Abstract
BackgroundInformation on the sequential appearance, duration, and magnitude of clinical and laboratory parameters in hemorrhagic fever with renal syndrome (HFRS) is limited.MethodsAnalysis of clinical and laboratory parameters obtained serially in 81 patients with HFRS, of whom 15 were infected with Dobrava virus and 66 with Puumala virus.ResultsThe initial signs/symptoms, appearing on median day 1 of illness, were fever, headache, and myalgia. These were present in 86%, 65%, and 40% of patients and had a median duration of 4, 4, and 5.5 days, respectively. The signs/symptoms were followed by myopia (appearance on day 5), insomnia (day 6), oliguria/anuria (day 6), polyuria (day 9), and sinus bradycardia (day 9.5). These were present in 35%, 30%, 28%, 91%, and 35% of patients; their median duration was 2, 2, 2, 7, and 1 day, respectively. Laboratory abnormalities, including thrombocytopenia, elevated alanine aminotransferase, CRP, procalcitonin, creatinine, diminished glomerular filtration rate, and leukocytosis, were ascertained on admission to hospital or on the following day (day 5 or 6 of illness) and were established in 95%, 87%, 99%, 91%, 94%, 87%, and 55% of patients, and had a median duration of 4, 3, 7, 3, 9, 8, and 2 days, respectively. Comparison of patients infected with Dobrava and Puumala viruses found several differences in the frequency, magnitude, and duration of abnormalities, indicating that Dobrava virus causes the more severe HFRS.ConclusionsIn the majority of patients, the classic clinical distinction into febrile, hypotonic, oliguric, polyuric, and convalescent phases of illness is unclear.
Highlights
Pathogenic hantaviruses are the etiologic agents of two clinical syndromes in humans, namely hemorrhagic fever with renal syndrome (HFRS) in Eurasia and hantaviruspulmonary syndrome in the Americas [1]
The clinical spectrum of hantavirus infections ranges from asymptomatic infection to severe disease with fatal outcome, depending, in part, on the causative virus [4,5,6,7,8]
The patients were grouped according to the etiology (HFRS caused by PUUV or DOBV), each of the two groups being further classified into subgroups with mild or severe disease
Summary
Pathogenic hantaviruses are the etiologic agents of two clinical syndromes in humans, namely hemorrhagic fever with renal syndrome (HFRS) in Eurasia and hantavirus (cardio)pulmonary syndrome in the Americas [1]. Transmission to humans occurs via aerosols or dust particles of virus-contaminated rodent urine, feces, or saliva, and probably via food or hands contaminated by these excretions [3]. Renal injury is a distinctive feature of HFRS, various extrarenal manifestations can develop, with pulmonary, hemorrhagic, pancreatobiliary, central nervous system, endocrine, and cardiovascular events [7, 10, 11]. Information on the sequential appearance, duration, and magnitude of clinical and laboratory parameters in hemorrhagic fever with renal syndrome (HFRS) is limited
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