Diagnosis Of Hantavirus Infection Research Articles

WHEN KIDNEY BIOPSY GUIDES THE DIAGNOSIS OF HANTAVIRUS INFECTION

Hantavirus infection is increasingly widespread in the last years, but diagnosing this infection could be difficult sometimes, given the nonspecific symptoms and the lack of experience by physicians into this direction. Hantavirus infection is a viral infection causing two major syndromes: Hemorrhagic fever with renal syndrome (HFRS) and Cardiopulmonary syndrome (CPS). We present the case of a young man, admitted to the hospital with fever, nausea, vomiting, diarrhea, abdominal pain and oligoanuria, in whom the diagnosis of hantavirus infection was established following the kidney biopsy, in addition to the ELISA assay. According to the literature, all histological findings concluded to hantavirus nephritis. Interstitial hemorrhage in the medulla is a main characteristic of hantavirus infection. Despite the fact that the identified serotype (Hantaan virus) is responsible for a severe form of this disease, the patient's evolution was favorable, with recovery of renal function after 1 month.

Comparison of indirect immunofluorescence and western blot method in the diagnosis of hantavirus infections.

BACKGROUNDSerologic cross-reactivity between hantaviruses often complicates the interpretation of the results.AIMTo analyze the diagnostic value of indirect immunofluorescence assay (IFA) and western blot (WB) in the diagnosis of hantavirus infections.METHODSOne hundred eighty-eight serum samples from Puumala (PUUV) and Dobrava (DOBV) orthohantavirus infected patients were analyzed. Serology was performed using commercial tests (Euroimmun, Lübeck, Germany).RESULTSUsing IFA, 49.5% of acute-phase samples showed a monotypic response to PUUV, while 50.5% cross-reacted with other hantaviruses. The overall cross-reactivity was higher for immunoglobulin G (IgG) (50.0%) than for immunoglobulin M (IgM) (25.5%). PUUV IgM/IgG antibodies showed low/moderate reactivity with orthohantaviruses Hantaan (12.3%/31.5%), Seoul (7.5%/17.8%), DOBV (5.4%/ 28.1%), and Saaremaa (4.8%/15.7%). Both DOBV IgM and IgG antibodies were broadly reactive with Hantaan (76.2%/95.2%), Saaremaa (80.9%/83.3%), and Seoul (78.6%/85.7%) and moderate with PUUV (28.5%/38.1%). Using a WB, serotyping was successful in most cross-reactive samples (89.5%). CONCLUSIONThe presented results indicate that WB is more specific than IFA in the diagnosis of hantavirus infections, confirming serotype in most IFA cross-reactive samples.

Peritonitis secondary to hemorrhagic fever with renal syndrome: a case report in GuangZhou China

BackgroundHantavirus infection is worldwide epidemic and can cause life-threatening consequences. With more and more cases reported in countries with atypical morbidity, it is necessarily urgent to know some atypical symptoms and signs of Hantavirus infection.Case presentationHere we report the case of a 44-year old male with a complaint of fever and diffuse abdominal pain, initially suspiciously diagnosed with acute peritonitis. The patient was eventually diagnosed as hemorrhagic fever with renal syndrome and enhanced CT scan showed peritonitis. The clinical condition of the patient was relatively mild and he was recovered 9 days later.ConclusionPeritonitis secondary to hemorrhagic fever with renal syndrome is rare in clinically practice. When confronted with atypical celialgia, it is important to make differential diagnosis of hantavirus infection.

Can hantavirus infections be predicted on admission to hospital?

The aim of this study was to investigate the predictive factors which contribute to diagnosis of hantavirus infection. One hundred patients from rural areas hospitalized with a preliminary diagnosis of hantavirus infection from different hospitals in Turkey were investigated. Hantavirus infection was confirmed in 20 patients (Group 1) using immunofluorescence and immunoblot assays at the Refik Saydam National Public Health Agency. Hantaviruses were not detected in the serum of the remaining 80 patients, other infectious and non-infectious diseases being diagnosed in this group (Group 2). Patients' demographic characteristics and clinical and laboratory data on admission were examined and compared between the two groups. Fever, proteinuria, hematuria, lethargy-weakness, and nausea-vomiting were the most frequent symptoms and findings in Group 1, seen in almost all patients. Proteinuria, hematuria, muscle pain, diarrhea/abdominal pain, hypotension, shock, and sweating were observed at significantly higher levels in Group 1 compared to Group 2. Serum urea, creatinine, uric acid, lactate dehydrogenase (LDH), aspartate transaminase (AST), alkaline phosphatase (ALP), and C-reactive protein (CRP) were significantly higher, but serum platelet counts were lower in Group 1 patients. Area beneath the receiver operating characteristics (ROC) curve analysis was used to calculate the discriminative ability of various laboratory values to identify patients with hantavirus infection. This analysis revealed that, serum CRP had a 100% negative predictive value, whilst, platelet, and creatinine had 75% and 70% positive predictive values for the diagnosis of hantavirus infection. In summary, laboratory markers used in clinical practice are of great importance predicting hantavirus infections.

