"Yesterday, the Chinese men's football team broke through history and won the Hercules Cup..."
On Saturday morning, Dadong was still asleep when his cell phone rang.
"Old Iron, it's ten o'clock!" Did you get up? Go fishing! ”
"Oh. . . oh! Well, here we go. ”
Dadong reacted for a while before remembering that yesterday he made an appointment with a friend to fish today, but he didn't expect to oversleep. The wife should have gone out early in the morning to meet friends. Dadong tried to wake up a little, feeling a little tired, and his mind was confused. However, there was an appointment first, he got up and drank some porridge and went out.
The next morning, Dadong woke up at ten o'clock and felt a headache.
"Yesterday I wasn't at home to rest well, but I want to go out to blow the wind, get up and eat something, eat and then go to sleep," Dadong's wife, Sister Fen, complained bitterly.
"Well..." Dadong just struggled to sit up, only to feel that the sky was spinning in front of him, and his stomach was turning upside down, and he quickly lay down again.
Looking at Dadong's cheeks flushed and his forehead scalding hot, Fenjie quickly took the thermometer, a measure, 39.5 ° C!
"Hurry up and go to the hospital!"
Can't help but say, Dadong was half supported by Sister Fen and half carried to the nearby community hospital, checked the blood, the doctor said that there was a little infection, it is estimated that the fishing blowing wind is cold, to prescribe two antibiotics and anti-fever drugs, let go home and rest well. Dadong originally wanted to say that he had begun to feel uncomfortable before fishing yesterday, but he felt that he didn't have the strength to speak, and he estimated that even if he said that the doctor might also use the medicine like this, he opened his mouth, and in the end he did not make a sound, and was half supported and half carried home by his wife.
After taking 2 days of medicine, Dadong still had a high fever, nausea, nausea, almost did not eat anything, strangely, the stomach is still getting more and more bloated.
"It doesn't feel like a small cold, go to the hospital again", Sister Fen was a little anxious.
The couple came to the central hospital this time, and after drawing blood, Dadong slumped down on a chair in the corridor and did not want to move.
"Is Liu Haidong here?" Liu Haidong! The doctor who had just received Dadong stood at the door of the examination room and shouted loudly, "Liu Haidong or his family should come over quickly."
"In, in!" Sister Fen immediately ran over.
"The laboratory department called, your patients' blood results are not very good, the inflammatory indicators are very high, the liver and kidney function is not good, the platelets are only 1/4 of normal people, hurry to take a CT", the doctor's expression is very serious.
Soon the CT results also came out: consider the possibility of acute kidney damage, diffuse peritonitis of the abdominal pelvis, abdominal pelvic effusion.
"The illness is too serious, hurry up and be hospitalized!"
After being hospitalized, the doctor gave me high-grade antibiotics and added some hormones, and Dadong's fever was not so bad, but his stomach was getting more and more upset. Why there is a fever and bloating stomach, the doctors do not know for a while.
Dadong was originally a big voice, usually talking a lot, and was often disliked by Sister Fen. This illness came like a mountain, there was no strength to speak, and she couldn't say a few words a day, Sister Fen was suddenly strangely uncomfortable, and the whole person was in a trance. Fortunately, there are many relatives in the family, and they all actively mobilize all social relations and ask everywhere for doctors who can cure this strange disease.
After several twists and turns, Dadong cousin hung up to the outpatient number of Professor Hu Bijie of the Department of Infectious Diseases of Zhongshan Hospital, and after Professor Hu learned about the situation, he immediately decided: the condition is critical, and he will be transferred to our department for hospitalization immediately!
The ambulance whistled and whistled, and Dadong, who was almost out of breath, drove to Zhongshan Hospital without stopping. The family was relieved, but the doctor took a breath after examining Dadong: Dadong's various blood test indicators were all red, especially the deterioration of kidney function was very obvious; not only did there be ascites on CT, but also pleural fluid in the chest cavity, and the lungs were compressed.
Each symptomatic treatment is shot one by one. But what is the reason for the problem of such rapid progress? Is it really an infection?
On the 3rd day after hospitalization, Dadong's kidney function continued to deteriorate, even if he used diuretics, he only urinated twice that day, and the excess water and toxins that could not be discharged were trapped in the body, making Dadong visibly swollen with the naked eye, and the heart and liver were also overwhelmed. Nephrologist consultants recommend that a renal aspiration biopsy identify the cause, "if the condition worsens further, dialysis may be required"
The word "dialysis" hit Sister Fen like a thunderbolt on a sunny day, and she froze, and she was alone in the stairwell for a long time.
When she returned to the ward, she passed by the doctor's office, it was almost eight o'clock in the evening, and there were actually three or four doctors in the office, each facing the computer, discussing with each other from time to time, and Sister Fen's heart moved: with them working hard, there might be hope.
"How do you consider the diagnosis of 7 beds? How can kidney function continue to deteriorate"? During the rounds, Professor Hu threw out the topic of discussion.
"Middle-aged male patients, acute course, peritonitis in the short term, multiserous cavity effusion, need to consider the more toxic pathogen infection, but the current various etiologic tests are negative."
"Patients with acute kidney injury may also have autoimmune diseases involving the kidneys, but the current relevant autoantibody indicators are negative, and nephrology consultation recommends renal puncture biopsy to clarify."
"The patient's initial blood and kidney function is still good, and then he has eaten acetaminophen, and then the kidney function is not good, is it possible that the kidney damage caused by drugs is caused?"
