The epidemic hemorrhagic fever clinical manifestations

The incubation period of 5 to 46 days, Usually, one or two weeks. Typical performance of the disease have fever, bleeding and kidney damage three main symptoms, as well as fever, low voltage, oliguria, polyuria and recovery, and other five clinical process. The majority of cases presented is not typical, or an outstanding period, or a period which was not obvious, "the period" phenomenon, or the former two to three overlapping.
(1) fever period reflected mainly in STD toxaemia and capillary damage caused by systemic symptoms.
Most sudden chills fever, body temperature in the 1 to 2 days up to 39 ~ 40 ° C, thermal-to flip-and missed more generally sustained 3 to 7. There systemic poisoning symptoms, a high degree of fatigue, body pain, headache and severe low back pain, orbital pain, known as the "three pain." Cerebral vascular headache may be related to the expansion of congestive; low back pain and renal peripheral hyperemia and edema; orbital pain may be caused by eyeball surrounding tissue edema. Gastrointestinal symptoms are more prominent, and often a vibration of appetite, nausea, vomiting, abdominal pain and diarrhea, and so on. Weight may have sleepiness,and delirium, and so on. But heat systemic poisoning symptoms after a decline did not reduce or add to the contrary, the heat is different from other sexually transmitted diseases clinical characteristics.
Face, neck and the chest showed diffuse flushing, eyelid and facial swelling slightly, conjunctival hyperemia and hemorrhage can point with the ball and membrane swelling, like drunken appearance. The onset after 2 ~ on the 3rd soft palate congestive Obviously, a majority of small bleeding points. Two arms, the chest, neck, shoulder and other places are scattered in the skin, cluster or -shaped, cable of the kind of stasis. The heavy bruising,can throughout the body, and can occur epistaxis, hemoptysis, or bleeding cavity, said conditions heavier, more due to the DIC.
(2) primarily for hypotension period of hypovolemia stolen plasma shock performance.
Generally fever 4-6, the body temperature or cooling started to decline soon after patients low blood pressure, weight, shock. DIC-wide and can be, heart failure, water and electrolyte imbalance, the clinical manifestations of heart rate faster, the cooler acromegaly, reduced amount of urine,unrest consciousness, your lips and limbs, the end of cyanosis, shortness of breath, bleeding heavier. The current general continued 1 ~ 3, Severe up on the 6th over. And due to heart and kidney failure resulting in death, this period may also not obvious and quickly oliguria or urine period.
(C) oliguria period oliguria period of hypotension and often no obvious limits, the two often overlap or come one after another, but also there hypotension shock, directly from fever to enter oliguria period. 24 hours in 400 ml of oliguria, who was less than 50 ml of urine. This issue's main clinical manifestations azotemia, water and electrolyte imbalance. Also due to the accumulation of liquid in organizations large gap back to the blood circulation, resulting in high hemorrhagic syndrome.
Urinary weight within membrane bar or hematuria, this period often varying degrees of uremia, acidosis and electrolyte disorders (high potassium, hyponatremia and hypocalcemia) performance. With high hemorrhagic syndrome, pulse enrich powerful vein, sexual, such as hypertension and blood dilution. Weight can be associated with heart failure, pulmonary edema and cerebral edema. At the same time increase the bleeding tendency, common skin large and cavity bleeding, and so on. The current general sustained 2 - 5, the weight of urine were no longer than one week, and oliguria, and the severity of the current phase of parallel azotemia.
(4) Multi-stage renal tissue damage urine gradually restored, but because of renal tubular function has yet to absorb fully restored, which significantly increased urine output, a 24-hour urine volume of 300 ml for polyuria, polyuria 4000 to 10,000 ml above.
Polyuria Initially, azotemia, hypertension and high blood volume will continue to exist, even heavier. To increase urine output, the gradual disappearance of symptoms, blood pressure gradually descending. If urine output without more timely supplement water and electrolyte imbalance can occur electrolysis (hypokalemia, hyponatremia) and second shock. The current period of secondary infection-prone, most sustained one to two weeks, a small number for several months.
(5) With the recovery of renal function gradually restored to 3000 ml urine following, and he entered recovery. Concentrated urine dilution and the gradual return function, mental and appetite pick up gradually, gradually restoring strength. Normally take the 1 ~ March back to normal.
(6) clinical classification according to severity can be classified into four types:
1. Light ① temperature 39 ° C, poisoning symptoms light; ② normal blood pressure; ③ less bleeding; ④ lesser kidney damage and urinary protein in "+~++", no obvious oliguria period.
2. ① medium temperature in 39 ~ 40 ° C, poisoning symptoms heavier, which markedly extravasation; ② systolic blood pressure less than 12.0 Kpa (90mmHg), or pulse pressure is less than 3.5 Kpa (26mmHg); ③ skin, mucosal bleeding obvious; ④ kidney Loss Obviously, the urinary protein can reach "30", there are clear oliguria period.
3. Heavy ① temperature ≥ 40 ° C, extravasation of systemic poisoning symptoms and serious phenomenon, or a toxic psychiatric symptoms; ② systolic blood pressure less than 9.3 Kpa (70mmHg) or pulse pressure is less than 3.5 Kpa (26mmHg); ③ skin, mucosal bleeding more heavy. If skin, cavity bleeding; ④ serious kidney damage, oliguria sustained period in the 5th within or urine were closed on the 2nd within.
4. Critical in heavy type on the basis of the following are any serious syndrome. ① refractory shock; ② serious bleeding, a major organ hemorrhage; ③ extremely serious kidney damage, oliguria over five on the above, or urine closed two days more, or urea nitrogen more than 120 mg / dl and above; ④ heart failure, pulmonary edema; ⑤ central nervous system complications; ⑥ serious secondary infection.
(7) Rattus norvegicus-the clinical features of hemorrhagic fever
Compared with wild rats type, the more light-Rattus norvegicus, after more than five incomplete. Fever relatively shorter period, the majority of heat illness alleviate withdrawal, sleepiness failure rare, low back pain and no significant orbital pain, gastrointestinal symptoms lighter; hypotension and oliguria period of light or none; polyuria period and a shorter recovery period; hemorrhage , kidney damage and edema were less exudative; fewer complications, but the type of liver damage than wild rats apparent low mortality rate.
Complications
(1) cavity bleeding and intracranial hemorrhage, massive gastrointestinal bleeding can lead to shock, the prognosis serious hemoptysis can lead to suffocation; intracranial hemorrhage can produce sudden convulsions, coma.
(2) heart failure, pulmonary edema was particularly prevalent in the shock and oliguria period, in the short term and more sudden onset, severity, there are clear signs of high blood volume.
(3) Adult respiratory distress syndrome (ARDS) was particularly prevalent in the shock stage and oliguria hypotension period, due to shock pulmonary circulation were corrected after a high-pressure or pulmonary vascular permeability changes due to excessive fluid replacement, due to pulmonary edema. Patients with chest tightness, breathing extreme distress, displayed a dry tone of Romania, blood gas analysis can have a significant reduction in PaO2 prognosis serious, high mortality.
(4) secondary infection oliguria maximum duration of pneumonia complicated by urinary easy period, urinary tract infections, fungal infections, such as sepsis and