Crimean hemorrhagic fever, also called Crimean-Congo hemorrhagic fever or CCHF, is an acute infectious disease that occurs in 2 stages, accompanied by muscle and headaches, intoxication of the body, hemorrhages on the skin and internal organs, increased bleeding (hemorrhagic syndrome) . The Crimean-Congo fever virus is transmitted through tick bites. The fever was first learned about in 1944, respectively, in Crimea. A little later, the same clinical picture and the same symptoms were recorded by doctors in the Congo, hence the name. And in 1945, scientists were able to identify the causative agent of the disease.

The method of transmission of Crimean hemorrhagic fever is most often transmissible, that is, the method in which the infection is in the blood or lymph. In addition, the disease is transmitted by contact - for example, when a tick is crushed on the skin and infected particles get on the wounds; aerogenously – in the presence of a virus in the air; Infection in medical institutions occurs due to poor handling of instruments and secondary use of syringes and needles.

The virus infects the endothelium of blood vessels, causing disorders of blood clotting and blood formation, and can also cause disseminated intravascular coagulation syndrome (a hemorrhagic diathesis that causes excessive acceleration of intravascular coagulation). This disease leads to hemorrhages in the internal organs, the central nervous system, as well as bruises on the skin and mucous membranes.

Symptoms

The asymptomatic period, which is called the incubation period, of Crimea-Congo fever takes on average from 2 to 14 days. The length of the incubation period varies depending on the method of infection of the patient. If the infection occurred due to the bite of a blood-sucking insect, then the incubation period lasts 1-3 days, if transmitted by contact, then 5-9 days. Symptoms can range from mild to very severe. To this we must add that the disease occurs in 3 periods - incubation, initial (pre-hemorrhagic) and hemorrhagic.

The initial period occurs after the incubation period. The temperature rises to 40 degrees, dizziness, chills, and weakness begin. Patients are worried about headaches, discomfort in the abdomen and lower back, myalgia (muscle pain that occurs due to cell hypertonicity both in a calm and tense state) and arthralgia (pain in the joints in the absence of visible joint damage). Also symptoms are: dry mouth, increased blood flow to the conjunctiva, neck, mucous membrane of the pharynx and face, possible nausea and vomiting. Possible surges of aggression, anger, and excitement. These symptoms are replaced by the opposite - fatigue, drowsiness, depression. Before the start of the second wave of fever, the body temperature drops to subfebrile (a constant temperature that ranges from 37.1 to 38.0 degrees).

Hemorrhagic period - at the height of Crimea-Congo fever, hemorrhagic manifestations begin to appear. Among them: exanthema (petechial rash on the skin), enanthema (rash that occurs on the mucous membranes of the mouth), purpura or ecchymoses, bruising after injections, coughing up blood, nosebleeds, in extreme cases, abdominal bleeding occurs, which can be gastric, uterine or pulmonary . Inflammatory damage to the lymph nodes or an increase in the size of the liver may appear. Other symptoms include convulsions, coma, and confusion.

Consequences of Crimean hemorrhagic fever

With timely treatment and the absence of complications, hemorrhages (bleeding) disappear after 4-7 days. The recovery process begins on the tenth day of the disease and takes approximately one and a half months. Psychopathic disorder after illness lasts for more than a year. The positive factor is that immunity to infection appears, which persists for another 1-2 years after the disease.

Complications after Crimea-Congo fever:

• pulmonary edema;
• renal and liver failure;
• thrombophlebitis (inflammation of the internal venous wall with the formation of a blood clot);
• infectious-toxic shock;
• pneumonia.

There is a risk of death, it is 4-30%; if death occurs, it occurs in the second week of the disease.

Diagnosis of Crimean hemorrhagic fever

Diagnosis is based on the following:

1. Clarification of epidemiological data - the possibility of the patient staying in places with an increased risk of infection, seasonality is taken into account.
2. Study of clinical signs - symptoms and features of the course of the disease.
3. Laboratory test results - general urine and blood analysis, enzyme immunoassay, PCR (polymerase chain reaction) and RNHA (indirect hemagglutination reaction).

During diagnosis, a lack of red blood cells, leukopenia, thrombocytopenia, and neutropenia are detected in the patient’s blood.

The examination and all contacts with patients must comply with strict sanitary standards and infection safety.

