Case Report: Hemorrhagic Fever with Renal Syndrome Complicated by Bilateral Subdural Hematoma.
The American journal of tropical medicine and hygiene
Hemorrhagic fever with renal syndrome (HFRS) is an acute, natural focal disease worldwide. Bilateral subdural hematoma (BSH) is a rare occurrence in patients with HFRS. A 51-year-old man was admitted with fever, headache, lower back pain, and reduced urine volume. The patient was diagnosed with HFRS accompanied by BSH, as evidenced by IgM and IgG antibodies for hantavirus that were positive, and abnormal blood test results and computed tomographic head scan. He recovered and was discharged after symptomatic treatment. Hemorrhagic fever with renal syndrome might present rare clinical manifestations with BSH. The early identification of this condition is crucial to an improved prognosis.
10.4269/ajtmh.23-0248
A case of hemorrhagic fever with renal syndrome and abnormal serum levels of ferritin, vitamin B12, and folic acid.
Journal of infection in developing countries
INTRODUCTION:Hemorrhagic fever with renal syndrome (HFRS) is a globally prevalent infectious disease caused by the hantavirus in rodents. CASE STUDY:This report describes a case of a 36-year-old male presenting with elevated ferritin, vitamin B12, and folic acid deficiency during the early onset phase of HFRS. Despite normal renal function at admission, the patient exhibited persistent fever and thrombocytopenia, leading to a potential misdiagnosis of an atypical HFRS presentation. Abnormal serum levels of ferritin, vitamin B12, and folic acid served as early indicators of renal dysfunction in patients with HRFS. The patient's condition improved rapidly with a combination of vitamin B6, methyl cobalamin, and folic acid, as evidenced by a subsequent decrease in the ferritin levels, from 3000 to 600 ng/mL, on days 4 and 24, respectively, and an increase in the vitamin B12 and folic acid levels to 200 pg/mL and 36.7 ng/mL, separately. CONCLUSIONS:These findings suggest that ferritin, vitamin B12, and folic acid have the potential to serve as biomarkers for HFRS and play a predictive role in the diagnosis and treatment of the disease.
10.3855/jidc.18541
Hemorrhagic Fever with Renal Syndrome Complicated by Acute Pancreatitis, High Intraocular Pressure, and Pulmonary Involvement: a Case Report.
Infection and drug resistance
Hemorrhagic fever with renal syndrome (HFRS), a naturally occurring epidemic disease, is primarily caused by hantaviruses. It frequently involves the lungs and is characterized by symptoms such as fever, hemorrhage, and renal failure. However, the occurrence of acute pancreatitis (AP) in HFRS patients can be neglected, and high intraocular pressure (IOP) is exceedingly uncommon. In this report, we discuss the case of a 30-year-old male who presented with fever, nausea, vomiting, and abdominal pain. Physical examination revealed extremity petechiae rashes and elevated IOP. Laboratory tests indicated coagulopathy and renal failure. A computed tomography scan confirmed AP. Further testing revealed a positive anti-hantavirus IgM antibody. The patient received supportive care, fluid hydration, hemofiltration, mannitol, brinzolamide, and brimonidine to reduce IOP. Three days post-admission, the patient developed shortness of breath and chest pain. Subsequent chest computed tomography revealed pulmonary edema and bilateral pleural effusion. Treatment included oxygen supply, respiratory support, and thoracentesis, with continued hemofiltration. The patient recovered, regaining normal pulmonary and renal functions and normalized IOP. This case underscores the importance of comprehensive evaluations and vigilant monitoring in HFRS patients, particularly measuring IOP in those with visual complaints, to save lives and reduce morbidity.
10.2147/IDR.S454049
Acute Pancreatitis and Leukemoid Reaction as the Presenting Manifestation of Hemorrhagic Fever with Renal Syndrome: A Case Report.
