Hantavirus-related Acute Interstitial Nephritis in Western Europe. Expansion of a World-wide Zoonosis

Abstract

We report the clinical, biological and serological characteristics of 76 cases of Hantavirus-induced acute interstitial nephritis diagnosed in Belgium and France between 1977 and 1986. The disease is characterized by a fever of sudden onset promptly accompanied by pain in the loin or abdomen, nausea and vomiting, myalgias and occasionally with acute myopia and conjunctival injection. Within a week acute renal failure develops, necessitating haemo- or peritoneal dialysis in up to 10 per cent of patients. Transient proteinuria, microscopic haematuria and leukocyturia are observed simultaneously. Thrombocytopenia and mild elevations of hepatic enzymes, LDH and CPK, as well as biological signs of acute inflammatory reaction are observed, lasting for a few days. Spontaneous complete recovery is the rule. This picture is virtually identical with that of nephropathia epidemica, a Hantavirus nephropathy observed in northern Europe. This conclusion is supported by the observation of elevated antibody titres against the Puumala virus, the agent of nephropathia epidemica. This rodent-borne infection is markedly milder than that caused by other Hantaviruses such as the Hantaan or the Seoul virus in Asia. Acute interstitial disease due to Hantavirus should be included in the differential diagnosis of febrile acute renal failure.