Hemorrhagic fever in children is a collective term that includes a number of diseases caused by various viruses, but with a common clinical picture. Hemorrhagic fever can be contracted only in certain places on our planet. In Russia, imported cases of infection are more often recorded.
Parents always need to assess the epidemic situation in a particular region before vacation.
The main causative agents of hemorrhagic fever
In modern medical literature, there are many types of hemorrhagic fever, and they differ in the causative agent of the infection. Basically, these are viruses that are similar in selective damage to certain tissues and organs of a person (the favorite localization of the lesion is the inner lining of blood vessels).
Let's analyze the causative agents of specific diseases. For example, Omsk hemorrhagic fever is caused by an RNA-containing virus from the genus arboviruses family Togaviridae... The source of the disease is small rodents, as well as water rats. Therefore, more often the disease is recorded in field workers, hunters, fishermen.
Omsk fever is observed in regions of Western Siberia. The carrier of the disease is a tick that parasitizes the infected host. A person can become infected through an insect bite, inhalation of the virus from the feces of rodents, and there may be a contact route of infection when interacting with a sick animal.
Crimean Congo Fever observed in the Republic of Crimea, as well as in the Caucasus region. The disease is caused by a neurovirus family Bunyaviridae... The source of infection is animals - mice, hares, goats, sheep, cows, horses, dogs. The carrier of the disease is a tick. The main route of infection is transmissible, that is, through insect bites.
Slightly different from the above dengue fever... Outbreaks of infection are recorded in territories with a tropical climate, therefore, only imported cases of the disease are observed in Russia. This type of hemorrhagic fever is caused by the dengue virus, which has several varieties of serovars. The source of the disease is various animals, bats, as well as a sick person. The disease is transmitted by mosquitoes. Infection occurs through the bite of an infected insect.
Children under 2 years of age are most susceptible to Dengue hemorrhagic fever.
Lassa fever cause viruses family Arenaviridae... The source of infection is usually mice, but it can also be a sick person. The disease develops after the virus enters the body of a healthy person by airborne droplets (with accidental inhalation of the pathogen from animal feces), contact (while using a personal hygiene item with a sick person), as well as sexually.
The causative agent of hemorrhagic fever Marburg is a virus of the same name, which belongs to the filovirus family and has an RNA-containing structure. Cases of infection from monkeys and sick people are described. The mechanism of infection is the same as for Lassa fever.
The virus that causes hemorrhagic Ebola fever similar to the causative agent of Marburg, differs only in antigenic structure. The virus is transmitted mainly by contact from sick animals and people. Airborne droplets are not possible with this type of fever.
Ebola can be contracted not only from living animals and people, but also from the dead.
Classification of the disease
There are several types of classifications in modern literature. Let's analyze one of them.
Mosquito bite hemorrhagic fevers
These include:
- yellow fever;
- Rift fever;
- Dengue hemorrhagic fever.
Hemorrhagic fevers caused by tick bites
These include:
- fever Crimea-Congo;
- Omsk hemorrhagic fever.
Highly contagious hemorrhagic fevers
These include:
- fever with renal syndrome;
- Ebola fever;
- Lassa fever;
- fever Marburg.
Stages of hemorrhagic fever
The stage of hemorrhagic fever characterizes the mechanism of the development of the disease at one time or another. All types of fevers go through the same stages of the pathological process, differing from each other only in their duration.
The first stage is the incubation period, which lasts from 1 to 3 weeks depending on the type of hemorrhagic fever. Then comes period of initial manifestations, lasting from 2 days to a week. This stage has nonspecific manifestations of the disease. Further, the disease manifests itself peak period (1 - 2 weeks). During this stage, the formation of complications of the disease is possible.
After comes recovery period, or the stage of convalescence... The duration of this stage depends on the type of fever and the severity of the disease. But the minimum is 1 week.
Manifestations. Symptoms and syndromes
The symptoms of hemorrhagic fever also vary according to the type of illness. It is necessary to remember about the features of the clinical picture of each fever separately.
Omsk hemorrhagic fever
The incubation period is 3 to 7 days. This type of disease has its own forms: recurrent and non-recurrent, typical and atypical. The course of fever can be mild, moderate, severe.
The typical clinical picture is the existing hemorrhagic syndrome - the main syndrome for all types of fevers. The disease begins acutely, with a temperature rise of up to 40 ºC. Symptoms of intoxication develop: weakness, lethargy, headache, impaired appetite, nausea.
Then there is swelling of the face, neck, reddening of the mucous membrane of the oropharynx, as well as the sclera. After some time, a hemorrhagic rash appears on the skin of the body and limbs, as well as on the mucous membrane of the oral cavity. With Omsk hemorrhagic fever, bleeding may develop. But they usually do not pose a threat to life.
