Hantavirus hemorrhagic fever with renal syndrome

Last updated
Transmission electron micrograph of Sin Nombre virus, a hantavirus. Sin Nombre virus Hanta TEM 1137 lores.jpg
Transmission electron micrograph of Sin Nombre virus, a hantavirus.

Hantavirus hemorrhagic fever with renal syndrome (HFRS) is a group of clinically similar illnesses caused by species of hantaviruses. It is also known as Korean hemorrhagic fever and epidemic hemorrhagic fever. It is found in Europe, Asia, and Africa. [1] The species that cause HFRS include Hantaan orthohantavirus , Dobrava-Belgrade orthohantavirus , Saaremaa virus, Seoul orthohantavirus , Puumala orthohantavirus and other orthohantaviruses. Of these species, Hantaan River virus and Dobrava-Belgrade virus cause the most severe form of the syndrome and have the highest morbidity rates. When caused by the Puumala virus, it is also called nephropathia epidemica. This infection is known as sorkfeber (vole fever) in Swedish, myyräkuume (vole fever) in Finnish, and musepest (mouse plague) in Norwegian.

Contents

Both HFRS and hantavirus pulmonary syndrome (HPS) are caused by hantaviruses, specifically when humans inhale aerosolized excrements of infected rodents. Both diseases appear to be immunopathologic, and inflammatory mediators are important in causing the clinical manifestations. [2]

Signs and symptoms

Symptoms of HFRS usually develop within one to two weeks after exposure to infectious material, but in rare cases, they may take up to eight weeks to develop. In Nephropathia epidemica, the incubation period is three weeks. Initial symptoms begin suddenly and include intense headaches, back and abdominal pain, fever, chills, nausea, and blurred vision. Individuals may have flushing of the face, inflammation or redness of the eyes, or a rash. Later symptoms can include low blood pressure, acute shock, vascular leakage, and acute kidney failure, which can cause severe fluid overload.

The severity of the disease varies depending upon the virus causing the infection. Hantaan and Dobrava virus infections usually cause severe symptoms, while Seoul, Saaremaa, and Puumala virus infections are usually more moderate. Complete recovery can take weeks or months. [3]

The course of the illness can be split into five phases:

Febrile phase
Symptoms include redness of cheeks and nose, fever, chills, sweaty palms, diarrhea, malaise, headaches, nausea, abdominal and back pain, respiratory problems such as the ones common in the influenza virus, as well as gastro-intestinal problems. These symptoms normally occur for three to seven days and arise about two to three weeks after exposure. [4]
Hypotensive phase
This occurs when the blood platelet levels drop and symptoms can lead to tachycardia and hypoxemia. This phase can last for two days.
Oliguric phase
This phase lasts for three to seven days and is characterised by the onset of renal failure and proteinuria.
Diuretic phase
This is characterized by diuresis of three to six litres per day, which can last for a couple of days up to weeks.
Convalescent phase
This is normally when recovery occurs and symptoms begin to improve.

This syndrome can also be fatal. In some cases, it has been known to cause permanent renal failure. [5]

Transmission

Hantaviruses infect various rodents, generally without causing disease. Transmission by aerosolized rodent excreta still remains the only known way the virus is transmitted to humans. In general, droplet and/or fomite transfer has not been shown in the hantaviruses in either the pulmonary or hemorrhagic forms. [6] [7]

For Nephropathia epidemica, the bank vole is the reservoir for the virus, which humans contract through inhalation of aerosolised vole droppings. [8]

Diagnosis

HFRS is difficult to diagnose on clinical grounds alone and serological evidence is often needed. A fourfold rise in IgG antibody titer in a one-week interval and the presence of the IgM type of antibodies against hantaviruses are good evidence for an acute hantavirus infection. HFRS should be suspected in patients with acute febrile flu-like illness, kidney failure of unknown origin and sometimes liver dysfunction. [9]

Prevention

Rodent control in and around the home remains the primary prevention strategy, as well as eliminating contact with rodents in the workplace and campsite. Closed storage sheds and cabins are often ideal sites for rodent infestations. Airing out of such spaces prior to use is recommended. Avoid direct contact with rodent droppings and wear a mask to avoid inhalation of aerosolized rodent secretions. [10]

Treatment

There is no cure for HFRS. Treatment involves supportive therapy including renal dialysis. Treatment with ribavirin in China and Korea, administered within seven days of onset of fever, resulted in a reduced mortality as well as shortened course of illness. [3] [4]

Epidemiology

HFRS is primarily a Eurasian disease, whereas HPS appears to be confined to the Americas. The geography is directly related to the indigenous rodent hosts and the viruses that coevolved with them. [9]

Although fatal in a small percentage of cases, nephropathia epidemica is generally milder than the HFRS that is caused by hantaviruses in other parts of the world. [11]

HFRS was the subject of an episode of the television series M*A*S*H. In season 8, episode 9 the 4077th dealt with a condition, with similar symptoms to HFRS, called "Korean Hemorrhagic Fever".

