Download 孙文闻-hemorrhagic fever with renal syndrome

天 津 医 科 大 学 授 课 教 案
（共 4 页、第 1 页）
课程名称： Internal Medicine
课程内容：Hemorrhagic Fever With Renal Syndrome
教师姓名：Sun Wenwen
职称：vice chief physician
授课日期：2013-5-2
8 时—10 时
授课对象：Students of International College of TMU
教材版本：Infectious Disease Teaching Textbook
授课方式：Multi media
ISBN 7-81071-338-8
学时数： 2
听课人数：80
本单元或章节的教学目的与要求：
To know the major causes of HFRS；
How it is transmitted;
The major manifestations of the disease;
To know how to diagnose, treat and prevent HFRS.
授课主要内容及学时分配：
Hantaviruses and reservoir-vectors ( 25 min);
The route of virus transmitted from rats to human ( 25 min) ;
The clinical manifestation of HFRS (5 stages) and lab studies ( 25 min);
Treatment and prevention of HFRS ( 25 min).
重点、难点及对学生要求（包括掌握、熟悉、了解、自学）
The student should be able to:
describe the common means of transmission of HFRS;
describe the major manifestations of HFRS;
describe how to diagnose, treat and prevent HFRS.
外语词汇：
Hemorrhagic fever with renal syndrome
Hantaan virus
辅助教学情况：
Multimedia teaching
复习思考题：
The pathogen of HFRS.
The clinical manifestation of severe HFRS.
参考资料：
Evans and Kaslow, Viral infections of human – epidemiology and control (forth
edition). Plenum Publishing Corp. 1997.
主任签字：
教务处制
天 津 医 科 大 学 授 课 教 案
（共 4 页、第 2 页）
1. Definition
A disease of Europe and Asia, characterized by fevers, capillary dilatation,
leakage of blood leading to hemorrhagic manifestations and in severe cases, shock and
renal tubular disease.
2. Etiology
2.1 Hantaan Virus






Family Bunyaviridae
spherical particles
Diameter: 80~160 nm
lipid membrane
Spikes as ligand
Fragile to: heat
sodium hypochlorite (1%)
glutaraldehyde (2%) ethanol (70%)
2.2 Members of Genus Hantavirus
Hantaan virus
Seoul virus
Puumala virus
Belgrade-Dobrava virus
3. Epidemiology
3.1 Source of infection
Reservoir: rodents and small mammals
Patients generally do not serve as a source of infection.
3.2 Route of transmission
3.2.1 Transmission between rodents
3.2.2 Transmission from rodent to human being

Respiratory spread

Through damaged skin or mucous membrane
3.3 Crowd Susceptibility
males>females
may caused by their probable increased frequency of outdoor activities, which leads to
contact with the infected rodents
4. Pathology
4.1 Patients who die of shock in the early stages demonstrate retroperitoneal gelatinous
edema. Macroscopic hemorrhages are seen in the pituitary and right atrium. The renal
medulla is congested and hyperemic
4.2 Patients who die later in the course of the disease have marked renal tubular necrosis
(due to sediment of immuno-complex), leading to acute uremia.
5. Clinical Manifestations
5.1 “ features ”
hemorrhagic manifestations
fever
renal lesions
5.2 “ pain ”
headache
lumbar backache
orbit pain
5.3 “ flush ”
facial flush
neck flush
upper chest flush
5.4 “ phases ”
Febrile
Hypotensive
Oliguric
Diuretic
Convalescent
5.5 Lab Studies
 CBC of peripheral blood
WBC: normal or increase
atypical lymphocyte may occur
thrombocytopenia

Coagulation profile

Urine analysis
proteinuria、hematuria、cylindruria

Blood chemical analysis
urea nitrogen and creatinine increase
usually accompanied by a rising alanine
aminotransferase
electrolyte and acid-base imbalance
 IgM or IgG antibodies become positive at the end of the first week
of illness. Antibody titers peak at 2 weeks
6. Diagnosis
Either IgM or IgG antibodies may be
measured
IgM is regarded as definitive
IgG level of Convalescence phase
IgG level of earlier phase
≥ 4
7. Treatment
 Mainly supportive
–
maintenance of fluid and electrolyte balance
–
preservation or restoration of circulating blood volume
–
control of elevated blood urea nitrogen and potassium
–
detection and treatment of secondary bacteria infection: especially in
diuretic phase
 Broad spectrum antivirus agent
ribavirin (virazole)
 Surgical Care
exploratory laparotomy
renal rupture
renal biopsy
8. PREVENTI0N
 monitoring epidemic situation
 reduce the density of rodents
 education on personal protection
 vaccines
教务处制