汉坦病毒感染致血小板减少的机制

汉坦病毒主要感染血管内皮细胞,引起两种人类疾病,即肾综合征出血热和汉坦病毒心肺综合征,它们的共同特点是毛细血管广泛损伤,通透性升高.汉坦病毒感染者血小板数量严重减少,不仅与"外周破坏增加"有关,而且还可能与"血小板生成和功能障碍"有关.尽管汉坦病毒感染引起血小板减少的机制尚不完全明确,但近年也取得了一些重要进展.本文主...     

Hemorrhagic fever with renal syndrome: four decades of research

Hemorrhagic fever with renal syndrome is an acute infectious illness characterized by fever, hemorrhage, and renal failure. Research over the last 40 years has led to the discovery and characterization of the causative viruses, detailed knowledge of the epidemiology of the disease, development of sensitive diagnostic assays, and improvements in patient management, which in turn have led to significant reductions in mortality. Considerable progress has also been made in elucidating the pathophysiology of the disease, although much more needs to be learned. Recent data show that hemorrhagic fever with renal syndrome has a wider geographic occurrence than previously thought. This syndrome must be considered in the differential diagnosis of acute renal failure of unknown cause.     

肾综合征出血热并发急性造血功能停滞的临床观察

目的 观察肾综合征出血热(HFRS)并发急性造血功能停滞(AAH)的临床特点,疗效和预后.方法 对18例HFRS并发AAH患者的临床特点进行回顾性分析.结果 18例HFRS患者,男10例.女8例,年龄14～55岁,发病第9～25天出现不规则发热、突发性贫血和多部位出血,外周血WBC降至(2.3～3.2)×109/L,PLT降至(23～31)×109/L,RBC降至(2.23～2.79)×1012/L,Hb降至52～67 g/L,网织红细胞0～0.002.骨髓穿刺(56次)示红细胞系增生降低,粒、红细胞比例明显升高,粒细胞系和巨核细胞系增生降低.采用糖皮质激素和输血为主的综合性治疗措施,26～60 d治愈.结论汉坦病毒感染可并发AAH,其预后良好.     

Parturient and perinatal dengue hemorrhagic fever

A Thai woman in the shock stage of dengue hemorrhagic fever delivered a healthy infant by normal delivery. She had high, prolonged fever for five days, hepatomegaly, thrombocytopenia and a right pleural effusion. The serology performed later established a diagnosis of secondary dengue infection. She had no serious complications except for postpartum anemia. The newborn became febrile at the 48th hour of life. He had fever for 2 days, hepatomegaly, thrombocytopenia and a right pleural effusion. Dengue virus type 1 was detected from his serum by polymerase chain reaction (PCR). Although he developed prolonged, marked thrombocytopenia (12 days), his illness was uncomplicated. He recovered uneventfully and was discharged with his mother. This report was one of dengue vertical transmission with dengue hemorrhagic fever in humans.     

Hantavirus infections in Ile-de-France

Hantavirus infections, Puumala serotype, is a well-known disease in the northeast of France, but not in the Paris area, despite regularly diagnosed cases. A retrospective study was performed from January 1999 to December 2000 to assess the clinical and epidemiological characteristics of this disease in the "Région Ile-de-France". Fourteen cases were diagnosed. All required hospitalisation. Patients presented usually with high fever, pain, renal failure, moderate thrombocytopenia and, sometimes, transitional acute myopia witch is pathognomonic of the disease. In each case, a contact with a forest was found. Twelve patients recovered completely. One patient with pre-existing chronic renal and hepatic failure died and another developed a persistent arterial hypertension. Invasive procedures were often used before the diagnosis. Hantavirus infections does exist in the "Région Ile-de-France". Failure to recognise this disease in this area lead to unnecessary invasive procedures and hospitalizations.     

Nephropathia caused by hantavirus puumala: a case report

We present a patient from Germany with Hantavirus infection, admitted in the Emergency room of our hospital, with fever, thrombocytopenia, acute renal failure, oliguria, mild proteinuria and hematuria. Percutaneous renal biopsy revealed an acute interstitial nephritis without medulla haemorrhages. The virus infection confirmation was made by detection of IgM against Hantavirus Puumala. This infection should be considered in patients with thrombocytopenia, fever and acute renal failure, over all if they are from North and Central Europe.     

A sporadic case of acute Hantavirus nephropathy in The Netherlands

A 32-yr-old man presented with acute renal failure preceded by a viral-like disease with high fever, bilateral loin pain, nausea, headache and slight thrombocytopenia. Renal biopsy revealed only minor tubulointerstitial abnormalities. Renal function completely normalised within 10 days after hospitalisation. The diagnosis of acute Hantavirus nephropathy was proved by serological examinations.     