Diagnosis of hantavirus infection in humans and rodents in Ribeirão Preto, State of São Paulo, Brazil

Hantavirus pulmonary and cardiovascular syndrome (HPCS) is an emerging serious disease in the Americas. Hantaviruses (Bunyaviridae) are the causative agents of this syndrome and are mainly transmitted through inhalation of aerosols containing the excreta of wild rodents. In the Ribeirão Preto region (state of São Paulo, Brazil), HPCS has been reported since 1998, caused by the Araraquara virus (ARAV), for which Necromys lasiurus is the rodent reservoir. This study aimed to show diagnostic results relating to infection in humans and rodents, obtained at the Virology Research Center of the Ribeirão Preto School of Medicine, University of São Paulo, between 2005 and 2008. HPCS was diagnosed by means of ELISA and/or RT-PCR in 11 (21.2%) out of 52 suspected cases, and 54.4% of these were fatal. Furthermore, 595 wild rodents (Necromys lasiurus, Akodon sp, Calomys tener and Oligoryzomys sp) were caught between 2005 and 2008. Fifteen (2.5%) of these rodents presented antibodies for hantavirus, as follows: Necromys lasiurus (4%), Calomys tener (1.9%) and Akodon sp (1.5%). Nucleotide sequences obtained through RT-PCR from one HPCS patient and one Calomys tener rodent were compared with hantavirus sequences from GenBank, which showed that both were homologous with ARAV. This work corroborates previous studies showing that ARAV is the hantavirus causing HPCS in the Ribeirão Preto region. It also shows that rodents infected with hantavirus represent a constant risk of transmission of this virus to man.

Diagnostic aspects for epidemic hemorrhage fever in legal medical autopsy: Report of 2 cases and review

Epidemic hemorrhagic fever (EHF) is known also as hemorrhagic fever with renal syndrome (HFRS). Hantaviruses, a notorious cause of EHF is spreaded by rodents or biting insects, can cause epidemic hemorrhagic fever. This report describes two rare medico-legal autopsy cases died from epidemic hemorrhagic fever. The victims were two male individuals aged 34 years and 29 years. The medico-legal autopsies were requested for alleged medical negligence. In both cases, autopsy reveals lesions to kidneys and lungs with multiple organ hemorrhage and edema, indicative of the generalized capillary damage. On admission to hospital, both patients had the symptom of fever, lumbago, renal failure and recent outdoor activities. The laboratory diagnosis results indicating multiple organ dysfunction syndrome are also important for certificating of EHF. Though the ELISA-based detection of virus-specific IgM antibody which has the highest titers between 8 and 25d after onset of disease is positive in the 34-year-old case and negative in 29-year-old case, the pathological findings and clinical laboratory analysis suggested the both victims died of EHF. In addition, immunohistochemistry analysis for Hantavirus antigen in lung or in tubular cells and PCR having been used increasingly in recent years contribute to the diagnosis of Hantavirus infection.

Detection and Typing of Human Pathogenic Hantaviruses by Real-Time Reverse Transcription-PCR and Pyrosequencing

Because the clinical course of human infections with hantaviruses can vary from subclinical to fatal, rapid and reliable detection of hantaviruses is essential. To date, the diagnosis of hantavirus infection is based mainly on serologic assays, and the detection of hantaviral RNA by the commonly used reverse transcription (RT)-PCR is difficult because of high sequence diversity of hantaviruses and low viral loads in clinical specimens. We developed 5 real-time RT-PCR assays, 3 of which are specific for the individual European hantaviruses Dobrava, Puumala, or Tula virus. Two additional assays detect the Asian species Hantaan virus together with Seoul virus and the American species Andes virus together with Sin Nombre virus. Pyrosequencing was established to provide characteristic sequence information of the amplified hantavirus for confirmation of the RT-PCR results or for a more detailed virus typing. The real-time RT-PCR assays were specific for the respective hantavirus species and optimized to run on 2 different platforms, the LightCycler and the ABI 7900/7500. Each assay showed a detection limit of 10 copies of a plasmid containing the RT-PCR target region, and pyrosequencing was possible with 10 to 100 copies per reaction. With this assay, viral genome could be detected in 16 of 552 (2.5%) specimens of suspected hantavirus infections of humans and mice. The new assays detect, differentiate, and quantify hantaviruses in clinical specimens from humans and from their natural hosts and may be useful for in vitro studies of hantaviruses.

Hantavirus Puumala infection as a cause of fever of unknown origin in a child

Hantavirus infection due to Puumala virus causes nephropathica epidemica, a disorder characterized by fever, haematological abnormalities, mild renal dysfunction and ophthalmological abnormalities. The prevalence in most European countries is low, but the virus can be endemic. In children, hantavirus infection is rare. This paper describes a young girl diagnosed with hantavirus infection. The patient presented with high fever, proteinuria, haematuria and eye lesions, but other typical hallmarks of the disease, such as thrombocytopenia and renal dysfunction, were absent. This case report demonstrates the need to consider the diagnosis of hantavirus infection in children with prolonged fever of unknown origin. The diagnosis is based on serological tests.