See also

Related Research Articles

<i>Orthohantavirus</i> Genus of viruses

Orthohantavirus is a genus of single-stranded, enveloped, negative-sense RNA viruses in the family Hantaviridae within the order Bunyavirales. Members of this genus may be called orthohantaviruses or simply hantaviruses.

Seoul orthohantavirus (SEOV) is a member of the genus Orthohantavirus of rodent-borne viruses, and is one of the four hantaviruses that are known to cause Hantavirus hemorrhagic fever with renal syndrome (HFRS). It is an Old World hantavirus; a negative sense, single-stranded, tri-segmented RNA virus.

<i>Andes orthohantavirus</i> Species of virus

Andes orthohantavirus (ANDV), a species of Orthohantavirus, is a major causative agent of hantavirus cardiopulmonary syndrome (HCPS) and hantavirus pulmonary syndrome (HPS) in South America. It is named for the Andes mountains of Chile and Argentina, where it was first discovered. Originating in the reservoir of rodents, Andes orthohantavirus is easily transmitted to humans who come into contact with infected rodents or their fecal droppings. However, infected rodents do not appear ill, so there is no readily apparent indicator to determine whether the rodent is infected or not. Additionally, Andes orthohantavirus, specifically, is the only hantavirus that can be spread by human to human contact via bodily fluids or long-term contact from one infected individual to a healthy person.

Puumala orthohantavirus (PUUV) is a species of Orthohantavirus. Humans infected with the virus may develop a haemorrhagic fever with renal syndrome (HFRS) known as nephropathia epidemica. Puumala orthohantavirus HFRS is lethal in less than 0.5% of the cases. Rarely, PUUV infection can cause Guillain–Barré syndrome.

Black Creek Canal orthohantavirus (BCCV) is a single-stranded, negative sense RNA virus species of New World Orthohantavirus. It was first isolated in cotton rats found in the Black Creek Canal area of Dade County, Florida in 1995. The discovery followed from an isolated case of Hantavirus pulmonary syndrome diagnosed in a Dade County resident.

Sangassou orthohantavirus(SANGV) is single-stranded, negative-sense RNA virus species of the genus Orthohantavirus in the Bunyavirales order. It was first isolated in an African wood mouse (Hylomyscus simus) in the forest in Guinea, West Africa in 2010. It is named for the village near where the mouse was trapped. It is the first indigenous Murinae-associated African hantavirus to be discovered.

<span class="mw-page-title-main">Hantavirus pulmonary syndrome</span> Viral pulmonary disease of humans

Hantavirus pulmonary syndrome (HPS) is one of two potentially fatal syndromes of zoonotic origin caused by species of hantavirus. These include Black Creek Canal virus (BCCV), New York orthohantavirus (NYV), Monongahela virus (MGLV), Sin Nombre orthohantavirus (SNV), and certain other members of hantavirus genera that are native to the United States and Canada.

Dobrava-Belgrade orthohantavirus (DOBV), also known as Dobrava virus, is an enveloped, single-stranded, negative-sense RNA virus species of Old World Orthohantavirus. It is one of several species of Hantavirus that is the causative agent of severe Hantavirus hemorrhagic fever with renal syndrome. It was first isolated in 1985 from a yellow-necked mouse found in the village of Dobrava, southeastern Slovenia. It was subsequently isolated in striped field mice in Russia and other parts of Eastern Europe. It has also been found in Germany but the reservoir host there is unknown.

Soochong virus (SOOV) is a zoonotic negative sense single-stranded RNA virus. It may be a member of the genus Orthohantavirus, but it has not be definitively classified as a species and may only be a strain. It is one of four rodent-borne Hantaviruses found in the Republic of Korea. It is the etiologic agent for Hantavirus hemorrhagic fever with renal syndrome (HFRS). The other species responsible for HFRS in Korea are Seoul virus, Haantan virus, and Muju virus.

Muju virus(MUV) is a zoonotic negative-sense single-stranded RNA virus of the genus Orthohantavirus. It is a member virus of Puumala orthohantavirus. It is one of four rodent-borne Hantaviruses found in the Republic of Korea. It is the etiologic agent for Hantavirus hemorrhagic fever with renal syndrome (HFRS). The other species responsible for HFRS in Korea are Seoul orthohantavirus, Hantaan orthohantavirus, and Soochong virus.

Prospect Hill orthohantavirus is a single-stranded, negative-sense Hantaan-like zoonotic RNA virus isolated from meadow voles and microtine and other cricetid rodents in the United States. It has a widespread distribution in Pennsylvania, Maryland, West Virginia, Minnesota and California. The overall risk of infection in humans is low. It was first isolated from a meadow vole found in Prospect Hill, Maryland for which it is named.

Monongahela virus (MGLV) is a single-stranded, negative-sense Orthohantavirus virus of zoonotic origin that causes hantavirus pulmonary syndrome.

