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Video:Hantavirus hemorrhagic fever with renal syndrome

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Description

Hantavirus hemorrhagic fever with renal syndrome is a group of similar illnesses caused by certain hantavirus infections.[1] Initial symptoms generally include headache, abdominal pain, fever, nausea, and blurred vision.Specifically it is cause by orthohantavirus of the Bunyavirales type.[1] Ribavirin may be useful if used early.[1]About 60 to 150 thousand cases occur a year.[2]

Presentation 1

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. The first being the 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]

Presentation 2

Hypotensive phase occurs when the blood platelet levels drop and symptoms can lead to tachycardia and hypoxemia. This phase can last for a few days.[5]

Presentation 3

Oliguric phase lasts for three to seven days and is characterised by the onset of renal failure and proteinuria.[5]

Presentation 4

Diuretic phase is characterized by diuresis of several litres per day, which can last for a couple of days up to weeks.[6][7]

Presentation 5

Convalescent phase is normally when recovery occurs and symptoms begin to improve.[6]Though this syndrome in some cases, has been known to cause permanent renal failure.[8]

Cause

The cause is one of four hantaviruses:[2][9]Hantaan virus is the most common cause of HFRS and causes a severe form of the disease [10], Seoul virus is found worldwide, causes a moderate form of HFRS[11], Puumala virus is in Russia and northern and central Europe,usually causes a mild form [12] and finally Dobrava-Belgrade virus is in southern Europe, the severity depending on its genotype.[13]

Transmission

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.[14][15]For Nephropathia epidemica, the bank vole is the reservoir for the virus, which humans contract through inhalation of aerosolised vole droppings.[16]

Mechanism 1

The pathogenesis of this condition indicates that 3 weeks is the incubation period for the virus. The virus causes vascular endothelial damage which causes loss of plasma, hypotension.[2] The virus enters the body through inhalation of aerosolized particles. It targets vascular endothelial cells and macrophages, which leads to widespread infection. Hantaviruses cause increased vascular permeability by infecting endothelial cells. This results in fluid leakage, which is responsible for many of the severe symptoms, including shock.The immune system's response to the virus can exacerbate the damage. Cytokine release and immune cell activation contribute to inflammation and more vascular damage.The kidneys are affected, leading to acute kidney injury.[2][17]

Mechanism 2

In short apparently the virus enters via beta-3 integrins receptors and then forces cytoskeletal reorganization. Additionally a severe immunological reaction of this condition can be a cytokine storm [2]

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 1-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.[18]

Differential diagnosis

The differential diagnosis in an individual with HFRS is as follows:septicemia, Ebola, Dengue, Leptospirosis, Yellow fever, Malaria and Murine typhus.[2]

Treatment

Treatment involves supportive therapy including renal dialysis. Treatment with ribavirin , administered within 7 days of onset of fever, results in a reduced mortality as well as shortened course of illness.[3][4][19]

Epidemiology

HFRS is primarily a Eurasian disease, whereas HPS appears to be confined to the Americas. [18]The geography is directly related to the indigenous rodent hosts and the viruses that coevolved with them.[18]

History

Hantavirus hemorrhagic fever with renal syndrome was first identified and studied during the Korean War in the early 1950s. [20][21]The disease was linked to the Hantaan virus, which was discovered by Dr. Ho Wang Lee, in 1976. His work helped establish the connection between the virus and the disease.[20]

Research

Hantavirus vaccine is a vaccine in development aimed to protect against Hantaan River virus.[22][23] An inactivated whole viral vaccine against the disease has been approved in China and South Korea but has limited evidence for its efficacy.[22]There is currently no approved hantavirus vaccine available in the United States or Europe.[23]

