Volume 21, Number 1—January 2015
CME ACTIVITY - Research
Clinical Course and Long-Term Outcome of Hantavirus-Associated Nephropathia Epidemica, Germany
Table 1
Variable | Median value (range) or no. or % patients positive for variable |
---|---|
Sex, no. | |
M | 290 |
F |
166 |
Age at diagnosis |
48 y (40–59) |
Patient status, no. | |
Inpatient | 335 |
Outpatient |
121 |
Duration of hospital stay |
7 d (5–9) |
Duration of illness at hospital admission or first visit to general practitioner/nephrologist |
5 d (3–7) |
Duration of fever before hospital admission |
4 d (2–6) |
Duration of disease |
4 wk (2–8) |
Assumed exposure to virus, % | |
Occupational | 7 |
During leisure activities |
93 |
Symptoms, % | |
Pain | |
Abdominal | 33 |
Back | 67 |
Limbs | 71 |
Headache | 68 |
Visual disorders | 22 |
Diarrhea | 20 |
Nausea/vomiting | 47 |
Dyspnea | 2 |
Loss of appetite | 4 |
Fatigue | 7 |
Shivering |
2 |
Clinical signs | |
Fever, % | 90 |
Duration of fever | 5 d (3–7) |
Hemorrhage, % | 7 |
Blood pressure | |
Systolic, | 130 mm Hg (120–146) |
Diastolic | 80 mm Hg (71–90) |
Heart rate | 76 beats/min (64–86) |
Hypertension, % | 15 |
Hypotension, % | 10 |
Shock, % | 1 |
Chest radiograph, % | 47 |
Pathologic findings on radiograph, % | 23 |
Abdominal ultrasound, % | 65 |
Splenomegaly, % | 14 |
Hepatomegaly, % | 4 |
Acute kidney injury, %* | 86 |
*According to RIFLE (risk of renal dysfunction) criteria (27).
References
- Schmaljohn CS, Dalrymple JM. Analysis of Hantaan virus RNA: evidence for a new genus of Bunyaviridae. Virology. 1983;131:482–91 . DOIPubMedGoogle Scholar
- Krüger DH, Ulrich R, Lundkvist AA. Hantavirus infections and their prevention. Microbes Infect. 2001;3:1129–44. DOIPubMedGoogle Scholar
- Peters CJ, Simpson GL, Levy H. Spectrum of hantavirus infection: hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome. Annu Rev Med. 1999;50:531–45. DOIPubMedGoogle Scholar
- Watson DC, Sargianou M, Papa A, Chra P, Starakis I, Panos G. Epidemiology of hantavirus infections in humans: a comprehensive, global overview. Crit Rev Microbiol. 2014;40:261–72. DOIPubMedGoogle Scholar
- Ettinger J, Hofmann J, Enders M, Tewald F, Oehme RM, Rosenfeld UM, Multiple synchronous outbreaks of Puumala virus, Germany, 2010. Emerg Infect Dis. 2012;18:1461–4 . DOIPubMedGoogle Scholar
- Boone I, Wagner-Wiening C, Reil D, Jacob J, Rosenfeld UM, Ulrich RG, Rise in the number of notified human hantavirus infections since October 2011 in Baden-Wurttemberg, Germany. Euro Surveill. 2012;17:20180 .PubMedGoogle Scholar
- Krüger DH, Ulrich RG, Hofmann J. Hantaviruses as zoonotic pathogens in Germany. Dtsch Arztebl Int. 2013;110:461–7 .PubMedGoogle Scholar
- Vapalahti O, Mustonen J, Lundkvist A, Henttonen H, Plyusnin A, Vaheri A. Hantavirus infections in Europe. Lancet Infect Dis. 2003;3:653–61. DOIPubMedGoogle Scholar
- Krautkrämer E, Zeier M, Plyusnin A. Hantavirus infection: an emerging infectious disease causing acute renal failure. Kidney Int. 2013;83:23–7. DOIPubMedGoogle Scholar
