Epidemic of hantavirus disease in Entre-Sambre-et-Meuse: year 1992-1993. Clinical and biological aspects

Abstract

A multihospital study allowed us to follow a total of 62 serologically proven cases of Nephropathia epidemica (NE) in the Belgian region between Sambre and Meuse during the 1992-1993 period. The clinical picture consisted of sudden high fever (100% of the cases), headache (71%), abdominal or lumbar pains (80%) and, as a less frequent but very specific sign, acute myopia (24%). Non-specific respiratory symptoms such as a non-productive cough and an abnormal lung auscultation were found in 1 case out of 4. Frequent laboratory anomalies were thrombocytopenia (69%), left-shift leucocytosis (77%), abnormal LDH (69%) and an inflammatory syndrome (86%) with levels of C-reactive protein (CRP) elevated up to a mean of 102 mg/L, often accompanied by a marked fall of total serum cholesterol and a rise of triglycerides. Impaired kidney function is the rule (84%), nevertheless serum creatinine levels remain inferior to 150 mumol/L (1.7 mg%) in 25% of the patients. As for neurological signs, 1 case of encephalitis and 1 syndrome of Guillain-Barré were observed. Relative bradycardia (< 90 bpm) was noted in 50% of the cases with fever, whereas Doppler-echocardiography detected pericarditis in 1 case, and transient impairment of the left ventricle function in 3 cases. Frequent elevation of liver enzymes (46%) confirms the observation that from now on, Hantavirus infections should be considered in the differential diagnosis of viral hepatitis. One severe case was observed with shock, diffuse intravascular coagulation and adult respiratory distress syndrome (ARDS), followed by 5 other patients presenting with marked degrees of hypoxemia and hypocapnia. We conclude that not only the causative Hantaviral serotype, but also the degree of "systemic inflammatory response syndrome" (SIRS) seems to determine the clinical picture in Hantavirus infections.