(Disclaimer: This article is for general science purposes only, and the information in the following content has been processed to protect patient privacy)
Abstract: Epidemic hemorrhagic fever is a natural epidemic disease with rodents as the main source of infection. The patient had a history of hepatitis B virus carriage for more than 10 years, with no progression of disease during several examinations and no other chronic diseases. The patient gradually recovered and was discharged from the hospital in good health.
Basic information】Male, 53 years old
Type of disease】Epidemic hemorrhagic fever
Hospital】The 988th Hospital of the PLA Joint Logistics and Security Forces
Time of consultation】March 2022
Treatment plan】Hemodialysis + drug treatment (ribavirin injection anti)
Treatment period】Inpatient treatment for 3 weeks, outpatient follow-up after 2 months
Treatment effect】The disease recovered, clinical symptoms were relieved, and all tests resumed normal indicators
I. Initial consultation
The patient came from the fever clinic with edema of the eyelids, redness of the face and ears, suspected alcoholic liver disease, complaining of back pain, headache, stomach distension, sober mind, no smell of alcohol on the breath, excluding the state of intoxication. The accompanying staff described that the patient had fever and headache a few days before, the headache worsened after taking antipyretic drugs, waist pain, stomach distension, little urine, swollen eyelids, and upon inquiry, he learned that there were rats in the place where he lived. The patient was quickly hospitalized, and two workers were told to stay in bed with him, and his family was immediately notified that the patient was unusually dangerous and would be given a notice of critical illness at any time.
II. Treatment
After hospitalization, the patient’s blood pressure fluctuated from 80-90/45-60 mmHg, urine volume was 600-800 ml in 24 hours, body temperature was normal, symptoms of back pain and headache were reduced, but abdominal distension was serious, abdomen was bulging, generalized bleeding and swelling, ultrasound indicated abdominal intestinal edema, small amount of ascites in the intestinal space, distension in the abdominal cavity was heavy, platelets dropped to 46×10^9/L, renal function deteriorated rapidly. The patient’s current condition was considered hypotensive shock phase overlapping with oliguric phase, which was the most serious stage of the disease, and improper treatment could easily occur pulmonary edema, hypervolemic syndrome and endanger life, and the patient had generalized edema and could not correct the shock state with large amount of rehydration. After 3 days, the patient entered the polyuric phase and experienced another frightening polyuric phase.
III. Treatment effect
After 3 weeks of treatment, the patient’s blood routine, renal function, urinary routine, abdominal ultrasound and other indicators basically returned to normal, back pain, headache, abdominal distension, generalized swelling disappeared, diet, sleep and spirit basically returned to the state before the onset, and the patient was granted discharge. The treatment principle of epidemic hemorrhagic fever is “three early, one on three prevention”, that is, early detection, early diagnosis, early treatment, and local treatment to prevent complications such as gastrointestinal bleeding, renal failure and pulmonary edema. As the patient was not admitted early and used antipyretic drugs during the fever period leading to profuse sweating, which aggravated the kidney injury during the hypotensive shock period, fortunately, hemodialysis treatment was started immediately after admission, which enabled the patient to pass the renal failure and maintain the blood volume well, and the overall treatment effect was good and the patient and family were satisfied. The patient was instructed to follow up in outpatient clinic after 2 months.
IV. Notes
I am glad that after treatment the patient’s clinical symptoms are relieved, epidemic hemorrhage is an acute infectious disease, and the condition does not usually recur after healing. Although the patient was discharged from the hospital after active treatment and healed, after all, the body suffered a blow and was greatly injured.
1, pay attention to rest, avoid strain, stay up late, strenuous exercise, quit smoking and alcohol.
2, strengthen nutritional support treatment, give high-calorie, high-protein, vitamin-rich diet, because of previous kidney damage, it is recommended to eat high-quality protein such as eggs, milk, fish.
3.Avoid private blind administration of drugs that are damaging to the kidney.
4. It is recommended to come back to the hospital after 2 months to review the blood routine, liver and kidney function, coagulation function, etc.
V. Personal insight
The patient had a history of hepatitis B, and the guide doctor took a look at the large stomach and considered cirrhosis of the liver and referred the patient to our department, and after many days of resuscitation, the patient turned to safety.
In recent years, the incidence of epidemic hemorrhagic fever has been significantly reduced, has been rare epidemic, but there is still a scattered incidence, especially farmers and workers who live in poor conditions like the patient, close contact with rodents, it is possible to get sick, if you refuse to regular general hospital examination, it is easy to delay the disease. As medical workers, we still call on the majority of patients to pay attention to their own and their family’s health, such as physical symptoms, timely medical treatment, so as not to delay the treatment of the disease.