- Braun N, Haap M, Overkamp D, Kimmel M, Alscher MD, Lehnert H, Characterization and outcome following Puumala virus infection: a retrospective analysis of 75 cases. Nephrol Dial Transplant. 2010;25:2997–3003. DOIPubMedGoogle Scholar
- Hjertqvist M, Klein SL, Ahlm C, Klingstrom J. Mortality rate patterns for hemorrhagic fever with renal syndrome caused by Puumala virus. Emerg Infect Dis. 2010;16:1584–6. DOIPubMedGoogle Scholar
- Makary P, Kanerva M, Ollgren J, Virtanen MJ, Vapalahti O, Lyytikainen O. Disease burden of Puumala virus infections, 1995–2008. Epidemiol Infect. 2010;138:1484–92. DOIPubMedGoogle Scholar
- Mustonen J, Brummer-Korvenkontio M, Hedman K, Pasternack A, Pietila K, Vaheri A. Nephropathia epidemica in Finland: a retrospective study of 126 cases. Scand J Infect Dis. 1994;26:7–13. DOIPubMedGoogle Scholar
- Settergren B, Juto P, Trollfors B, Wadell G, Norrby SR. Hemorrhagic complications and other clinical findings in nephropathia epidemica in Sweden: a study of 355 serologically verified cases. J Infect Dis. 1988;157:380–2. DOIPubMedGoogle Scholar
- Rasche FM, Uhel B, Kruger DH, Karges W, Czock D, Hampl W, Thrombocytopenia and acute renal failure in Puumala hantavirus infections. Emerg Infect Dis. 2004;10:1420–5 . DOIPubMedGoogle Scholar
- Ala-Houhala I, Koskinen M, Ahola T, Harmoinen A, Kouri T, Laurila K, Increased glomerular permeability in patients with nephropathia epidemica caused by Puumala hantavirus. Nephrol Dial Transplant. 2002;17:246–52. DOIPubMedGoogle Scholar
- Niklasson B, Hellsten G, LeDuc J. Hemorrhagic fever with renal syndrome: a study of sequelae following nephropathia epidemica. Arch Virol. 1994;137:241–7. DOIPubMedGoogle Scholar
- Mäkelä S, Ala-Houhala I, Mustonen J, Koivisto AM, Kouri T, Turjanmaa V, Renal function and blood pressure five years after Puumala virus–induced nephropathy. Kidney Int. 2000;58:1711–8. DOIPubMedGoogle Scholar
- Miettinen MH, Mäkelä SM, Ala-Houhala IO, Huhtala HS, Koobi T, Vaheri AI, Ten-year prognosis of Puumala hantavirus–induced acute interstitial nephritis. Kidney Int. 2006;69:2043–8. DOIPubMedGoogle Scholar
- Lähdevirta J. Nephropathia epidemica in Finland. A clinical histological and epidemiological study. Ann Clin Res. 1971;3:1–54 .PubMedGoogle Scholar
- Lähdevirta J, Collan Y, Jokinen EJ, Hiltunen R. Renal sequelae to nephropathia epidemica. Acta Pathol Microbiol Scand [A]. 1978;86:265–71 .PubMedGoogle Scholar
- Rubini ME, Jablon S, Mc DM. Renal residuals of acute epidemic hemorrhagic fever. Arch Intern Med. 1960;106:378–87. DOIPubMedGoogle Scholar
- Kleinknecht D, Rollin PE. Hypertension after hemorrhagic fever with renal syndrome. Nephron. 1992;61:121. DOIPubMedGoogle Scholar
- Krautkrämer E, Grouls S, Urban E, Schnitzler P, Zeier M. No gender-related differences in the severity of nephropathia epidemica, Germany. BMC Infect Dis. 2013;13:457. DOIPubMedGoogle Scholar
- Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension. 2005;45:142–61. DOIPubMedGoogle Scholar
- Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–72 . DOIPubMedGoogle Scholar
- Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204–12. DOIPubMedGoogle Scholar