Hantavirusinduzierte Nephropathia epidemica

Hantavirus-induced nephropathia epidemica (NE) is a relatively mild manifestation of hemorrhagic fever with renal syndrome which has a favorable prognosis. In Germany more than 1,700 cases of NE have already been serologically verified during the first 9 months of 2010. Typical clinical symptoms are an acute onset with high fever, acute renal failure, thrombocytopenia, pronounced proteinuria and hematuria. Severe cases of NE may require a differential diagnosis by renal biopsy. In NE the combined light microscopical, immunohistochemical and electron microscopical examination of biopsy specimens usually results in a characteristic morphological pattern (in the outer medulla focal interstitial nephritis, multifocal hemorrhages, endothelial cell defects and platelet aggregates within peritubular capillaries and in the cortex potentially reversible diffuse proximal tubular damage and normal glomeruli) allowing a reliable differentiation from other types of interstitial nephritis, from glomerulonephritis as well as from leukocytoclastic vasculitis and thrombotic microangiopathy.     

Epidemic hemorrhagic fever with renal syndrome in Yugoslavia, 1986

An epidemic of hemorrhagic fever with renal syndrome (HFRS) occurred in Yugoslavia May-November 1986; all Republics and Provinces were involved. Serum samples were received from 260 of 276 persons with symptoms clinically compatible with a diagnosis of HFRS. Presumptive infection with a hantavirus was determined serologically for 161 of these. Many patients with serious clinical pictures, including severe renal insufficiency and shock, were hospitalized; 11 died. Indirect fluorescent antibody tests with antigens of 4 hantaviruses (Hantaan, Fojnica, Puumala, and the Vranica strain of Puumala virus) showed that greater than 1 serotype was circulating during this epidemic. Hantavirus antigens were detected in the lungs of 86 of 302 (28.5%) wild-caught small mammals.     

应用捕获ELISA检测肾综合征出血热患者尿液中特异性IgM抗体

目的 检测紧综合征出血热患者尿液中特异性IgM抗体,研究早期诊断方法。方法：用MacELISA法检测不同病日HFRS病人尿液中特异性IgM抗体。结果：HFRS病人尿夜中特异性IgM抗体总阳性率为76.47%,第3病日即可出现阳性,7－9病日阳性率可达83.87%,与同期HFRS病人血清抗体检测对比无显著性差异（P＞0.05）。结论：用MacELISA检测HFRS尿液中特异性IgM抗体敏感性高,特异性强,适合早期诊断。     

Hantavirus pulmonary syndrome in Brazil: clinical aspects of three new cases

Hantavirus pulmonary syndrome (HPS) has been recognized recently in Brazil, where 28 cases have been reported as of September 1999. We report here the clinical and laboratory findings of three cases whose diagnoses were confirmed serologically. All the patients were adults who presented a febrile illness with respiratory symptoms that progressed to respiratory failure that required artificial ventilation in two of them. Laboratory findings were most of the time consistent with those reported in the United States in patients infected with the Sin Nombre virus, and included elevated hematocrit and thrombocytopenia; presence of atypical lymphocytes was observed in one patient. The chest radiological findings observed in all the patients were bilateral, diffuse, reticulonodular infiltrates. Two patients died. Histopathological examination of the lungs of these patients revealed interstitial and alveolar edema, alveolar hemorrhage, and mild interstitial pneumonia characterized by infiltrate of immunoblasts and mononuclear cells. In the epidemiologic investigation of one of the cases, serologic (ELISA) tests were positive in 3 (25%) out of 12 individuals who shared the same environmental exposure. HPS should be included in the differential diagnosis of interstitial pneumonia progressing to acute respiratory failure.     

肾综合征出血热的临床特征及其治疗方法

目的对肾综合征出血热患者的临床特征进行分析,并探讨其治疗方法。方法回顾性分析本院2012年1月至2013年3月收治的34例肾综合征出血热患者临床资料,总结其临床病症特征与治疗方法。结果多脏器功能损害是肾综合征出血热患者的临床主要表现特征,最常见为血液系统和肝肾同时受损,具有典型症状的患者占32.4%。酶联免疫吸附法检测特异性抗体阳性率为73.5%。34例患者经相应治疗后,33例患者治愈,治愈率97.1%,1例因病情延误治疗无效而死亡。结论肾综合征出血热病情重,临床特征复杂,应重视该病的诊断和治疗,降低死亡率,接种出血热疫苗是控制该病的关键。     

Acute renal failure caused by leptospirosis and Hantavirus infection in an urban hospital

