.

Pathogenetic therapy of renal syndromes:

• NSAIDs or nonsteroidal anti-inflammatory drugs (indomethacin, etc…)
• Desagregants (chimes)
• Corticosteroids (prednisone)
• Detoxifying agents – infusion
• Angioprotectors (rutin, ascorbic acid)
• Glucose-novocaine mixture to reduce hyperkalemia

Symptomatic treatment:
Painkillers, sedatives.

Extracorporeal hemodialysis is considered with the development of severe acute renal failure.

Verified by: Dr.Diab (January 7, 2017)

Citation: Dr.Diab. (January 7, 2017). Hemorrhagic fever with renal syndrome HFRS. Medcoi Journal of Medicine, 8(2). urn:medcoi:article16211.