References

  1. ↑ 1.0 1.1 1.2 "CDC - Hemorrhagic Fever with Renal Syndrome (HFRS) - Hantavirus". www.cdc.gov. 22 February 2019. Archived from the original on 16 November 2019. Retrieved 29 March 2021.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Romero, MG; Anjum, F (January 2021). "Hemorrhagic Fever Renal Syndrome". StatPearls. PMID 32809495.
  3. ↑ 3.0 3.1 Lee HW, van der Groen G (1989). "Hemorrhagic fever with renal syndrome". Prog. Med. Virol. 36: 62–102. PMID 2573914.
  4. ↑ 4.0 4.1 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. Archived from the original on 2018-09-04. Retrieved 2020-03-25.
  5. ↑ 5.0 5.1 Canada, Public Health Agency of (19 August 2011). "Pathogen Safety Data Sheets: Infectious Substances – Hantavirus spp". www.canada.ca. Retrieved 10 March 2025.
  6. ↑ 6.0 6.1 Fulhorst, Charles F.; Koster, Frederick T.; Enría, Delia A.; Peters, C. J. (1 January 2011). "CHAPTER 71 - Hantavirus Infections". Tropical Infectious Diseases: Principles, Pathogens and Practice (Third ed.). W.B. Saunders. pp. 470–480. ISBN 978-0-7020-3935-5.
  7. ↑ Mir, Sheema (18 January 2022). "Hantavirus Induced Kidney Disease". Frontiers in Medicine. 8. doi:10.3389/fmed.2021.795340. PMC 8804099. PMID 35118091.
  8. ↑ Kulzer P, Heidland A (December 1994). "[Acute kidney failure caused by Hantaviruses]". Ther Umsch (in Deutsch). 51 (12): 824–31. PMID 7784996.
  9. ↑ "Clinician Brief: Hemorrhagic Fever with Renal Syndrome". Hantavirus. 23 May 2024.
  10. ↑ Yu, Xue-jie; Tesh, Robert B. (1 December 2014). "The Role of Mites in the Transmission and Maintenance of Hantaan Virus (Hantavirus: Bunyaviridae)". The Journal of Infectious Diseases. 210 (11): 1693–1699. doi:10.1093/infdis/jiu336. ISSN 0022-1899. PMC 4296190. PMID 24958909.
  11. ↑ "Seoul virus – United States of America and Canada". www.who.int. Retrieved 5 March 2025.
  12. ↑ Meyer, Barbara J; Schmaljohn, Connie S (1 February 2000). "Persistent hantavirus infections: characteristics and mechanisms". Trends in Microbiology. 8 (2): 61–67. doi:10.1016/S0966-842X(99)01658-3. ISSN 0966-842X. PMID 10664598.
  13. ↑ Papa, Anna (August 2012). "Dobrava-Belgrade virus: phylogeny, epidemiology, disease". Antiviral Research. 95 (2): 104–117. doi:10.1016/j.antiviral.2012.05.011. ISSN 1872-9096. PMID 22659378.
  14. ↑ 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.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ Lupuşoru, Gabriela; Lupuşoru, Mircea; Ailincăi, Ioana; Bernea, Lavinia; Berechet, Andreea; Spătaru, Radu; Ismail, Gener (12 July 2021). "Hanta hemorrhagic fever with renal syndrome: A pathology in whose diagnosis kidney biopsy plays a major role (Review)". Experimental and Therapeutic Medicine. 22 (3): 984. doi:10.3892/etm.2021.10416. PMC 8311249. PMID 34345266.
  18. ↑ 18.0 18.1 18.2 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.
  19. ↑ "Clinician Brief: Hemorrhagic Fever with Renal Syndrome". Hantavirus. 23 May 2024. Retrieved 5 April 2025.
  20. ↑ 20.0 20.1 Song, Jin-Won (2022). "In Memoriam: Professor Ho Wang Lee (1928–2022)". Journal of Korean Medical Science. 37 (36): e274. doi:10.3346/jkms.2022.37.e274. PMC 9485066.
  21. ↑ Cameron, J. Stewart (1 June 2001). "The history of viral haemorrhagic fever with renal disease (hantavirus)". Nephrology Dialysis Transplantation. 16 (6): 1289–1290. doi:10.1093/ndt/16.6.1289. ISSN 0931-0509.
  22. ↑ 22.0 22.1 "The Next Pandemic: Hantavirus?". www.gavi.org. Archived from the original on 22 November 2021. Retrieved 31 January 2022.
  23. ↑ 23.0 23.1 Liu, Rongrong; Ma, Hongwei; Shu, Jiayi; Zhang, Qiang; Han, Mingwei; Liu, Ziyu; Jin, Xia; Zhang, Fanglin; Wu, Xingan (30 January 2020). "Vaccines and Therapeutics Against Hantaviruses". Frontiers in Microbiology. 10. doi:10.3389/fmicb.2019.02989. ISSN 1664-302X.{{cite journal}}: CS1 maint: unflagged free DOI (link)
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