(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: Epidemic hemorrhagic fever, also known as renal syndrome hemorrhagic fever, is a naturally epidemic disease caused by an epidemic hemorrhagic fever virus, known as hantavirus. Many people mistake the disease for plague, which are actually two completely different diseases. In this case, the patient was admitted to the hospital with fever and facial flushing, and was clearly diagnosed with epidemic hemorrhagic fever, and was given treatment such as liver protection, rehydration and immunomodulation.
Basic information】Female, 49 years old
Type of disease】Epidemic hemorrhagic fever
Hospital】Liaoning Provincial People’s Hospital
Time of consultation】October 2018
【Treatment plan】Medication (polyenyl phosphatidylcholine capsule, compound dichloroacetate diisopropylamine tablet, injectable conversion sugar, injectable pantoprazole sodium, thin glucagon injection, injectable torasemide, levofloxacin sodium chloride injection)
[Treatment period] Hospitalization for 10 days, outpatient follow-up after 2 weeks
Treatment effect】Cured
I. Initial consultation
The patient, Ms. Chen, complained of dizziness and nausea for 5 days and fever for 3 days. The patient had dizziness and nausea without any cause 5 days ago, and fever with a maximum temperature of 38.5℃ 3 days ago. She was seen in the emergency room of another hospital, and laboratory tests revealed thrombocytopenia (18×10^9/L), increased leukocytes, and elevated lipase. On examination: acute face, conjunctival congestion in both eyes, flushed face, positive percussion pain in the liver area, no percussion pain in the kidney area, no edema in the lower limbs. In order to seek further diagnosis and treatment, he was admitted to the hematology department with “fever pending investigation of acute pancreatitis? “The diagnosis of epidemic hemorrhagic fever was made at the consultation, and the family agreed to transfer the patient to the Department of Infectious Diseases for further treatment after communication.
II. Treatment process
The patient had no obvious abdominal pain, dizziness improved, urine output increased and entered the early stage of polyuria. Combined with the characteristics of the patient’s case: middle-aged female, farmer, fever, dizziness, nausea and other symptoms, conjunctival congestion, facial flushing, thrombocytopenia, urine protein 4+, liver and kidney damage, with oliguria, positive antibodies to hemorrhagic fever, IgM, IgG are positive, epidemic hemorrhagic fever (renal syndrome hemorrhagic fever) diagnosis is clear. He was given polyenyl phosphatidylcholine capsule and compound dichloroacetate diisopropylamine tablet for liver protection, intravenous drip of converted sugar for injection for electrolyte supplementation, sodium pantoprazole for injection for gastric acid suppression and gastric mucosa protection, and thin glucose peptide injection for immune enhancement. Since the patient was no longer febrile after transfer, no antiviral treatment was given. The 24-hour urine volume and fluid intake and output were recorded, and the amount of rehydration fluid was adjusted according to the intake and output. In addition, the routine blood and urine tests were normalized and the liver and kidney function gradually improved, but hypoproteinemia and hyperkalemia were observed. One week after hospitalization, lower abdominal pain, urinary frequency, urinary urgency, urinary pain and other symptoms appeared in the late stage of polyuria, and the urinary routine leukocytes increased.
III. Treatment effect
After 10 days of hospitalization, the patient’s urine volume dropped to below 2000ml and entered the recovery period, with improvement in urinary frequency, urinary urgency and pain, reduction in fatigue and abdominal distension, no nausea, and improvement in dizziness and appetite. The patient’s liver function, kidney function and abdominal CT improved, ascites subsided, and he was discharged from the hospital with stable condition.
IV. Notes
However, it takes 1-3 months for patients with epidemic hemorrhagic fever to fully recover, and a few patients may have sequelae such as hypertension, liver and kidney dysfunction, and myocardial injury, so patients still need to pay attention to rest, ensure balanced nutritional intake, and gradually recover their strength after discharge. Pay attention to monitoring blood pressure on a daily basis, and follow the doctor’s instructions to recheck liver and kidney function, blood routine and urine routine at the hospital 2 weeks after discharge. If symptoms such as weakness, yellow urine and reduced urine volume appear, consult a doctor in time.
V. Personal insight
Epidemic hemorrhagic fever is a clinical syndrome caused by hantavirus infection with fever, hypotensive shock, congestive hemorrhagic signs and kidney damage as the main manifestations. The main source of infection is rats, but people are not the main source of infection, so contact with patients with epidemic hemorrhagic fever is generally not infectious. Therefore, attention should be paid to the prevention of epidemic hemorrhagic fever in daily life by paying attention to food hygiene and personal hygiene, preventing rats and exterminating rats, and vaccinating against epidemic hemorrhagic fever under the guidance of a doctor.