Pulmonary edema in patients with hemorrhagic fever with renal syndrome]

Eight patients suffering from hemorrhagic fever with renal syndrome (HFRS) running a severe course complicated by pulmonary edema developed absolute hyperhistaminemia and hyperserotoninemia, histamine and serotonin accumulation in tissues. These amines inactivation in blood and lungs and excretion of catecholamines with urine got disturbed. High blood and lung tissue levels of biologically active substances resultant in enhanced permeability of the vascular wall and alveolar epithelium, hemodynamic disturbances due to hypoexcretory hypercatecholaminemia are thought to underlie the occurrence of this grave HFRS complication.     

Diagnosis of hemorrhagic fever with renal syndrome

The authors observed 22 patients with hemorrhagic fever with the renal syndrome (HFRS). The diagnosis turned out to be difficult in outpatient clinics as all the patients were referred to hospital with erroneous diagnoses. Epidemiological causes of infection of HFRS were indicated. The authors singled out 3 periods in a course of this disease with characteristic symptoms. The diagnosis was confirmed serologically in the reaction of indirect immunofluorescence, a 4-fold increase and over in antibody titer was observed. A case history was presented.     

肾综合征出血热肾脏的超声显像观察

目的 探讨肾综合征出血热(HFRS)的肾脏超声显像变化及其意义。方法 我院对95例HFRS患进行肾脏超声显像观察。结果 肾综合征出血热(HFRS)患的肾脏为主要受损器官，超声图像的改变具有一定的特异性，其改变特点为肾脏肿大。肾实质增厚，肾锥体高度增大类似肾囊肿，肾窦面积与肾面积比值下降，部分重型患出现肾周暗带。结论 HFRS患肾损害各期的声像图与其临床病理变化密切相关，超声能动态观察病情各期对肾损害的轻重，并能估计HFRS病情轻重，了解HFRS患的临床治疗效果及其预后。B超检查具有准确，迅速，方便及无痛苦的优点。     

辽宁省肾综合征出血热流行特征分析

目的探索辽宁省肾综合征出血热(HFRS)的流行规律,为制定防制策略提供科学依据。方法采用描述流行病学方法分析HFRS疫情,开展宿主动物监测,检测鼠密度和鼠带病毒率。结果 1962-2008年辽宁省累计报告HFRS病例53525例,年平均发病率为2.85/10万,死亡1042例,病死率为1.95%。家鼠型疫区不断扩大,混合型疫区逐年增加,病例地区分布由20世纪80年代的仅4个地区发展为现今病例覆盖全省14个市90%的县(区)。每年3-6月和11月至次年1月有2个流行高峰。年龄发病以15～60岁人群为主,职业以农民为主,约占70%。结论自21世纪初辽宁省HFRS疫情呈快速上升趋势,2005年以后由于在重点地区和人群中疫苗的大规模应用,疫情得到了有效遏制。     

3 cases of hemorrhagic fever with renal syndrome morbidity

Viral origin of hemorrhagic fever with renal syndrome (HFRS) is known since 40th years of last century. Also it is known that contamination of person is performed mainly by air pollution way. We observed a focus with 3 HFRS cases (with laboratory confirmation--antibodies to HFRS Hantavirus were found) in one family with one lethal outcome. Contamination of patients occurred by air pollution way during stocking vegetables contaminated with rodent's excrements. Lethal outcome was stipulated by incorrect diagnosis made by district doctor (nonmetering epidemiological anamnesis and HFRS territory endemicity and seasonal prevalence) which leaded to late hospitalization and absence of possibility to render all complex of treatment and reanimation in the hospital.     

Nervous system involvement in hemorrhagic fever with renal syndrome

The authors of the article describe two cases of hemorrhagic fever with renal syndrome (HFRS) with prevalence of signs of nervous system involvement. The first case was a 40-year-old woman with moderate HFRS, who developed Guillain-Barre syndrome of axonal-demyelinating polyneuropathy. An important observation was the absence of hemorrhagic or renal syndrome; combined therapy including plasmapheresis was successful. The second case demonstrated polymorphism of HFRS clinical manifestations with prevalence of neurological symptoms, which consisted in encephalopathy and no renal failure signs; hemorrhagic syndrome was moderate. In both cases the diagnosis was confirmed by elevated titer of antibodies to HFRS virus, belonging to the group of hantaviruses.     

Analysis of fatal outcome in hemorrhagic fever with renal syndrome

The analysis of 88 lethal outcomes of hemorrhagic fever with renal syndrome (HERS) showed the occurrence of adenohypophyseal hemorrhage and necrotic foci in 75.5% of cases as well as combined involvement of adenohypophysis and adrenals in 18.4%. Pathogenetically, adenohypophyseal affection is related to anatomical-physiological features of the vessels, microcirculatory disorders, acute venous congestion. Contributing factors may be acute DIC syndrome, relapsing and prolonged collapses, hyperhydration leading to brain edema and hemostasis. Uncontrollable vomiting recorded in all the deceased patients seemed to promote destruction of adenohypophysis. Clinically, this gross pathomorphology ++ was equivalent to severe form of the disease--hypopituitary coma. Proper prophylaxis of the above complications is one of the conditions entailing reduction of mortality in HFRS.