Treatment of Crimean hemorrhagic fever

Even if Crimea-Congo fever is suspected, immediate hospitalization and isolation of the patient is necessary.

It is important for the patient to adhere to bed rest and diet; in combination, the patient is prescribed vitamin therapy.

As treatment, it is possible to use convalescent immune serum and hyperimmune γ-globulin. In addition, the patient is prescribed antiviral drugs that have a therapeutic effect: alpha interferon, ribavirin.

At the beginning of treatment, hemostatic and detoxification therapy is carried out, and blood transfusions are performed. When diagnosing infectious-toxic shock, glucocorticosteroids are prescribed.

Prognosis for Crimean hemorrhagic fever

If the fever develops rapidly, moreover, has acute symptoms, the risk becomes serious. Serious complications can occur, and in extreme cases, death. But most often, with timely and correct treatment, the prognosis is favorable.

Prevention of Crimean hemorrhagic fever

The main way to protect yourself from Crimea-Congo fever is to beware of tick vector bites. To do this, you need to use sprays and ointments against ticks, wear protective clothing and shoes, use repellents, and regularly conduct self-examinations if you are outdoors.

Hospitals must adhere to hygiene and sanitary standards. This includes high-quality processing of instruments, the use of only disposable syringes, and compliance with the rules when working with the patient’s secretions and blood. There is no vaccine against Crimean hemorrhagic fever.

To summarize, CCHF is a severe viral disease that requires immediate hospitalization and treatment. The disease is most often transmitted by ticks. If you follow some rules, infection can be avoided. Particular care must be taken in medical institutions; sometimes you can take control into your own hands, since the human factor can never be ruled out: even doctors can be negligent in their work. It is worth noting that this disease is highly not recommended to be treated with traditional methods; at best they are useless, at worst they are harmful. Self-medication is also not allowed, as this can cause irreparable harm to your condition.

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Crimean hemorrhagic fever (CHF)- an acute, dangerous, zoonotic, naturally focal viral infectious disease with a transmissible mechanism of pathogen transmission, characterized by generalized vascular damage, hemorrhagic syndrome, intoxication and severe course.

History and distribution

The disease was described by M.P. Chumakov in 1945-1947, who discovered its causative agent. Since 1945, cases of the disease have been detected, in addition to Crimea, in the Krasnodar and Stavropol territories, Rostov and Volgograd regions, Central Asia, and a number of countries in Eastern Europe, Africa and Asia. A related virus was isolated in 1967-1969. in the Congo, however, it rarely causes disease in humans, and it is not accompanied by a hemorrhagic syndrome.

CCHF occurs in sporadic cases and small outbreaks. Serological and virological studies have shown that natural foci exist for a long time in which the virus constantly circulates, but clinically significant cases of CCHF are not recorded.

Etiology

The causative agent of CCHF belongs to the bunyavirus family, genus Nairovirus, contains RNA, is resistant to freezing and drying. Heat labile, sensitive to chlorine-containing disinfectants.

Epidemiology

Natural foci are formed in steppe, forest-steppe and semi-desert areas with a warm climate and developed cattle breeding. The source of the pathogen is cattle and wild mammals, the main carrier is the ixodid tick of the genus Hyalomma. Ticks transmit the virus transovarially to their offspring, and therefore serve as a reservoir of the virus. Sick people also pose a danger to others, especially during periods of bleeding, since their blood contains the virus.

Infection is possible when caring for a patient and getting his blood on the skin and mucous membranes. Cases of infection of medical workers, family members and laboratory workers working with blood and secretions of patients have been described. In cases of infection from patients, the disease is more severe. Susceptibility to CCHF is high. Repeated cases of the disease have not been described. The incidence is seasonal with a peak in June-July.

Pathogenesis

From the site of the bite, the virus spreads hematogenously and is fixed by vascular endothelial cells, where it replicates, which is accompanied by cell damage and the development of generalized vasculitis. The vessels of the microvasculature are most affected. The permeability of the vascular wall increases, the hemostasis system is activated with the consumption of blood clotting factors (consumption coagulopathy), which leads to the development of hemorrhagic syndrome. The virus also multiplies in the epithelial cells of the liver and kidneys, causing their damage.

