Hantavirus pulmonary syndrome in patient with haemorragic fever with renal syndrome

Abstract

Background: Hantaviruses cause in humans hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). HFRS holds a leading position in Russia among other natural focal infections. We present a clinical example of lung damage in a 39-year old patient with HFRS, a resident of the Republic of Mordovia. Case Description: The patient's illness started with a fever to 39.2 °C, chills, cough. He sought medical help two days after the symptoms onset. Lungs X-ray revealed signs of bilateral pneumonia. Cough with sputum, shortness of breath, crepitus in the left lung, slight increase of transaminases and small erythrocyturia were detected. Antiviral, antibacterial and supportive treatment was started, but the patient's condition deteriorated. Symptoms of the progressive shortness of breath and acute renal failure were appeared. Repeated X-ray of the lungs shown negative dynamics (an increase of the intensity of infiltration on both sides of lungs). Symptoms of respiratory failure (shortness of breath, weakened breathing), hemorrhagic syndrome (hematomas on the skin at the injection sites, extensive hemorrhages in the sclera of both eyes) were noted within 8 days of hospitalization. Symptoms of acute renal failure (pain in the lumbar area, repeated vomiting, oliguria) were observed, but laboratory manifestations of renal failure were mild (slight proteinuria and hematuria). Hemoconcentration, leukocytosis, thrombocytopenia were detected. Thoracic CT, ultrasound of the abdomen and kidneys determined the signs of polyserositis. Anti-Hantaan IgM 1:800 and Anti-Hantaan IgG – 1:800 weredetected in the indirect immunofluorescence reaction. The diagnosis of HFRS, severe course, HPS were diagnosed. 500 ml of transudate was removed from the pleural cavity during puncture of the right pleural cavity. Positive dynamics began to be observed from the 12th day of the disease: a decrease in the symptoms of intoxication and respiratory failure, free fluid was disappeared from the pleural and abdominal cavities. The patient was discharged on the 28th day of illness in a satisfactory condition. Discussion: Respiratory pathology usually does not play a major role in the clinical picture of HFRS, but recently it started to be more manifested. Conclusion: HFRS and HPS in rare cases can develop simultaneously in a patient with hantavirus infection