Early diagnosis of Hantavirus infection by family doctors can reduce inappropriate antibiotic use and hospitalization

Abstract

Objective. Hantavirus infections are emerging infections that cause either Hantavirus pulmonary syndrome or haemorrhagic fever with renal syndrome (HFRS). A recent Swedish outbreak of nephropathia epidemica, a European HFRS, was analysed to study the patient flow and clinical picture and to investigate the value of an early diagnosis in general practice. Design. In a retrospective design, medical records of verified cases of Hantavirus infection were studied. Setting. The study was conducted in the county of Norrbotten, Sweden. Subjects. Data from Hantavirus patients diagnosed between 2006 and 2008 were analysed. Main outcome measures. Demographic data, level of care, treatment, clinical symptoms, and laboratory findings were obtained. Results. In total, 456 cases were included (58% males and 42% females). The majority of patients first saw their general practitioner and were exclusively treated in general practice (83% and 56%, respectively). When diagnosed correctly at the first visit, antibiotics and hospitalization were significantly lowered compared with delayed diagnosis (14% vs. 53% and 30% vs. 54%, respectively; p < 0.0001). The clinical picture was diverse. Early thrombocytopenia was found in 65% of the patients, and haemorrhagic manifestations were documented in a few cases. Signs of renal involvement – haematuria, proteinuria, and raised levels of serum creatinine – were found in a majority of patients. Conclusions. Raised awareness in general practice regarding emerging infections and better diagnostic tools are desirable. This study of a Hantavirus outbreak shows that general practitioners are frontline doctors during outbreaks and through early and correct diagnosis they can reduce antibiotic treatment and hospitalization.     

Hantavirus cardiopulmonary syndrome due to Puumala virus in Germany

In Germany Puumala virus (PUUV), known to cause mild forms of hemorrhagic fever with renal syndrome (HFRS), is the predominating endemic hantavirus. We herein describe an unusually severe case of a PUUV infection that occurred in summer 2015 in South Eastern Germany in a region known to be endemic for PUUV since over ten years. A 54-year-old female gardener was admitted to hospital with fever, cough and dyspnea. Within 48 hours the patient developed a rapid progressive adult respiratory distress syndrome (ARDS) with circulatory failure and required ECMO (extracorporeal membrane oxygenation) treatment. Serological and molecular biological examinations of serum samples confirmed an infection with PUUV. Partial sequences of the S- and M-segment clustered to a strain previously described in South Eastern Germany. Our reported case highlights, that in rare incidents PUUV can cause hantavirus cardiopulmonary syndrome, a syndrome that is usually found after infections with New World hantaviruses, and neurological symptoms.     

Factors Influencing Microbe/Insecticide Interactions

Abstract

Hantaviruses comprise an emerging global threat for public health, affecting about 30?000 humans annually. Infection may lead to Hantavirus pulmonary syndrome (HPS) in the Americas and hemorrhagic fever with renal syndrome (HFRS) in the Europe and Asia. Humans are spillover hosts, acquiring infection primarily through the inhalation of aerosolized excreta from infected rodents and insectivores. Risk factors for infection include involvement in outdoor activities, such as rural- and forest-related activities, peridomestic rodent presence, exposure to potentially infected dust and outdoor military training; prolonged, intimate contact with infected individuals promotes transmission of Andes virus, the only Hantavirus known to be transmitted from human-to-human. The total number of Hantavirus case reports is generally on the rise, as is the number of affected countries. Knowledge of the geographical distribution, regional incidence and associated risk factors of the disease are crucial for clinicians to suspect and diagnose infected individuals early on. Climatic, ecological and environmental changes are related to fluctuations in rodent populations, and subsequently to human epidemics. Thus, prevention may be enhanced by host-reservoir control and human exposure prophylaxis interventions, which likely have led to a dramatic reduction of human cases in China over the past decades; vaccination may also play a role in the future.     

云南省2010年肾综合征出血热监测分析

目的对云南省肾综合征出血热人间和鼠间疫情进行监测,分析流行病学特点,提供防治参考。方法收集监测点本病疫情资料,并在监测县采集人血清以及鼠型动物肺脏和鼠血清作汉坦病毒抗原或抗体检查。结果 2010年全省共报告出血热病例15例,死亡1例,病死率6.67%,其中大理州8例和楚雄州3例。2010年在红河州泸西县、昆明市五华区、大理州祥云县的居民区和野外共捕获鼠形动物10种406只。其中居民区以黄胸鼠和褐家鼠为优势鼠种,野外以大绒鼠、中华姬鼠为优势鼠种,鼠间汉坦病毒总带毒率为8.33%(33/396),阳性鼠型动物为黄胸鼠、褐家鼠、大绒鼠、小家鼠、灰麝鼩,带病毒率依次为2.02%(2/99)、6.38%(3/47)、22.03%(26/118)、16.67%(1/6)、50.00%(1/2)。结论滇中和滇西地区为本病主要发病地区。调查地区广泛存在以褐家鼠为主要传染源的家鼠型HFRS疫源地,泸西县还存在以大绒鼠为主要传染源的野鼠型HFRS疫源地。     