Pathomorphology

Multiple hemorrhages are detected in the skin, mucous and serous membranes. Particularly characteristic are hemorrhages in the mucous membrane of the stomach and small intestine. The stomach, small and large intestines contain liquid blood. In the liver, hemorrhages, degeneration and necrosis of hepatocytes are detected, in the kidneys - degeneration and necrosis of the tubular epithelium, in all organs - hemorrhages, microcirculation disorders. The vessel wall is swollen, endothelial cells are swollen. There are dystrophic changes and necrosis.

Main reason deaths- massive bleeding. Death can also occur as a result of ITS, pulmonary edema, and secondary bacterial complications.

Clinical picture

The incubation period is from 2 to 14 days, more often 3-5 days. The disease occurs cyclically. There is an initial period (pre-hemorrhagic), a period of height (hemorrhagic manifestations) and a period of convalescence. Depending on the presence of hemorrhagic syndrome and its severity, CCHF without hemorrhagic syndrome and CCHF with hemorrhagic syndrome are distinguished. CCHF without hemorrhagic syndrome can occur in a mild to moderate form. CHF with hemorrhagic syndrome occurs in mild, moderate and severe forms.

In mild cases of CCHF with hemorrhagic syndrome, there are hemorrhages on the skin and mucous membranes. There is no bleeding. In the moderate form, in addition to hemorrhages, light bleeding is observed. Most often, a severe course of the disease is noted, which is characterized by heavy repeated bleeding.

The disease begins acutely with severe chills and an increase in body temperature to 39-40 °C. Patients complain of headaches, muscle and joint pain, abdominal and lower back pain, and dry mouth. Vomiting occurs frequently. Characterized by severe hyperemia of the face, neck, upper chest, injection of blood vessels in the sclera and conjunctiva. Heart sounds are muffled.

Hypotension and relative bradycardia and liver enlargement are observed. On the 3-6th day of illness, body temperature decreases briefly. At the same time, the patients' condition progressively worsens. A hemorrhagic rash appears, often on the abdomen, lateral surfaces of the chest, hemorrhages in the mucous membranes of the eyes, bleeding of the oral mucosa, nasal, gastrointestinal, uterine and renal bleeding, which are characterized by duration, recurrence and significant blood loss. During this period, pallor of the skin, subicteric sclera, cyanosis, tachycardia, severe hypotension up to collapse are noted. Possible lethargy, disturbances of consciousness, convulsions, meningeal syndrome.

The total duration of fever is about 7-8 days. After a lytic decrease in body temperature, the condition of patients begins to slowly improve. The convalescence period is 1-2 months or more.

Blood tests reveal pronounced leukopenia up to 1.0.10⁹/L, thrombocytopenia, often azotemia, and metabolic acidosis. When examining urine, proteinuria and hematuria are revealed, the density of urine is reduced.

Complications: ITS, hemorrhagic shock, pulmonary edema, acute renal failure, pneumonia and other bacterial complications, thrombophlebitis.

Diagnosis and differential diagnosis

The diagnosis is established on the basis of epidemiological (tick bite, contact with a patient) and clinical (intoxication, two-wave fever, hemorrhagic syndrome, leuko- and thrombocytopenia) data. However, in the absence or mild severity of hemorrhagic syndrome, it is necessary to use virological (isolation of the virus from the blood) and serological (RSC, RPHA) methods.

Differential diagnosis is carried out with other hemorrhagic fevers, meningococcemia, leptospirosis, sepsis, septic form of plague and generalized form of anthrax.

Treatment

Patients are subject to emergency hospitalization. In the early stages of the disease, convalescent serum or plasma is effective in a dose of 100-300 ml intravenously, as well as specific equine immunoglobulin in a dose of 5.0-7.5 ml.

Detoxification therapy is also carried out, hemostatic agents and antiplatelet agents are used. In case of significant blood loss, transfusion of blood, red blood cells, platelets, and blood substitutes is indicated.

Forecast

With transmissible infection, the mortality rate is about 25%, and with infection from patients it reaches 50% or more.

Prevention

The main areas of prevention are protection against tick bites and prevention of infection from sick people. Patients are subject to strict isolation. When caring for them, you must work in rubber gloves, a respirator or gauze mask, and safety glasses. Only disposable needles, syringes, and transfusion systems are used. The discharge of patients is disinfected.

Yushchuk N.D., Vengerov Yu.Ya.

The Office of Rospotrebnadzor for the Astrakhan Region informs that favorable climatic conditions in the region contribute to the activation of insects, including ticks, which are carriers of Crimean hemorrhagic fever (CHF) and Astrakhan rickettsial spotted fever (ARSF).

