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Abstract: The patient in this case was 27-year-old Xiao Liu, who usually liked outdoor activities and contracted renal syndrome hemorrhagic fever, a type of hemorrhagic disease, after a field activity. After consultation, he was given general treatment such as calorie and fluid supplementation, physical cooling and symptomatic treatment with medication, and he was discharged successfully after 3 weeks of treatment with disappearance of clinical symptoms and normal auxiliary examination.
Basic information】Male, 27 years old
Disease Type】Hemorrhagic fever with renal syndrome
Hospital】Beijing Huairou District Hospital of Traditional Chinese Medicine
Date of consultation】May 16, 2022
Treatment plan】Medication (recombinant interferon alpha 2b for injection, thymidine for injection, dexamethasone injection, salvia injection)
【Treatment period】3 weeks of inpatient treatment
Treatment effect] The clinical symptoms disappeared and the indexes gradually normalized.
I. Initial consultation
Xiao Liu was wheeled by his family to the clinic with a temperature of 40.5℃, facial congestion and flushing, and depression. He reported that he had a fever last night and thought it was a cold, and after taking oral cold medicine, he developed a high fever, headache, body aches, dizziness, weakness and loss of appetite at noon today. He was examined for renal function in the emergency room, which indicated that renal function was significantly impaired; urinalysis and urinary tetralogy indicated that proteinuria and membranous material appeared in urine. He described that he had gone to climb the Great Wall 10 days before the fever, and considered renal syndrome hemorrhagic fever together with the symptoms, medical history and auxiliary examination.
(Membranous material in urine)
(urine analysis)
II. Treatment history
Xiao Liu had severe symptoms and was admitted to the hospital urgently for treatment. Xiao Liu was instructed that he needed bed rest and avoided floor activities during his hospitalization. After admission, anti-viral treatment with recombinant human interferon α2b for injection and thymidine for injection was carried out. Intravenous saline and glucose injection were infused to replenish calories and fluids to maintain a stable internal environment and also to help Xiao Liu’s body temperature drop. Xiao Liu was hyperthermic and was given physical cooling by placing towel-wrapped ice packs in the axillae and groin. Xiao Liu was depressed and toxic symptoms were considered. The hormone dexamethasone injection was administered to improve hyperthermia and toxic symptoms. Renal syndrome hemorrhagic fever is also prone to complication of diffuse intravascular coagulation, and intravenous salvia injection was given for blood activation treatment.
III. Treatment effect
At the time of admission, Xiao Liu had obvious weakness around his body, could hardly walk independently, and his appetite was reduced, and his daily food intake was about 1/10 of the previous amount. 1 week after admission, Xiao Liu could go to the toilet and eat independently, and his food intake was about 1/2 of the previous amount, while his fever was basically normalized, and his body temperature fluctuated from 36.2℃ to 37.3℃. After 2 weeks of treatment, Xiao Liu’s mental status returned to normal and he could walk independently in the ward hallway for more than 10 minutes, and no increase in body temperature was seen within 72 hours. After 3 weeks of treatment, urinalysis, renal function and urinary quadruplex were not significantly abnormal on recheck, and Xiao Liu was discharged successfully.
IV. Notes
We are glad that Xiao Liu’s symptoms have improved after treatment, but Xiao Liu still needs to pay attention to rest after discharge. In addition to the usual activities such as toileting, washing, dressing and eating, he can go out for a small amount of activities, but should not do too much activity, and it usually takes at least 2 months to return to normal activity, and at least 3 months before considering physical exercise. As for diet, because of the poor function of the spleen and stomach, eat foods that are easy to digest and nutritious, such as milk, egg custard, lean meat porridge and green vegetables, etc. Avoid exposure to tobacco and alcohol. After discharge, blood pressure, blood glucose and urine volume should be checked daily, and the Infectious Disease Clinic will follow up one week after discharge.
V. Personal insight
Renal syndrome hemorrhagic fever, also called epidemic hemorrhagic fever, is a natural epidemic disease, with rats as the main source of infection. Xiao Liu considered that he might have been infected by touching his eyes and mouth after coming into contact with rat urine and feces with virus while climbing the Great Wall in the wild, or he might have been infected by parasitic bites on the body surface of rodents. Renal syndrome hemorrhagic fever progresses rapidly, and if treatment is delayed it can quickly develop into a serious illness with a long duration, many complications, a poor prognosis, and a high mortality rate. If there is only fever, the condition is generally milder, the course of the disease is shorter, and the prognosis is also better after timely and active treatment. As in this case, the patient Xiao Liu, who came to the clinic on the 2nd day of illness, was considered to be relatively timely and was mildly ill at the time of hospitalization, and recovered to normal after about 3 weeks of treatment. In conclusion, the principle of treatment for hemorrhagic fever in renal syndrome is early detection, early diagnosis and early treatment.