Infection and drug resistance
Background:Hemorrhagic fever with renal syndrome (HFRS), caused by Orthohantavirus hantanense (HTNV) infection, is characterized by a range of symptom including fever, hemorrhage, and renal impairment. Acute pancreatitis and leukemoid reaction associated with HFRS have been less frequently reported. Case Presentation:A 20-year-old male presented with fever, dizziness, and gastrointestinal symptom, which progressed to acute pancreatitis and leukemoid reaction. Despite initial treatment, his condition worsened, necessitating transfer to a tertiary care facility. Upon admission, the patient exhibited signs of organ dysfunction, and laboratory tests confirmed leukocytosis and thrombocytopenia, with imaging suggestive of pancreatitis. HTNV antibody test results were positive. Discussion:This case illustrates the complexity of diagnosing HFRS when the disease presents atypically. The symptom that are shared with other conditions can lead to misdiagnosis. Treatment of HFRS patients requires a multidisciplinary approach, with particular attention to the timing and type of therapy to manage complications effectively. Conclusion:This report emphasizes the importance of recognizing atypical presentations of HFRS and the benefits of a prompt and comprehensive treatment strategy. Early diagnosis and a tailored therapeutic approach are crucial for improving patient outcomes in such rare and complex cases. The case underscores the necessity for clinicians to be vigilant for secondary symptom of HFRS, particularly in high-incidence regions, and the role of early diagnosis and treatment in improving outcomes.
10.2147/IDR.S499197
Acute Hemorrhagic Rectal Ulcer Presenting With Severe Lower Gastrointestinal Bleeding: A Case Report of an Emerging Entity.
Cureus
Acute hemorrhagic rectal ulcer (AHRU) is a rare but potentially life-threatening condition. We present the case of a 74-year-old man who developed sudden massive hematochezia and hypotension during hospitalization for fever of unknown origin. He was known to have alcohol-related liver cirrhosis, hypoalbuminemia and coronary artery disease (CAD) and was on daily aspirin. He was transfused and transferred to intensive care. Esophagogastroduodenoscopy (EGD) revealed no abnormalities, while colonoscopy showed two deep round ulcers in the distal rectum, one of which was spurting blood, promptly and successfully managed with hemoclip placement. There was no recent history of shock, constipation, or nonsteroidal anti-inflammatory drug (NSAID) use. A diagnosis of AHRU was made. The patient had no rebleeding but died two weeks later of septic shock. Gastroenterologists should consider AHRU in elderly patients with risk factors for AHRU such as prolonged bed rest, CAD, hypoalbuminemia, renal failure and anti-thrombotic drug use, who develop in-hospital lower gastrointestinal bleeding. Suggestive endoscopic findings are solitary or multiple rectal ulcer(s), with circumferential, round, Dieulafoy-like or geographical appearance and normal surrounding mucosa and location within 10 cm from the dentate line. Other etiologies should be excluded, and endoscopic hemostasis is often successful. It is important to recognize this entity and diagnose it early to decrease its associated morbidity and mortality.
10.7759/cureus.73465
FDG PET/CT in Hantavirus Hemorrhagic Fever With Renal Syndrome.
Clinical nuclear medicine
ABSTRACT:A 58-year-old man with fever, myalgia, and dysuria was admitted to the hospital. Because of prolonged fever, FDG PET/CT was performed. Surprisingly, bilateral kidneys were rapidly enlarged for 5 days with the renal parenchyma showing intense hypermetabolism. FDG PET/CT demonstrated physiology of Hantavirus invading kidneys and causing nephritis. This case illustrates that FDG PET/CT could be the choice of image modality for diagnosis and treatment evaluation of patients suspected of hemorrhagic fever with renal syndrome. To the best of our knowledge, this is the first report of FDG PET/CT image for a patient with hemorrhagic fever with renal syndrome.
10.1097/RLU.0000000000004915
Hemorrhagic Fever with Renal Syndrome Complicated with Rhino Mucormycosis: A Case Report.
Infection and drug resistance
Mucormycosis (MCR) is a rare but aggressive fungal disease. Rhino-orbito-cerebral mucormycosis is the most common clinical form of MCR infection, and sinonasal inoculation is the primary site of infection. The morbidity and mortality rates associated with MCR remain high. In this case report, we describe the successful use of amphotericin B in a 40-year-old male with hemorrhagic fever with renal syndrome (HFRS) complicated by rhinomucormycosis. This case report provides evidence for the successful treatment of HFRS.