肾综合征出血热重型患者G1基因的变异

目的：探讨武汉地区肾综合征出血热重型患者感染的汉坦病毒M片段G1基因变异的情况。方法：用RT－PCR对34份肾综合征出血热患者发病1周内血清中的汉坦病毒G1基因扩增，并选取7份重型，1份轻型及1份中型患者的PCR产物测序，分别与标准株HV114和R22株相应序列比较。结果：1．Ⅰ型重型患者G1区在151－210位核苷酸有意义突变的频率很高，而轻型患者则无此改变。2．Ⅱ型重型患者G1区549位，552位和692位核苷酸变异引起编码氨基酸的改变相同，中型患者无此特点，结论：这些核苷酸变异可能与病毒毒力增强有关，从而引起临床重症表现。     

肾综合征出血热10年病情变化比较

目的探讨肾综合征出血热（HFRS）流行病学规律、临床表现和病原学变化特点，为临床早期诊断和早期治疗提供依据，方法采用回顾性分析方法．收集哈尔滨医科大学第一临床医学院感染科1995年和2005年HFRS住院患者的病历资料，比较不同年份的病例在性别，发病年龄、职业分布、发病区域、发病季节、临床分型方面的差异，并分析产生差异的原因。结果1995年和2005年．HFRS流行方式仍然是散发，高发人群以男性青壮年为主。1995年HFRS发病高峰为冬季，11、12月份发病例数为全年病例的65．33％（49／75）；2005年HFRS发病时间发生了变化，冬季发病仅占31．48％（34／108），春夏季病例增加，3—6月份发病病例数为全年病例的43．52％（47／108），比较两年各月发病例数，差异有统计学意义（Х^2=30．88，P〈0．01）；2005年发病人群中农民所占的比例下降，由1995年的81.33％下降勾2005年的55．56%，差异有统计学意义（Х^2=13．13，P〈0．01）；同1995年相比，2005年病例重型和危重型减少．轻型和不典型增多，差异有统计学意义（Х^2=28．24，P〈0．01）；结论黑龙江省部分地区HFRS病例出现了春夏季发病增多．农民发病比例下降，轻型和不典型病例增多，提示黑龙江省部分HFRS病例为家鼠型病毒感染     

2004～2005年滇西地区肾综合征出血热调查

目的 为掌握滇西地区肾综合征出血热流行病学特点,提供防治参考,对人间和鼠间疫情进行了调查.方法 收集滇西本病疫情资料,并在该地区采集人血清以及鼠肺脏和血清作汉坦病毒抗原和抗体检查.结果 滇西地区2004和2005年共报告病例41例,占全省同期发病数的40.59%.主要发病地区为祥云、兰坪、古城、永胜、宁蒗、宾川、巍山、弥渡、大理市(县、区),人群隐性感染率为1.81%.2004和2005年在玉龙、古城、永胜、宾川、祥云、大理、澜沧、景东、龙陵、盈江、腾冲、昌宁、宁蒗县和兰坪县(市、区)采集到16种1 825份鼠肺标本,鼠间汉坦病带毒率为2.47%.居民区以褐家鼠和黄胸鼠为优势鼠种,野外以高山姬鼠和大绒鼠为优势种,带毒鼠种为褐家鼠、黄胸鼠、大绒鼠、大足鼠、高山姬鼠和臭鼩鼱.结论 该地区广泛存在以褐家鼠和黄胸鼠为主要宿主动物的家鼠型疫源地,也存在着以高山姬鼠和大绒鼠为主的野鼠型疫源地.滇西疫区正在扩大,应采取以灭家鼠和健康人群接种家鼠型或两型混合疫苗为主的防治措施.     

Seroepidemiological study in a Puumala virus outbreak area in South-East Germany

Puumala virus (PUUV) is the cause of the majority of haemorrhagic fever with renal syndrome cases in Germany. In 2004, a nephropathia epidemica outbreak was recorded in Lower Bavaria, South-East Germany. For a seroepidemiological study in this region including the resident population at four locations (n = 178) and soldiers from one location (n = 208) indirect immunoglobulin M (IgM) and immunoglobulin G (IgG) enzyme-linked immunosorbent assays (ELISAs) and immunoblot tests based on a yeast-expressed PUUV nucleocapsid protein were established. The validation using human serum panels originating from Germany revealed a diagnostic sensitivity and specificity of 98/100% for the IgM ELISA, 99/99% for the IgG ELISA, 99/100% for the IgM immunoblot test and 100/96% for the IgG immunoblot test. Using the novel IgG assays as well as a commercial IgG ELISA and an immunofluorescence assay for the resident population an average prevalence of 6.7% (12 of 178) with a range of 0% (0 of 21) to 11.9% (7 of 59) was observed. Positive serological results were equally distributed between males and females with an average age of 63 for males and 52 for females. The seroprevalence in the soldier group was found to be about 1% with one positive male of 203 (age 46 years) and one positive female of five (age 47 years). In conclusion, the PUUV seroprevalence in the residents of the outbreak region in Lower Bavaria was found to be up to fivefold higher than the average hantavirus seroprevalence of the German population.     

青岛地区肾综合征出血热病毒基因分型

目的 调查青岛地区肾综合征出血热病毒的流行情况,研究病毒在该地区的分子流行病学特征及基因分型.方法 采集64例肾综合征出血热(HFRS)急性期患者血清标本,提取血清中病毒RNA作为模板.根据GenBank中汉坦病毒基因序列,设计HTN型和SEO型的通用外套引物,同时分别设计HTN型特异性引物和SEO型的特异性引物作为内...