During the peak period, manifestations of damage to various organs and systems appear. The formation of bronchitis and pneumonia is more often observed. Also, the nervous system is damaged, which is manifested by the appearance of cerebral symptoms, paresis, during the examination, the doctor observes meningeal signs. Blood pressure is low in many patients. On palpation of the abdominal cavity, an enlarged liver is observed.
An interesting fact is that the temperature rises in 2-3 weeks. The disease lasts no more than 40 days. In the period of recovery phenomena, weakness and lethargy are observed. Complications can be the addition of a secondary infection, neurological disorders. Death is possible from massive blood loss or from toxic shock.
Crimean Congo Fever
In this case, the incubation period depends on the type of infection (with an insect bite, the disease manifests itself faster than with contact with a sick animal or person). The period of initial manifestations is also not specific, as in the case of Omsk fever.
Further pain syndrome is formed. Patients may be disturbed by pains of various localization and severity. On examination, there is redness and swelling of the face and neck, attention is drawn to the dryness of the mucous membrane of the oropharynx. Neurological disorders include agitation, fear of light, depression, aggressiveness.
During the peak period, the main manifestation is hemorrhagic syndrome. Its severity can be different from a hemorrhagic rash to cavity bleeding. Against the background of the latter, the condition of patients deteriorates sharply, there is an increase in heart rate, pallor, lethargy, and blood pressure decreases. Against the background of a severe course of the disease, convulsions, confusion of consciousness, up to coma may develop.
The recovery period is quite long, in which weakness can disturb patients up to 2 years.
Dengue fever
There are 2 variants of the course of the disease: classic and hemorrhagic. The incubation period lasts from 3 days to 2 weeks. Until the peak period, the patient may be disturbed by malaise, weakness, headache, catarrhal symptoms.
The classical form is characterized by an acute onset and an increase in temperature to hyperexia. Pain syndrome appears. On examination, there is an increase in lymph nodes, redness of the mucous membrane of the oropharynx and sclera. The temperature drops for a while and then rises again.
Hemorrhagic syndrome develops at the height of the fever. The rash is polymorphic, and localization can be different. In patients, peeling and itching are noted. The peak period can last up to 10 days.
The hemorrhagic form is a more dangerous form, since cavity bleeding may occur on the 5th day. Against the background of them, shock often develops, which increases the risk of death.
Lassa hemorrhagic fever
The disease begins either gradually or acutely. The temperature rises to high numbers. Against the background of fever, symptoms of intoxication appear. Patients complain of weakness, lethargy, and malaise. At the same time, changes appear in the oropharynx. There are complaints of a sharp sore throat. On examination, the doctor can detect a sharp hyperemia of the mucous membrane of the oropharynx and palatine tonsils.
A distinctive feature of Lassa hemorrhagic fever is an increase in symptoms that can lead to dehydration. These signs include vomiting, stool disorders. You need to be especially careful with young children, as they develop dehydration more quickly.
Along with this, hemorrhagic syndrome is also observed, which also has a varying degree of severity: from hemorrhagic rash to cavity bleeding. Perhaps the development of cerebral symptoms and the appearance of meningeal signs. On examination, the signs of Lassa fever are very similar to previous types of the disease.
Lassa fever is a particularly dangerous infection, because the disease has a high incidence of severe disease and death. Death often occurs 2 weeks after the onset of the disease. Children under 2 years of age and pregnant women are most susceptible to adverse outcomes.
Marburg hemorrhagic fever
The disease begins acutely with a rise in temperature to high numbers, lasting up to 2 weeks. At the same time, patients develop symptoms of intoxication. Nausea, vomiting, diarrhea are also possible. In this situation, it is important to prevent dehydration of the body.
When examining the patient, a rash on the mucous membrane of the oropharynx or erosive changes can be detected. After 5-7 days, the patient develops rashes on the entire skin. And bleeding is also possible. Against the background of the disease, organs and systems are affected.
Death is possible at 2 weeks of illness from cerebral edema, renal failure. Patients with a more favorable prognosis recover for a long time during the period of convalescence.
Ebola hemorrhagic fever
The disease also develops acutely with a sharp rise in temperature. Signs of hemorrhagic fever vary. Intoxication symptoms, cough, chest pain, muscle weakness. Rashes are not detected in all patients.
Bleeding indicates an unfavorable course of the disease. At the same time, there is a decrease in kidney and liver function. An interesting fact is that if the patient does not recover after 2 weeks from the onset of the disease, then most likely death will occur.
Diagnostic methods
Diagnosis of the disease is based on a thorough history taking, examination of the patient and laboratory data. When talking with a patient, it is important to clarify the place where he was in the near future. By localization, you can assess the epidemic situation in the area. It is also necessary to clarify whether there has been contact with animals or infected people.
Blood tests
Laboratory data may vary depending on the type of fever.