BACKGROUND: Leptospirosis (LS) and Hantavirus (HV) infection have many common clinical manifestations, including acute renal failure. In as much as clinical experience with these diseases is quite limited in urban centers, we identified cases of Leptospira and HV-induced acute renal failure and compared the clinical course and evolution of these diseases. METHODS: Patients hospitalized with acute renal failure, suspected to be caused by infection, were retrospectively studied over a 13-year period (1985-1998). Based on pertinent clinical data and positive serology, a total of 26 patients were included in the study, 17 patients with LS and 9 patients with HV infection. RESULTS: Both diseases presented as flu-like syndromes with high fever. In LS, 2 patients presented with acute meningitis and died soon after admission. Symptoms and signs from other organs began after the fifth day of illness. Jaundice occurred in 71% of LS patients but not in HV. Hemorrhagic phenomena occurred in both diseases but affected predominantly patients with icteric LS. Anuria or oliguria occurred in 76% of patients with LS and 78% with HV infection. Laboratory studies demonstrated minor transaminase elevations in all patients with LS and in 44% with HV. Hypoprothrombinemia or thrombocytopenia was uncommon, although disseminated intravascular coagulation (DIC) developed in 2 patients that had icteric Ls and major bleeding. Nephropathy was associated with haematuria in 71% with LS and all patients with HV. Proteinuria was evident in 35% of patients with LS compared to 78% with HV. Abnormal chest radiographs were seen in 24% with LS and in 33% with HV. In both diseases, aggressive supportive treatment was given, including hemodialysis or peritoneal dialysis in 4/26 patients. Of the 26 patients, 22 survived and four died. The latter all had LS, and the causes of death were meningitis and DIC with multiple organ failure. Follow-up, after 6 months, showed that renal function had returned to normal in the 22 survivors. CONCLUSION: It is important to include LS and HV infection in the differential diagnosis of acute renal failure. Both diseases present with flu-like symptoms and may be complicated by thrombotic microangiopathy with hemorrhagic phenomena and hepatic and pulmonary involvement. Jaundice should alert the physician to icteric LS, a severe disease associated with significant mortality that requires antimicrobial treatment.     

Neonatal dengue infection: report of dengue fever in a 1-day-old infant

A male infant was admitted because of fever. He was born at 37-weeks' gestation. His mother had experienced acute febrile illness with headache and myalgia. Her illness persisted with onset of active labor pain on day 5, which prompted cesarean section; postoperatively, the hematocrit decreased, requiring transfusion. The infant was well until fever developed at 16 hours after birth. There were petichiae on his face and trunk and the liver was enlarged. Fever subsided on day 5 without evidence of plasma leakage or severe hemorrhage. He made an uneventful recovery after 8 days of illness. Leukopenia and thrombocytopenia were present in the mother and infant. Both were diagnosed as dengue fever. Dengue type 1 was recovered from the infant by polymerase chain reaction. The dengue enzyme-linked immunoassay showed secondary infection in the mother and primary infection in the infant. In dengue-endemic areas, clinicians should be alert to dengue fever/dengue hemorrhagic fever in pregnant women presenting with acute febrile illness, and be prepared for proper management.     

辽宁省首次发现的新布尼亚病毒其培养特性的研究

摘要 目的 自2009年起我省从发热伴粒细胞、血小板减少的患者血液中,分离出一种能够引起人类患有类似肾综合征出血热（hemorrhagic fever with renal syndrome,HFRS）疾病的病毒。采用逆转录的方法扩增病毒核酸（RT-PCR）。选择有地区代表性的病毒株采用23对引物扩增病毒全部基因序列,将获得的全部氨基酸序列经BLAST检索,与GenBank中已知的汉坦病毒属、白蛉热病毒属基因序列排列做比对,确定了我省新分离出的病毒株属于布尼亚科新型病毒。2010年3月17日由中国疾病预防控制中心病毒病预防控制所李德新老师在《新英格兰医学杂志》首次向世界公布我国新分离的病毒株被正式命名为：发热伴血小板减少综合征布尼亚病毒（SFTSV）,简称 “新布尼亚病毒”,并确定了该病毒为“蜱咬病”的元凶。为叙述方便以下简称“新病毒”。方法 收集发病一周以内发热伴粒细胞、血小板减少的患者血液首先做汉坦病毒（Hantavirus,HV）血清学检测,然后将样本采用多种细胞培养的方法进行病毒分离。结果 从我省发热伴出血征候群血液样本分离出新型病毒12株。结论 我省东部山区及丘陵地带有布尼亚新病毒流行,其临床症状及体征与肾综合征出血热极为相似。但体外细胞培养及核苷酸序列却存在着明显的差别。 关键词 新布尼亚病毒 RT-PCR 细胞培养     