10.2147/IDR.S391035
Case Report: Multiple Organ Failure Caused by Hemorrhagic Fever with Renal Syndrome.
The American journal of tropical medicine and hygiene
Hemorrhagic fever with renal syndrome (HFRS), a natural epidemic disease caused by hantavirus (HV), is one of the viral diseases that pose a major threat to our health. Considering the increasing number of atypical-onset cases reported in some countries, it is important to be familiar with the symptoms of HFRS and the signs of HV infection. This report describes the case of a 55-year-old man with complaints of fever, vomiting, and diarrhea. His symptoms showed no significant improvement after routine anti-infective, antipyretic, and other symptomatic supportive treatments administered at a local clinic. During these treatments, the patient had progressive oliguria; after 3 days, he also developed multiple organ failures, such as the liver and kidney, and was examined for positive serum IgM antibodies to hemorrhagic fever during treatment at our hospital. The patient was finally diagnosed with HFRS followed by multiple organ failure. After antiviral therapy, including ribavirin, piperacillin, and tazobactam, continuous renal replacement therapy, fluid metabolism adjustment, and related supportive therapy were administered, which improved his liver and kidney function. He was discharged on the 25th day after hospitalization. It is difficult to manage patients who develop multiple organ failure after HFRS. Moreover, this condition is rare in clinical settings, with fever being the initial indication. For diseases with unknown origin such as refractory fever and diarrhea, it is crucial to differentiate them from common pathogenic infection and HV infections to provide timely treatment that improves the prognosis of patients.
10.4269/ajtmh.23-0078
Hemorrhagic fever with renal syndrome and reversible splenial lesion syndrome.
Neurosciences (Riyadh, Saudi Arabia)
Hemorrhagic fever with renal syndrome (HFRS) and reversible splenial lesion syndrome are both considered uncommon conditions relatively rare. Fever, hemorrhage, and acute kidney injury are the prevailing symptoms frequently observed in cases of HFRS. We describe a case of a middle-aged man who had been hospitalized with fever and acute neurological symptoms. His main symptom was recurrent dizziness. Cranial computed tomography (CT) did not reveal any obvious lesions, such as encephalorrhagia or infarctions. The splenium of corpus callosum showed hyperintensity on brain magnetic resonance imaging (MRI), which is in line with the characteristic radiographic observations of reversible splenial lesion syndrome (RESLES). Further analyses revealed that the patient's platelet counts had decreased to 7×10/L while hemorrhagic fever antibodies were positive. Eventually, the patient was diagnosed with HFRS and exhibited clinical improvements after active treatment.
10.17712/nsj.2023.4.202300133
Hemorrhagic Fever with Renal Syndrome in Asia: History, Pathogenesis, Diagnosis, Treatment, and Prevention.
Viruses
Hemorrhagic Fever with Renal Syndrome (HFRS) is the most frequently diagnosed zoonosis in Asia. This zoonotic infection is the result of exposure to the virus-contaminated aerosols. Orthohantavirus infection may cause Hemorrhagic Fever with Renal Syndrome (HRFS), a disease that is characterized by acute kidney injury and increased vascular permeability. Several species of orthohantaviruses were identified as causing infection, where Hantaan, Puumala, and Seoul viruses are most common. Orthohantaviruses are endemic to several Asian countries, such as China, South Korea, and Japan. Along with those countries, HFRS tops the list of zoonotic infections in the Far Eastern Federal District of Russia. Recently, orthohantavirus circulation was demonstrated in small mammals in Thailand and India, where orthohantavirus was not believed to be endemic. In this review, we summarized the current data on orthohantaviruses in Asia. We gave the synopsis of the history and diversity of orthohantaviruses in Asia. We also described the clinical presentation and current understanding of the pathogenesis of orthohantavirus infection. Additionally, conventional and novel approaches for preventing and treating orthohantavirus infection are discussed.
10.3390/v15020561
Haemorrhagic fever with renal syndrome: literature review and distribution analysis in China.