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

As of July 6, 2018, 2,050 victims of tick bites, including the vector KGL-524, contacted medical organizations in the Astrakhan region. Of all those who applied, 42.3% were children under 14 years of age (867 people).

As of July 6, 2018, 6 cases of CCHF disease were registered in the Astrakhan region: in Astrakhan - 1 case and in 4 districts of the region: Narimanovsky - 1 case, Kharabalinsky - 2 cases, Krasnoyarsk - 1 case. and Privolzhsky - 1 word. All patients 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 transmissible mechanism of infection. Translated from Latin, hemorrhage means bleeding.

How can you get infected?

Infection of humans with CCHF occurs mainly through the bite of a carrier, by crushing ticks removed from domestic animals with hands, as well as by contact with the blood of patients with CCHF (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 the 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, and vomiting. Muscle pain bothers me. The main manifestations of CCHF are hemorrhages in the skin, bleeding from the gums, nose, ears, uterus, stomach and intestines, which, if not promptly sought medical help, can lead to death. The first symptoms of the disease begin, like many viral infections, with a sharp increase in temperature and severe intoxication, accompanied by headache and muscle pain.

Who is susceptible to infection?

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

Those most at risk are those whose activities involve staying in the forest - workers caring for farm animals and growing crops, geological exploration parties, builders of roads and railways, oil and gas pipelines, power lines, topographers, hunters, tourists. City dwellers become infected in suburban forests, forest parks, and garden plots.

How can you protect yourself from CCHF?

CCHF disease can be prevented by individual prevention.

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

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

Before using the drugs, you should read the instructions.

Each person, being in a natural focus of CCHF during the season of insect activity, should periodically inspect his clothing and body independently or with the help of other people, and remove any identified ticks. Children under 14 years of age must be examined every 5 minutes, adolescents - every 10 minutes, adults - every 15 minutes.

Persons who find an attached tick should be under the supervision of specialists from the medical network for 2 weeks. Daily thermometry and timely consultation with 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 influence the reduction of tick numbers by actively participating in clearing the territories of summer cottages from last year's grass, dead wood, garbage, as well as the adjacent territory to the summer cottage. For preventive purposes, it is recommended to carry out anti-tick treatments on farm animals by seeking help from veterinarians. It is advisable to prevent grazing of farm animals on the territory of summer cottages, summer health institutions, school playgrounds, etc.

How to remove a tick?

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

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

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

Grab the tick with tweezers or fingers wrapped in clean gauze (cellophane) as close to its oral apparatus as possible and holding it 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 suitable product (70% alcohol, 5% iodine, cologne),

After removing the tick, wash your hands thoroughly with soap and water.

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

The removed tick must be taken for examination toThe removed tick must be placed in a tightly closed bottle and delivered to Laboratory of Particularly Dangerous Infections of the Federal Budgetary Institution of Health "Center for Hygiene and Epidemiology in the Astrakhan Region" at the address: st. N. Ostrovsky, 138, tel. 33-64-66, Monday-Friday from 9 a.m. to 4 p.m. - for species identification.

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

Crimean hemorrhagic fever has an incubation period of 2-14 days (on average 3-5).

There are three clinical forms of the disease:

• Crimean hemorrhagic fever with hemorrhagic syndrome;
• Crimean hemorrhagic fever without hemorrhagic syndrome;
• inapparent form.

Crimean hemorrhagic fever without hemorrhagic syndrome can occur in mild and moderate forms; with hemorrhagic syndrome - in mild, moderate and severe forms. The course of the disease is cyclical and includes the following periods:

• initial period (pre-hemorrhagic);
• period of height (hemorrhagic manifestations);
• period of convalescence and long-term consequences (residual).

The initial period lasts 3-4 days; symptoms of Crimean hemorrhagic fever appear, such as: a sudden rise in temperature, severe headache, aches and pains throughout the body (especially in the lower back), severe weakness, lack of appetite, nausea, and vomiting not associated with food intake; in severe cases - dizziness and impaired consciousness. Hypotension and bradycardia are also detected.