But most are characterized by features in blood tests:
- a decrease in the number of leukocytes and platelets in the general blood test;
- a decrease in the concentration of hemoglobin;
- increased erythrocyte sedimentation rate;
- changes in the coagulogram (increased prothrombin index and activated partial thromboplastin time).
Crops
To establish the correct diagnosis, a culture of urine, blood is required to determine the causative agent of the disease. Also, special methods are used to detect the virus: polymerase chain reaction, detection of antibodies and an increase in their titer. To determine the function of various organs, dynamic monitoring of their condition using instrumental diagnostics is required.
Treatment of hemorrhagic fever in children and adults
Timely treatment is one of the most successful principles of therapy.
Patient isolation and regimen
If hemorrhagic fever is suspected, the patient should be immediately isolated and hospitalized in the infectious diseases department. In the hospital, the patient is placed in a special separate box with a separate exit to the street. Contact is also monitored.
The disease is highly contagious (contagious), therefore, medical personnel must comply with all sanitary and anti-epidemic rules and have special protective clothing.
The patient's diet is prescribed a gentle, fortified, easily digestible. That is, the products should be wiped warm.
Drug groups
Etiotropic therapy for hemorrhagic fever has not yet been developed. Therefore, the treatment is symptomatic. Antipyretics are shown to absolutely everyone, since with hemorrhagic fever, the temperature always rises to high values.
If hemorrhagic syndrome is present, vitamin K should be given to reduce the risk of bleeding. When bleeding begins, patients are often given the introduction of erythrocyte mass. The development of a state of shock involves the administration of glucocorticosteroids.
Infusion therapy is indicated for almost everyone. Particular attention is paid to patients with dehydration due to repeated vomiting and watery diarrhea. With severe pain syndrome, antispasmodic and analgesic drugs are indicated.
Also, along with the treatment of the main symptoms, treatment of complications should be carried out.
Antibiotic therapy is indicated for the layering of a bacterial infection. With the development of acute renal failure, when renal function is rapidly declining, hemodialysis may be prescribed to patients (to cleanse the body of harmful toxins).
Convalescence period
The recovery period in patients with hemorrhagic fever is quite long. Patients should be supervised, and also adhere to bed rest. During the recovery period, medications are used depending on the patient's condition.
Complications of hemorrhagic fever
Complications of hemorrhagic fever are not uncommon. They can be very diverse.Most often develop against the background of the disease: uveitis, orchitis, testicular atrophy, infertility, encephalitis, meningitis, otitis media, pneumonia, neurological disorders.
Against the background of reduced immunity, under the influence of a viral infection, the body is more susceptible to the addition of secondary flora, therefore, complications are often bacterial in nature. It is also important to note that the virus irreversibly infects organs, therefore, even after recovery, the function of many systems suffers.
Forecast for life and recovery
There is no general prognosis for all hemorrhagic fevers. Anyone can be fatal. Early detection of the disease and timely medical care significantly improve the prognosis. But the body can react to a disease in different ways.
Cavity bleeding, complications of the underlying disease and shock conditions significantly worsen the prognosis. Also, the fact that there is no etiotropic treatment for the disease is an adverse event.
Preventive actions
Hemorrhagic fever vaccination is in clinical trials. Of course, there is already a vaccine against some species, but specific prevention in this case is not fundamental.
Prevention of hemorrhagic fevers should primarily have a non-specific focus. This option of prevention consists in the destruction of vectors, as well as animals that act as a reservoir of infection. Endemic areas must be especially careful about their surroundings. It is important to control the level of contamination of food and water, and also to avoid contact of food with animals.
Travelers should always pay attention to diseases that may occur in the territory considered for recreation. If a vaccine is available, specific prophylaxis should be made. On vacation, try not to contact with wild animals, to process the skin from insect bites.
It is especially important to supervise children, as they are at a special risk group. It is important to always process food before eating, especially vegetables and fruits. You should not drink water from questionable sources. It is imperative for people working in endemic areas to comply with personal safety measures. On the fields during working hours, use thick clothing, boots and gloves. Also, do not forget about insect repellents.
Conclusion
Hemorrhagic fever is a very contagious disease, regardless of the type of pathogen. There are many types of fevers and all of them are very dangerous to life and health. It is important to understand that the likelihood of infection depends only on the person himself. Compliance with the rules of personal hygiene is one of the most important measures that can prevent infection with a dangerous infection.
The danger of the disease lies in the fact that absolutely everyone is susceptible to fever viruses, regardless of gender and age. The death rate from hemorrhagic fever has a very high percentage. It is also overshadowed by the fact that no specific treatment for the disease has been developed.
But nevertheless, if you suspect a disease, you must immediately seek medical help. Consultation with a specialist will not only help the patient to cope with the infection, but also reduce the risk of infection in other healthy people.