Zou Lu-Xi,Chen Mao-Jie,Sun Ling
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
Hantaviruses infect their reservoir hosts and humans, but the infection only causes disease in humans. In Asia and Europe (the Old World), the hantaviruses usually cause haemorrhagic fever with renal syndrome (HFRS). This article summarizes the current understanding of hantavirus epidemiology, as well as the clinical manifestations, pathogenesis, renal pathology, diagnosis, treatment, and prevention of HFRS. Moreover, the spatiotemporal distribution of HFRS was analysed based on the latest data obtained from the Chinese Centre for Disease Control and Prevention, for the period January 2004 to April 2015, to provide valuable information for the practical application of more effective HFRS control and prevention strategies in China.
10.1016/j.ijid.2016.01.003
Increased blood CD226 inflammatory monocytes with low antigen presenting potential correlate positively with severity of hemorrhagic fever with renal syndrome.
Annals of medicine
BACKGROUND:Hantaan virus (HTNV) infection can cause severe hemorrhagic fever with renal syndrome (HFRS). Inflammatory monocytes (iMOs) are involved in early antiviral responses. Previous studies have found that blood iMOs numbers increase in the acute phase of HFRS. Here, we further identified the phenotypic characteristics of iMOs in HFRS and explored whether phenotypic changes in iMOs were associated with HFRS severity. MATERIALS AND METHODS:Blood samples from 85 HFRS patients were used for phenotypic analysis of iMOs by flow cytometry. Plasma HTNV load was determined using RT-PCR. THP-1 cells overexpressing CD226 were used to investigate the effects of CD226 on HLA-DR/DP/DQ and CD80 expression. A mouse model was used to test macrophage phenotype following HTNV infection. RESULTS:The proportion of CD226 iMOs in the acute phase of HFRS was 66.83 (35.05-81.72) %, which was significantly higher than that in the convalescent phase (5.32 (1.36-13.52) %) and normal controls (7.39 (1.15-18.11) %) ( < 0.0001). In the acute phase, the proportion of CD226 iMOs increased more in patients with more severe HFRS and correlated positively with HTNV load and negatively with platelet count. Notably, CD226 iMOs expressed lower levels of HLA-DR/DP/DQ and CD80 than CD226 iMOs, and overexpression CD226 could enhance the expression of HLA-DR/DP/DQ and CD80. In a mouse model, HTNV also induced the expansion of CD226 macrophages, with decreased expression of I-A/I-E and CD80. CONCLUSIONS:CD226 iMOs increased during HTNV infection and the decrease in CD226 hampered the expression of HLA-DR/DP/DQ and CD80, which may promote the immune escape of HTNV and exacerbate clinical symptoms.
10.1080/07853890.2023.2247000
Aspartate aminotransferase to platelet ratio at admission can predict the prognosis of patients with hemorrhagic fever with renal syndrome.
Journal of medical virology
Early indicators are needed to predict the prognosis of patients with hemorrhagic fever with renal syndrome (HFRS). Aspartate aminotransferase to platelet ratio index (APRI) has been shown to be related to mortality risk of patients with various diseases. This study evaluated the prognostic value of APRI and other inflammatory scores in HFRS patients. Data of hospitalized HFRS patients from a tertiary hospital in northwest China were collected and the inflammatory scores such as APRI and neutrophil to lymphocyte count ratio (NLR) were calculated at the day of patient admission. Independent factors related to the survival of patients were determined by multivariate logistic regression. Receiver operating characteristic curve was used to analyze the predictive value, and area under the curve (AUC) and 95% confidence interval (CI) were calculated for quantification. Of the 317 HFRS patients included in study, 15 patients died. Age (OR: 1.10, 95% CI: 1.04-1.16, p = 0.001), NLR (OR: 1.11, 95% CI: 1.02-1.19, p = 0.01), and APRI (OR: 1.06, 95% CI: 1.03-1.10, p = 0.001) were quantitative objective factors independently associated with the survival of patients. APRI had an AUC of 0.95 (95% CI: 0.91-1.00, p < 0.001) for predicting the prognosis of patients, with a sensitivity of 93.3% and a specificity of 86.8%. The performance of APRI was better than that of age or NLR. Patients with an APRI ≥ 6.15 had significantly decreased survival compared with those with an APRI < 6.15. In conclusion, this simple index APRI calculated at admission can serve as a biomarker to identify HFRS patients at risk of poor prognosis.
