出血热(英文)

Korea, China, Eastern Russia
Seoul
NNoorrwwaayy rraatt (Rattus norvegicus)
Worldwide
Puumala
BBaannkk vvoolleess (Clethrionomys Western Europe glareolus)
DobravaBelgrade
presence of specific antibodies and T cells at the onset of symptoms
marked cytokine production, kallikrein-kinin activation, complement pathway activation, or increased levels of circulating immune
Pathogenesis: acute renal failure
➢Decreased blood flow ➢Direct injury to the kidney
Pathology
➢Basic pathological changes Systemic microvascular endothelial edema,
negative sense RNA segments---S, M, L S (small): encodes neucleocapsid protein M (medium): encodes envelope glycoprotein L(large): encodes polymerase
Overview
➢Hemorrhagic fever with renal syndrome (HFRS) is caused by an airborne contact(main route) with secretions from rodent hosts infected with hantaviruses from the family Bunyaviridae
degeneration and necrosis ➢The most dramatic damage is seen in the
kidneys ➢Retroperitoneal edema is seen ➢Larger visceral and cerebral hemorrhages can
but is extremely rare.
Epidemiology
➢Susceptibility of population People are generally susceptible Commonly reported in male adult Total subclinical infection rate is
Secondary shock:
occurs after oliguric stage
Pathogenesis: hemorrhage
➢Damage of the blood vessel wall ➢Thrombocytopenia ➢Uremic bleeding defects ➢Increase of heparin–like substances ➢DIC
➢5 progressive stages: Febrile stage; Hypotensive stage; Oliguric stage; Polyuric stage; Convalescent stage
Clinical Manifestations: Febrile stage
➢Abrupt onset of fever lasting 3-7 days ➢Gastrointestinal discomfort
Hemorrhagic Fever with Renal Syndrome
epidemic hemorrhagic fever
Overview
➢ HFRS includes a group of clinically similar illnesses
Epidemic hemorrhagic fever(China) Korean hemorrhagic fever(Korean) Nephropathis epidemica(Puumala)
Direct introduction of infectious material through broken skin or onto mucous membranes
Through rodent bites from infected animals From mother to child Transmission from one human to another may occur,
occur (e.g., myocardium, pituitary)
Clinical Manifestations: overview
➢Incubation period varies from 4-46 days, usually 1 to 2 weeks
➢A triad of fever, hemorrhage, and renal insufficiency
➢Natural focal diseases
Main Clinical Manifestations
➢fever, hemorrhage, and renal damage
➢5 progressive stages: Fever stage; Hypotensive shock stage; Oliguric stage; Polyuric stage; Convalescent stage
YYeellloloww-neecckkeeddffieieldldmmouosuese Balkans (Apodemus flavicollis)
Striped field mouse
Apodemus agrarius
Norway rat
Rattus norvegicus,
Bank voles
2.5~4.3%; In children the disease is mild and often subclinical Stable and persistent immunity
Pathogenesis
➢The pathogenesis is largely unknown ➢Human cells infected with hantaviruses
Pathogenesis: shock
Immune mediated vascular endothelial injury
Increased capillary permeability
Plasma extravasation
Insufficient blood volume
Primary shock
occurs before oliguric stage
Massive hemorrhage or
Secondary infection or
Insufficient water-electrolyte supply
during polyuric stage
Insufficient blood volume
Hantaviruse
G1 L G2 M S
100nm
RNA Size(bp) Protein products Size(KDa)
L 6530 M 3616
S 1696
Polymerase Coat glycoprotein(G1) Coat glycoprotein(G2) Nucleocapsid protein
pulmonary syndrome (America)
Epidemiology
➢ Sources of transmission: rodent reservoirs
Virus
Reservoir
Epidemic &
species
endemic areas
Hantaan
SStrtirpipeedd ffiieellddmmoouussee (Apodemus agrarius)
do not demonstrate the cytopathic effects of viral replication
Pathogenesis
➢Immune mechanisms play an important role
Virus is present in blood only during the initial stage of infection and is usually absent at the time that severe symptoms begin
➢ Capillary injury: signs of hemorrhagic tendency Dermatorrhagia
①Petechiae often develop in areas of pressure, axilla ②Ecchymosis in severe case
Flushing over Frunken face), and the back
Mucosal hyperemia
Conjunctival suffusion, pharyngeal injection
Drunken face
Clinical Manifestations: Febrile stage
Virology of Hantaviruse
➢Belong to the family Bunyaviridae ➢Spherical enveloped viruses about 80-120
nm in diameter ➢Genome consists of three single-stranded,
247 68-76 52-58 50-54
Virology of Hantaviruse
➢The viruses that cause hemorrhagic fever with renal syndrome include:
Hantaan Dobrava-Belgrade Seoul Puumala ➢Sin Nombre virus can cause hantavirus
Anorexia, nausea , vomiting and abdominal pain
➢Systemic toxic symptoms
Myalgia, triad of pains (Headache, lumbago and retroorbital pain)
➢Signs of Capillary injury
➢Occurs mainly in Europe and Asia
➢Characterized by fever and renal failure associated with hemorrhagic manifestations.
➢Supportive therapy is the mainstay of care for patients with hantavirus infection
Congestion Hemorrhagic tendency Exudation and edema
Clinical Manifestations: Febrile stage
➢Capillary injury: signs of congestion Dermathemia: triad of flushings
Clethrionomys glareolus
Yellow-necked field mouse
A. flavicollis
Epidemiology
➢Route of transmission Exposure to aerosolized urine, droppings, or
saliva of infected rodents