流行性出血熱に関する臨床的研究

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During the period from 1978 to 1979, there were 11 cases with epidemic hemorrhagic fever. The patients were doctors who engaged in experiments handling rats at our university. Clinical manifestation and treatment of this disease were discussed. The onset of the illness was characterized by sudden high fever (39-40°c), shaking chills, and sharp lumbar and musclar pain. The temperature of above 37°cremained consistently elevated from 8 to 11 days, in most cases from 6 to 7 days. As the fever disappeared, the severity of symptoms diminished. Albumiuria was noted in 9 cases, and 8 patients showed polyuria after the fever declined. In 7 of the latter, the urine volume was over 3000 ml/day at around the tenth day after onset. The incubation period was suspected to be about 3 weeks. In hematological examination, the white cell count and the blood platelet count were found to be under 5, 000/cmm and 50, 000/cmm respectively on the initial stage of the disease. This leucocyte count tended to increase with passing day. On the nineth or tenth day, the leucocytosis was found and the WBC count returned to the normal level around the fifteenth day. The platelet count increased gradually, and attained more than 10×104/crnm around the eleventh day. As to the peripheral blood picture, atypical lymphocytes were observed in 4 of 5 patients. Clinically, a hemorrhagic tendency such as nasal bleeding, buccal mucous hemorrhage spots or positivity for occult blood in feces was observed in 3 patients. These cases were diagnosed as disseminated intravascular coagulation (DIC) from the coagulation test data. All patients showed impairment of liver function tests, moderate elevation of serum transaminase, high level lactic dehydrogenase but normal serum bilirubin level. This characteristic liver impairment disappeared within 30 days in 9 of 11 cases, and no patients indicated abnormal value after 3 months. Liver biopsy was done in 5 cases. In 3 cases whom biopsy was performed at one month after onset, livercells were somewhat unequality in size. Furthermore, an acidophilic body formation and ballooning degeneration were noted. Kupffer cells were swelled and mobilized in places. Due to the severe loss of appetite and the shaking chills experienced in the initial stage of the disease, transfusion were well in most of the patients. There were DIC as complication in 3 cases in whom clear recovery was evident within a short time by treatment for DIC and their laboratory tests were improved. As to the cause of the obvious hemorrhagic tendency noted in our patients, the DIC complication would be assumed to be a main cause. In severe cases, there were, DIC complications present. The hematological and blood chemical findings were more pronounced in them than in the other cases. So, special measures against the DIG would effectively prevent cases from becoming worse and thus be very important.
日本感染症学会の論文

流行性出血熱に関する臨床的研究

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日本感染症学会 | 論文

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