10.1002/jmv.29126
Maturing neutrophils of lower density associate with thrombocytopenia in Puumala orthohantavirus-caused hemorrhagic fever with renal syndrome.
Frontiers in immunology
Puumala orthohantavirus-caused hemorrhagic fever with renal syndrome (PUUV-HFRS) is characterized by strong neutrophil activation. Neutrophils are the most abundant immune cell type in the circulation and are specially equipped to rapidly respond to infections. They are more heterogenous than previously appreciated, with specific neutrophil subsets recently implicated in inflammation and immunosuppression. Furthermore, neutrophils can be divided based on their density to either low-density granulocytes (LDGs) or "normal density" polymorphonuclear cell (PMN) fractions. In the current study we aimed to identify and characterize the different neutrophil subsets in the circulation of PUUV-HFRS patients. PMNs exhibited an activation of antiviral pathways, while circulating LDGs were increased in frequency following acute PUUV-HFRS. Furthermore, cell surface marker expression analysis revealed that PUUV-associated LDGs are primarily immature and most likely reflect an increased neutrophil production from the bone marrow. Interestingly, both the frequency of LDGs and the presence of a "left shift" in blood associated with the extent of thrombocytopenia, one of the hallmarks of severe HFRS, suggesting that maturing neutrophils could play a role in disease pathogenesis. These results imply that elevated circulating LDGs might be a general finding in acute viral infections. However, in contrast to the COVID-19 associated LDGs described previously, the secretome of PUUV LDGs did not show significant immunosuppressive ability, which suggests inherent biological differences in the LDG responses that can be dependent on the causative virus or differing infection kinetics.
10.3389/fimmu.2024.1419787
Imaging of hemorrhagic fever with renal syndrome: a potential bioterrorism agent of military significance.
Bui-Mansfield Liem T,Cressler Dana K
Military medicine
Hemorrhagic fever with renal syndrome (HFRS) is a potentially fatal infectious disease with worldwide distribution. Its etiologic agents are viruses of the genus Hantavirus of the virus family Bunyaviridae. Hypothetical ease of production and distribution of these agents, with their propensity to incapacitate victims and overwhelm health care resources, lend themselves as significant potential biological agents of terrorism. HFRS has protean clinical manifestations, which may mimic upper respiratory tract infection, nephrolithiasis, and Hantavirus pulmonary syndrome and may delay proper treatment. Sequelae of HFRS, such as hemorrhage, acute renal failure, retroperitoneal edema, pancreatitis, pulmonary edema, and neurologic symptoms, can be detected by different imaging modalities. Medical providers caring for HFRS patients must be aware of its radiologic features, which may help to confirm its clinical diagnosis. In this article, the authors review the epidemiology, pathophysiology, clinical presentation, diagnosis, treatment, and complications of HFRS.
10.7205/milmed-d-11-00048
Hantavirus in humans: a review of clinical aspects and management.
The Lancet. Infectious diseases
Hantavirus infections are part of the broad group of viral haemorrhagic fevers. They are also recognised as a distinct model of an emergent zoonotic infection with a global distribution. Many factors influence their epidemiology and transmission, such as climate, environment, social development, ecology of rodent hosts, and human behaviour in endemic regions. Transmission to humans occurs by exposure to infected rodents in endemic areas; however, Andes hantavirus is unique in that it can be transmitted from person to person. As hantaviruses target endothelial cells, they can affect diverse organ systems; increased vascular permeability is central to pathogenesis. The main clinical syndromes associated with hantaviruses are haemorrhagic fever with renal syndrome (HFRS), which is endemic in Europe and Asia, and hantavirus cardiopulmonary syndrome (HCPS), which is endemic in the Americas. HCPS and HFRS are separate clinical entities, but they share several features and have many overlapping symptoms, signs, and pathogenic alterations. For HCPS in particular, clinical outcomes are highly associated with early clinical suspicion, access to rapid diagnostic testing or algorithms for presumptive diagnosis, and prompt transfer to a facility with critical care units. No specific effective antiviral treatment is available.
10.1016/S1473-3099(23)00128-7