"It is possible, but this does not explain the patient's high fever and peritonitis"
……
"Acute course, fever, impaired renal function, will it be hemorrhagic fever in nephrotic syndrome?" Director Hu put forward his own ideas.
Nephrotic syndrome hemorrhagic fever is a disease caused by hantavirus infection that, as the name suggests, presents with fever, bleeding, and renal impairment. The virus is generally carried by rodents of the family Rodents and Hamsters, and humans are infected by inhaling aerosols from animal secretions, urine or feces, or in direct contact with their excrement, and infections generally occur in both forest and rural areas due to the relatively low number of rats in cities.
"The patient had a fever and had impaired kidney function, but the patient did not live in the affected area before the onset of the disease, nor did he have contact with rodents, the most important point is not met, and the patient has no bleeding at all."
"Indeed, although there is no bleeding, but the platelets are significantly reduced and there is a tendency to bleed, is it possible that there is an atypical manifestation of hemorrhagic fever in nephrotic syndrome?" More than 30 years of medical experience, experienced in clinical experience, so that Professor Hu deeply understand the clinical actual cases are far more complex than textbooks, "Moreover, although this viral infection is dangerous, it is self-limiting, and it does not require a large number of antibiotics that are currently empirically applied, as long as it helps patients through the most difficult 'oliguria period', there is a hope of complete reversal." ”
Time is life, time is kidney function. Doctors urgently arranged for hantavirus testing and renal aspiration biopsy; at the same time, because Dadong's kidneys were no longer able to perform normal drainage and detoxification functions, doctors arranged for temporary bedside emergency hemodialysis. Thick tubes draw Dadong's blood out of the body, filtering out metabolic waste, toxins, and excess water for re-infusion. Although the scene was scary, after doing the blood, Dadong felt that his whole body was much more relaxed.
That night, the epidemic haemorrhagic fever virus (Hantavirus) results returned: both the antibody and the nucleic acid were positive! The follow-up was confirmed by the review of the Shanghai Municipal Center for Disease Control and Prevention. At the same time, renal puncture pathology suggests acute tubular necrosis, consistent with hantavirus infection.
Epidemic haemorrhagic fever typically presents fever phases, hypotensive shock phases, oliguria phases, polyuria phases, and recovery phases, but many patients do not have the typical five periods and only some symptoms. Dadong did not go through the hypotensive shock period, and there was no bleeding, that is to say, he did not "fall ill according to the textbook", and the diagnosis of this atypical case tested the doctor's clinical level the most.
Epidemic haemorrhagic fever is a viral infection, antimicrobials are ineffective, and treatment is mainly symptomatic supportive care. The doctor resolutely stopped the antibiotics, continued to actively support the treatment of symptomatic support, and "smoothly" entered the polyuria phase out of the "oliguria phase", and the urine output increased to more than 4000 mL in 24 hours on the 4th day after admission. At this stage, Dadong truly realized the meaning of the advertising slogan: "Detoxification, easy"!
After the doctor's precise symptomatic support treatment, Dadong successfully avoided various risk pits in the "polyuria period" and gradually entered the recovery period. More than half a month later, the original vigorous Dadong Spirit had returned, all the indicators were basically close to normal, the urine output basically returned to normal levels, and even the voice was much louder. Although he came in lying down, he walked out happily when he was discharged.
But what he couldn't figure out was how he got the virus. He has been living in a residential building in the city and has no access to rats, nor has it been the case with relatives, friends and colleagues around him. He also did not know how the "destined" rat had transmitted the virus indirectly to him through a tortuous way, and whether it had anything to do with the wild fishing he usually liked.
Doctor reminds
1. What is renal syndrome hemorrhagic fever?
Hemorrhagic fever with renal syndrome (HFRS) is caused by viral infection of the genus Bunyavirus Hantavirus and is often referred to as epidemic haemorrhagic fever. The main manifestations are fever, bleeding, hypotension, and renal injury, and the typical course of the disease goes through five phases: fever, hypotensive shock, oliguria, polyuria, and recovery. However, some cases may be atypical, and clinicians should be vigilant to avoid missed diagnoses.
2. How are humans infected with hantavirus?
The annual incidence of HFRS in the continent is the highest in the world, about 16,000-100,000 cases/year. Hantavirus is mainly carried by rodents of the family Rodents (mice, voles, shrews, and rats, etc.), especially haddocks and brown rats. Humans are infected by inhaling aerosols from animal secretions, urine, feces, or by direct contact with excreta. Many patients may encounter live or dead rodents 2 to 4 weeks before symptoms develop, or enter rooms where there is evidence of significant rodent infestation.
3. In which people may develop hemorrhagic fever in renal syndrome?
(1) Farmers (spring ploughing, autumn harvest season;
(2) Personnel of animal research institutions or laboratory rodent keepers;
(3) Pet rat keepers.
4. How to treat and prevent hemorrhagic fever in renal syndrome?
The case fatality rate of HFRS cases fluctuates from 0.60% to 13.97% per year, but there are currently no specific antiviral drugs against hantavirus, mainly active symptomatic supportive therapy. NSAIDs may cause acute kidney injury and should be avoided.
Preventive measures are mainly vaccination and rat extermination. Avoid entering areas where large numbers of rodents live, or prevent rodents from living near their homes and work areas.
This article was first published in the "Infection Team of Zhongshan Hospital Affiliated to Fudan University (zsgr2020)", and the physician newspaper was authorized to publish it!
Author: Li Na Huang Yingnan
Review: Hu Bijie Pan Jue
Review: Xinya