During the height of the disease (2-4 days of the disease), a short-term decrease in body temperature is detected (within 24-36 hours), and then it rises again and on the 6-7 days begins to decrease lytically (“two-humped” temperature curve) ; hemorrhagic syndrome develops in the form of a petechial rash on the lateral surfaces of the chest and abdomen, hemorrhages at injection sites, hematomas, bleeding gums, bloody discharge from the eyes and ears, as well as nasal, pulmonary, gastrointestinal and uterine bleeding. The patient's condition sharply worsens: symptoms of intoxication are pronounced, muffled heart sounds, arterial hypotension, bradycardia is replaced by tachycardia, the liver enlarges. They reveal lethargy, adynamia, sometimes stupor and confusion, less often - agitation, hallucinations, delirium. Meningeal symptoms are often pronounced (stiff neck, Kernig's sign), transient anisocoria, pyramidal signs, and convergence disorder are detected. Patients have a characteristic appearance: the pharynx, face, neck and upper chest are hyperemic; sclera injected; enanthema is pronounced on the soft palate and mucous membrane of the oral cavity; Jaundice rarely occurs. The severity and outcome of the disease are determined by the severity of the hemorrhagic syndrome. Jaundice in combination with other manifestations of liver damage are poor prognostic symptoms of Crimean hemorrhagic fever. The dominance of hepatitis in the clinical picture can lead to death.

The convalescence period is long (from 1-2 months to 1-2 years or more); begins with the normalization of body temperature and the cessation of manifestations of hemorrhagic syndrome. This period is characterized by the following symptoms of Crimean hemorrhagic fever: asthenovegetative disorders: weakness, fatigue, dizziness, headaches and heart pain, injection of scleral vessels, hyperemia of the oropharyngeal mucosa, hypotension and pulse lability (persist for 2-3 weeks).

Contents of the article

Crimean hemorrhagic fever(synonyms for the disease: Acute infectious capillary toxicosis, Crimean-Congo hemorrhagic fever) is an acute natural focal infectious disease, which is caused by a virus, transmitted by ticks, characterized by high, often two-wave fever with severe hemorrhagic syndrome, thrombocytopenia.

Historical data of hemorrhagic fever

The first cases of Crimean hemorrhagic fever were identified in the steppe regions of the Crimean region in the summer of 1944 among the population engaged in haymaking and harvesting. For the first time, the clinical and epidemiology of the disease was studied in detail by A. A. Kolachov, Y. K. Gimelfarb, 1. R. Drobinsky, V. M. Domracheva. The disease was tentatively named “acute infectious capillary toxicosis.” Expedition led by Academician M.P. Chumakov in 1944-1945 pp. established the viral etiology of the disease.

Etiology of hemorrhagic fever

The causative agent of CHF-virus belongs to the genus Najarovirus, family Bunyaviridae, and contains RNA. Virions have two glycoproteins on the surface of the envelope and a nucleocapsid protein, as well as a large protein that probably has transcriptase activity. Glycoproteins determine high pathogenic properties.

Epidemiology of hemorrhagic fever

The source of infection for CHH are wild and domestic animals - cows, sheep, goats, hares, African hedgehogs, etc. The reservoir and carrier of the virus are about 20 species of ticks with transovarial transmission of the pathogen. A typical carrier of the pathogen is ixodid ticks. In Crimea it is Hyalomma plumbeum.
The mechanism of infection is transmissible through the bite of an infected tick. Infection is possible through contact with infected blood of sick people (nosocomial, family) and animals, and in laboratory conditions also through aerogenic means. Mostly livestock breeders, shepherds, milkmaids, veterinarians, etc. get sick. After an illness, viscospedic immunity remains. In endemic areas, the incidence is seasonal - March - September (the period of tick activity) and increases during the period of agricultural work (July - August). CHH is observed in the steppe regions of Crimea; isolated cases occur in the Odessa and Kherson regions of Ukraine. According to some scientists (M.P. Chumakov), hemorrhagic fevers of Central Asia are identical to CHH.

Pathogenesis and pathomorphology of hemorrhagic fever

The virus enters the body through the skin when bitten by an infected tick. This leads to viremia, which lasts throughout the incubation period and the first 3-5 days of the febrile period. Viremia is associated with infectious-toxic manifestations of the initial period, damage to the autonomic nervous system, especially vascular nerves. The CHG virus directly affects the vascular wall, increasing its permeability. Disturbances occur in the blood coagulation system, and DIC syndrome develops. Viremia also leads to damage to the bone marrow (thrombocytopenia and other signs) and liver. At autopsy, numerous hemorrhages and serous-hemorrhagic impregnation are found in almost all organs. The liver, kidneys and autonomic ganglia also show degenerative changes.