- Outinen TK, Tervo L, Mäkelä S, Huttunen R, Mäenpää N, Huhtala H, Plasma levels of soluble urokinase-type plasminogen activator receptor associate with the clinical severity of acute Puumala hantavirus infection. PLoS ONE. 2013;8:e71335. DOIPubMedGoogle Scholar
- Outinen TK, Mäkelä SM, Ala-Houhala IO, Huhtala HS, Hurme M, Paakkala AS, The severity of Puumala hantavirus induced nephropathia epidemica can be better evaluated using plasma interleukin-6 than C-reactive protein determinations. BMC Infect Dis. 2010;10:132. DOIPubMedGoogle Scholar
- Krautkrämer E, Grouls S, Stein N, Reiser J, Zeier M. Pathogenic old world hantaviruses infect renal glomerular and tubular cells and induce disassembling of cell-to-cell contacts. J Virol. 2011;85:9811–23. DOIPubMedGoogle Scholar
- Vaheri A, Strandin T, Hepojoki J, Sironen T, Henttonen H, Mäkelä S, Uncovering the mysteries of hantavirus infections. Nat Rev Microbiol. 2013;11:539–50. DOIPubMedGoogle Scholar
- Turčinov D, Puljiz I, Markotić A, Kuzman I, Begovac J. Clinical and laboratory findings in patients with oliguric and non-oliguric hantavirus haemorrhagic fever with renal syndrome: an analysis of 128 patients. Clin Microbiol Infect. 2013;19:674–9. DOIPubMedGoogle Scholar
- Heyman P, Vaheri A, Lundkvist A, Avsic-Zupanc T. Hantavirus infections in Europe: from virus carriers to a major public-health problem. Expert Rev Anti Infect Ther. 2009;7:205–17. DOIPubMedGoogle Scholar
- Hautala N, Kauma H, Vapalahti O, Mahonen SM, Vainio O, Vaheri A, Prospective study on ocular findings in acute Puumala hantavirus infection in hospitalised patients. Br J Ophthalmol. 2011;95:559–62. DOIPubMedGoogle Scholar
- Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense HW, Joffres M, Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA. 2003;289:2363–9. DOIPubMedGoogle Scholar
- Elgh F, Linderholm M, Wadell G, Tarnvik A, Juto P. Development of humoral cross-reactivity to the nucleocapsid protein of heterologous hantaviruses in nephropathia epidemica. FEMS Immunol Med Microbiol. 1998;22:309–15. DOIPubMedGoogle Scholar
- Elgh F, Lundkvist A, Alexeyev OA, Stenlund H, Avsic-Zupanc T, Hjelle B, Serological diagnosis of hantavirus infections by an enzyme-linked immunosorbent assay based on detection of immunoglobulin G and M responses to recombinant nucleocapsid proteins of five viral serotypes. J Clin Microbiol. 1997;35:1122–30 .PubMedGoogle Scholar
- Maes P, Clement J, Gavrilovskaya I, Van Ranst M. Hantaviruses: immunology, treatment, and prevention. Viral Immunol. 2004;17:481–97. DOIPubMedGoogle Scholar
- Klempa B, Meisel H, Rath S, Bartel J, Ulrich R, Kruger DH. Occurrence of renal and pulmonary syndrome in a region of northeast Germany where Tula hantavirus circulates. J Clin Microbiol. 2003;41:4894–7. DOIPubMedGoogle Scholar
- Klempa B, Schutt M, Auste B, Labuda M, Ulrich R, Meisel H, First molecular identification of human Dobrava virus infection in central. J Clin Microbiol. 2004;42:1322–5. DOIPubMedGoogle Scholar
Page created: December 17, 2014
Page updated: December 17, 2014
Page reviewed: December 17, 2014
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.