2009年云南省肾综合征出血热监测分析

目的进一步掌握肾综合征出血热（HFRS）在云南省的流行特征,为防治提供依据。方法收集云南省本病疫情资料,采集人血清、鼠类肺脏作汉坦病毒（HV）抗体和抗原检查。结果2009年云南省共报告本病16例,死亡1例,年发病率为0．04／10万。病死率为6．25％：发病地区为大理、昆明、红河、文山、楚雄和怒江州（市）。在固定监测点泸西县、祥云县和昆明市五华区捕获鼠类8属15种559只,人血清292份,其中居民区以黄胸鼠和褐家鼠为优势鼠种,野外以大绒鼠和高山姬鼠为优势鼠种;鼠间HY带毒率为3．78％（20／529）,带毒鼠型动物为褐家鼠、黄胸鼠、小家鼠、大足鼠、大绒鼠、臭鼩鼱和灰麝鼩。健康人血清HV抗体检测,人群隐性感染率4．45％（13／292）。结论进一步证实了云南省存在着以褐家鼠和黄胸鼠为主要宿主的家鼠型HFRS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;近几年发病率有所下降与鼠密度和鼠间HV感染率降低有关。     

Febrile cytolysis disclosing hemorrhagic fever with renal syndrome

We report the case of a 40-year-old-man who developed febrile cytolysis as the presenting sign of hemorragic fever with renal syndrome (HFRS). On admission, he had fever (40 degrees C) and epigastric pain. The AST level was at 2N, the ALT at 3N. There was a thrombocytopenia (61 000/mm(3)) without anemia or hyperleukocytosis. Three days after admission, the platelet count decreased to 40 000/mm(3), serum urea and creatinine increased from normal rate to 10.8mmol/l, 204.0 micromol/l, respectively. The HIV, HBV, HCV, leptospirosis antibodies were negative. The Hantavirus serology was positive (Ig G: 1/512). This case suggests that HFRS should be entertained as a possible cause of cytolysis with thrombocytopenia in patients with fever and no initial sign of renal involvement in North-Eastern France.     

Ruptur eines Leberhämatoms mit akutem Nierenversagen als Folge einer Hantavirusinfektion

Introduction

Hantavirus infection, which was hardly known in central Europe in the past, has become more and more relevant to clinical daily routine during recent years. Pathologic findings extend from signs of influenza infection to hemorrhagic fever with acute renal or pulmonary failure.

Case report

A 23 year old woman attended a periphery hospital because of clinical signs of influenza infection with additional abdominal pain. Ultrasound showed an unclear liver tumor and free fluid in the abdominal cavity. During laparoscopy a rupture of a subcapsular liver hematoma was diagnosed and therefore a laparotomy was performed. Because of increasing bleeding, the liver was compressed with abdominal towels and the patient was transferred to our department. We found a capsular liver defect between liver segment 2 and 3 caused by a ruptured liver hematoma or hemangioma. Within four days, acute renal failure developed. The assumed diagnosis of a Hantavirus infection was proven by clinical findings and puumula virus IgG and IgM antibodies.

Conclusion

Hantavirus infection should be considered in young patients with acute renal failure of unknown origin combined with abdominal pain and clinical symptoms of an influenza infection.     

Serological evidence of hantavirus infections in Malaysia

Hantaviruses are primarily rodent-borne and transmission is by inhalation of virus-contaminated aerosols of rodent excreta, especially urine and saliva. The genus Hantavirus, family Bunyaviridae, comprises at least 14 serotypes and the symptoms of clinical illness range from mild fever to severe hemorrhagic manifestations with renal complications. Many countries in Southeast Asia are unaware of the importance of hantavirus infections and give them low priority. Malaysia, like other countries in the region, has conducted very few studies on the epidemiology of hantaviruses - and even these were conducted in the 1980s. Using a more extensive range of hantavirus antigens, we conducted a seroprevalence study of rodents and humans and found further evidence of hantavirus infections. Moreover, the data from the antibody profiles strongly suggest the presence of different hantaviruses at the study sites.     

以急性胰腺炎为主要特征的肾综合征出血热3例

肾综合征出血热以急性胰腺炎为主要特征表现较少,表现特殊,易造成误诊.本3例患者临床表现均以腹痛为主,查血尿淀粉酶明显增高,CT及彩超胰腺肿大,易误诊为"急性胰腺炎".后经感染科会诊结合流血病学,临床特征与实验室检查才得以确诊.临床医生需开阔思路,在临床诊治过程中遇到类似病例不排外为肾综合征出血热.