(精编)【体外膜肺ECMO精品课件】 Hantavirus教学课件.ppt

HFRS: Recovery Diuretic Phase: Lasts a few days to a few weeks Clinical recovery begins 3-6 liters of urine/ day Anorexia, lassitude due to dehydration Convalescent Phase: Lasts 2-3 months Progressive improvement in glomerular filtration, renal blood flow, and urine concentrating ability Nephropathia Epidemica (NE) Puumala strain Most common form of HFRS in Europe Generally a milder form of HFRS Similar sequence of symptoms, but attenuated Only 6% of serologically confirmed cases require hospitalization Stages of Hantavirus Pulmonary Syndrome (HPS) After asymptomatic incubation of 4-30 days… 1) Febrile Phase 2) Cardiopulmonary Phase 3) Diuretic Phase 4) Convalescent Phase HPS: Febrile phase Lasts 3-5 days (1-12 days) Fever, myalgias, malaise Other symptoms: headache, dizziness, anorexia, nausea, vomiting, and diarrhea. Difficult to diagnose as HPS at this stage, since the symptoms are similar to many other viral prodromes Image from CDC HPS: Cardiopulmonary Phase Non-productive cough and tachypnea appear Presentation and rapid progression of shock and pulmonary edema (4-24h). Hypovolemia due to progressive leakage of high protein fluid from blood to lung interstitium and alveoli Myocardial failure Hypotension and oliguria Death within 24-48 hours due to hypoxia and/or circulatory compromise. HPS Diuretic Phase Rapid clearance of pulmonary edema Resolution of fever and shock Early sign: spontaneous diuresis Convalescent Phase (up to 2 months) Slow but full recovery Short term finding: pulmonary dysfunction. Decreased small-airways flow and diminished diffusing capacity HPS Clinical Laboratory Findings Thrombocytopenia (decrease in number of platelets): this is consistent in almost all cases in Americas Normal or elevated white cell count on presentation of symptoms which increases to high values as disease progresses (leukocytosis). A left shift and presence of immunoblasts from late in febrile phase. Hemoconcentration HPS Radiologic Findings Radiograp