Hemorrhagic fever clinic

The incubation period lasts 2-14, on average 3-7 days. At the site of the tick bite, a feeling of heat appears, and subsequently itching. The disease begins acutely, with chills, body temperature rises to 39-40 ° C, headache is observed, as well as pain in the muscles, joints, abdomen and lumbar region, and sometimes vomiting. Patients are apathetic, some may experience psychomotor agitation. The skin of the face, neck, and upper chest turns red; at the same time, hyperemia of the conjunctiva and pharyngeal mucosa appears. It turns out there is arterial hypertension, relative bradycardia. On the 3-6th day of illness, often after a short, for 1-2 days, decrease in body temperature (two-wave temperature curve), most patients experience symptoms of hemorrhagic diathesis. A hemorrhagic rash appears on the skin, which is most significant on the lateral surfaces of the torso, abdomen, limbs, axillary and groin areas, as well as at injection sites (hematomas). In severe cases, hemorrhagic purpura and ecchymoses are found on the skin.
If the course is mild, the rash is sometimes non-hemorrhagic in nature and resembles erythema macular or roseola. The Konchalovsky-Rumpel-Leede (tourniquet) and Hecht-Moser (pinch) signs are not always present. 1-2 days before the rash appears, a small enanthema often appears on the mucous membrane of the soft palate, sometimes hemorrhagic.
In cases of severe disease, bleeding of the mucous membrane of the gums, mouth, tongue, conjunctiva, nosebleeds, hemoptysis, metrorrhagia, and gross hematuria appears. A severe prognostic sign is massive gastrointestinal bleeding. Changes in the central nervous system quickly appear - drowsiness, lethargy, meningeal symptoms, and sometimes loss of consciousness. Arterial hypotension increases, bradycardia can change into tachycardia, and sometimes a collapsed state develops. The liver enlarges. In complicated cases, acute renal failure with anuria and azotemia may develop.
The febrile period usually lasts 1.5-2 weeks. From the 7-9th day, a gradual, stepwise decrease in body temperature begins. The course of the convalescence period is very slow, patients experience weakness, apathy, and dizziness for a long time (up to 4-8 weeks).
Possible course of CHH without hemorrhagic syndrome (abortive forms), when the disease is diagnosed only using specific research methods.
Forecast in severe hemorrhagic syndrome, the mortality rate reaches 10-30%.
Complicated ong>. Most often, these are massive hemorrhages into internal organs and cavities. Possible acute renal failure, pneumonia, pulmonary edema, thrombophlebitis, myocarditis, infectious-toxic shock.

Diagnosis of hemorrhagic fever

The main symptoms of the clinical diagnosis of CHH are the acute onset of the disease, a two-wave nature of body temperature, hyperemia of the face, neck (lapel symptom), conjunctiva in the initial period, severe hemorrhagic syndrome during the height of the disease, leukopenia, thrombocytopenia. Epidemiological history (tick bites, stay in an endemic area) is important.

Specific diagnosis of hemorrhagic fever

There are methods for isolating the virus from the blood during viremia. In clinical practice, serological reactions are used - RSK, RGNGA, RNIF, RDPA, which are carried out in the dynamics of the disease (paired serum method). To isolate the virus, newborn white mice are infected with the blood of patients.

Differential diagnosis of hemorrhagic fever

CHH should be differentiated from hemorrhagic fevers of other etiologies, meningococcal disease, influenza, leptospirosis, typhus, thrombocytopenic purpura (Werlhof's disease), hemorrhagic vasculitis (Henoch-Henoch disease), sepsis, yellow fever.

Treatment of hemorrhagic fever

Patients are isolated in separate boxes with special personnel and equipment. Prescribe pathogenetic and symptomatic treatment, hemostatic drugs, if necessary, replaceable blood transfusions, red blood cells and platelets, use glycocorticosteroids, and antibiotics if indicated. A positive effect is achieved by using convalescent immune serum of 60-100 ml (proposed by M.P. Chumakov in 1944) and hyper-unified immunoglobulin.
Prevention. The cells take a set of measures to destroy ticks and provide personal protection against tick bites. According to epidemiological indications, they are vaccinated with a specific vaccine and immunoglobulin against CHG is administered.