Tula orthohantavirus, formerly Tula virus (TULV), is a single-stranded, negative-sense RNA virus species of orthohantavirus first isolated from a European common vole found in Central Russia. It causes Hantavirus hemorrhagic fever with renal syndrome. The Microtus species are also found in North America, Europe, Scandinavia, Slovenia, Asia, and Western Russia. Human cases of Tula orthohantavirus have also been reported in Switzerland and Germany.

Hantaan orthohantavirus (HTNV) is an enveloped, single-stranded, negative-sense RNA virus species of Old World Orthohantavirus. It is the causative agent of Korean hemorrhagic fever in humans. It is named for the Hantan River in South Korea, and in turn lends the name to its genus Orthohantavirus and family Hantaviridae.

Choclo orthohantavirus (CHOV) is a single-stranded, negative-sense RNA zoonotic New World hantavirus. It was first isolated in 1999 in western Panama. The finding marked the first time Hantavirus pulmonary syndrome (HPS) was found in Central America.

Nova virus is a single-stranded, negative-sense, enveloped RNA virus with a trisegmented genome. It belongs to one of the most divergent lineages of the hantavirus group, which consists of zoonotic viruses belonging to the family Bunyaviridae. As of now, no human cases of infection have been reported.

Rockport virus (RKPV) is a single-stranded, enveloped, negative-sense RNA orthohantavirus.

Gou virus (GOUV) is a single-stranded, negative-sense, enveloped novel RNA orthohantavirus. It is one of the known hantaviruses responsible for hantavirus hemorrhagic fever with renal syndrome in humans.

Hantavirus vaccine is a vaccine that protects in humans against hantavirus infections causing hantavirus hemorrhagic fever with renal syndrome (HFRS) or hantavirus pulmonary syndrome (HPS). The vaccine is considered important as acute hantavirus infections are responsible for significant morbidity and mortality worldwide. It is estimated that about 1.5 million cases and 46,000 deaths occurred in China from 1950 to 2007. The number of cases is estimated at 32,000 in Finland from 2005 to 2010 and 90,000 in Russia from 1996 to 2006.

Bloodland Lake virus (BLLV) is a single-stranded, negative-sense RNA virus of New World Orthohantavirus first isolated in a Prairie vole near Bloodland Lake, Fort Leonard Wood, Pulaski County, Missouri in 1994. BLLV has also been isolated in Prairie voles in St. Louis County, Missouri.

References

  1. ↑ Cosgriff TM, Lewis RM (December 1991). "Mechanisms of disease in hemorrhagic fever with renal syndrome". Kidney Int. Suppl. 35: S72–9. PMID   1685203.
  2. ↑ Peters, Md; Simpson, Md, Phd, Mph, Gary L.; Levy, Md, Phd, H. (1999). "Spectrum of Hantavirus Infection: Hemorrhagic Fever with Renal Syndrome and Hantavirus Pulmonary Syndrome1". Annual Review of Medicine. 50: 531–545. doi:10.1146/annurev.med.50.1.531. PMID   10073292.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. 1 2 Lee HW, van der Groen G (1989). "Hemorrhagic fever with renal syndrome". Prog. Med. Virol. 36: 62–102. PMID   2573914.
  4. 1 2 Muranyi, Walter; Bahr, Udo; Zeier, Martin; Van Der Woude, Fokko J. (2005). "Hantavirus Infection". Journal of the American Society of Nephrology. 16 (12): 3669–3679. doi: 10.1681/ASN.2005050561 . PMID   16267154.
  5. ↑ Kulzer P, Heidland A (December 1994). "[Acute kidney failure caused by Hantaviruses]". Ther Umsch (in German). 51 (12): 824–31. PMID   7784996.
  6. ↑ Peters CJ (2006). "Emerging infections: lessons from the viral hemorrhagic fevers". Trans. Am. Clin. Climatol. Assoc. 117: 189–96, discussion 196–7. PMC   1500910 . PMID   18528473.
  7. ↑ Crowley, J.; Crusberg, T. "Ebola and Marburg Virus Genomic Structure, Comparative and Molecular Biology". Dept. of Biology & Biotechnology, Worcester Polytechnic Institute. Archived from the original on 2013-10-15.
  8. ↑ Rose AM, Vapalahti O, Lyytikäinen O, Nuorti P (January 2003). "Patterns of Puumala virus infection in Finland". Euro Surveill. 8 (1): 9–13. doi: 10.2807/esm.08.01.00394-en . PMID   12631978.
  9. 1 2 Peters CJ, Simpson GL, Levy H (1999). "Spectrum of hantavirus infection: hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome". Annu. Rev. Med. 50: 531–45. doi:10.1146/annurev.med.50.1.531. PMID   10073292.
  10. ↑ "CDC - Hantavirus Pulmonary Syndrome (HPS) - Hantavirus". Cdc.gov. 2013-02-06. Retrieved 2013-07-07.
  11. ↑ Jonsson CB, Figueiredo LT, Vapalahti O (April 2010). "A global perspective on hantavirus ecology, epidemiology, and disease". Clin. Microbiol. Rev. 23 (2): 412–41. doi:10.1128/CMR.00062-09. PMC   2863364 . PMID   20375360.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.