Genetic detection of Dobrava/Belgrade virus in a Czech patient with Haemorrhagic fever with renal syndrome

In the summer of 2008, a 15-year-old boy was hospitalized in a paediatric intensive care unit in the Czech Republic. Laboratory diagnosis of hantavirus infection was established by serological and molecular methods. Sequence and phylogenetic analyses showed that the causative strain was Dobrava/Belgrade virus, which is genetically closer to strains associated with Apodemus flavicollis rodents.     

Case report: severe neurological manifestation of Dobrava hantavirus infection

In Europe infection with Puumala or Dobrava viruses causes hemorrhagic fever with renal syndrome (HFRS). In the course of HFRS, mild neurological symptoms such as headache, vertigo, and nausea are common. However, the data about the occurrence of severe, potentially life-threatening neurological manifestations are rather scarce. Here, we present a case of HFRS with serologically proven Dobrava virus infection complicated by epileptic seizures and hemiparesis due to focal encephalitis.     

Co‐circulation of three pathogenic hantaviruses: Puumala,Dobrava, and Saaremaa in Hungary

Hantaviruses (Bunyaviridae) cause hemorrhagic fever with renal syndrome (HFRS) in Eurasia and hantavirus (cardio)pulmonary syndrome (HCPS) in the Americas. HFRS is caused by Hantaan virus (HTNV), Seoul virus (SEOV), Dobrava virus (DOBV), Saaremaa virus (SAAV), and Puumala virus (PUUV). Of those, only HTNV is not present in Europe. In recent years, hantaviruses, described in other parts of Europe, were also detected at various locations in Hungary. To study the genetic properties of Hungarian hantaviruses in detail, sequences of the viral S and M segments were recovered from bank voles (Myodes glareolus), yellow‐necked mice (Apodemus flavicollis), and striped field mice (Apodemus agrarius) trapped in the Transdanubian region. As expected, the sequences recovered belonged, respectively, to PUUV (two strains), DOBV (one strain), and SAAV (one strain). On phylogenetic trees two new Hungarian PUUV strains located within the well‐ supported Alpe‐Adrian (ALAD) genetic lineage that included also Austrian, Slovenian, and Croatian strains. Analysis of the Hungarian SAAV and DOBV genetic variants showed host‐specific clustering and also geographical clustering within each of these hantavirus species. Hungarian SAAV and DOBV strains were related most closely to strains from Slovenia (Prekmurje region). This study confirms that multiple hantaviruses can co‐circulate in the same locality and can be maintained side‐by‐side in different rodent species. J. Med. Virol. 81:2045–2052, 2009. © 2009 Wiley‐Liss, Inc.     

Serum thrombospondin-1 is altered in patients with hemorrhagic fever with renal syndrome

Hemorrhagic fever with renal syndrome (HFRS) is a severe acute viral disease with pathological changes of impaired capillary and small vessels and thrombocytopenia. In this study, serum thrombospondin (TSP)-1 concentration in patients with HFRS was determined to explore its possible role in the pathogenesis of HFRS. The concentration of TSP-1 was measured using a competitive enzyme-linked immunoabsorbent assay. Significantly decreased levels of serum TSP-1 were observed in HFRS patients at febrile and hypotensive phases compared with those in the controls. The serum levels of TSP-1 in HFRS patients with more severe clinical types was reduced more profoundly than those in patients with milder clinical types at febrile and hypotensive phases, although the differences in TSP-1 were not significant. It was indicated that insufficient production or increased consumption of TSP-1, or both of these, may contribute to the impairment of capillary and small vessels and the development of hypotension at the early stage of HFRS, and the decreased degree may be associated with disease severity.     

广州市2009年肾综合征出血热监测分析

目的分析广州市肾综合征出血热（HFRS）的流行特征和规律,探讨防制对策。方法采用人间疫情监测、健康人群抗体水平监测、宿主动物监测方法,其中实验室用间接免疫荧光法检测血清特异性IgG抗体,直接免疫荧光法检测鼠肺汉坦病毒（HV）抗原。结果共报告HFRS71例,死亡1例,发病率为0.69/10万,病死率为1.41%;排查病例抗体阳性率为16.14%（188/1165）,健康人群抗体阳性率为0.50%（2/400）;鼠密度为4.60%（361/7856）,鼠肺抗原阳性率为8.31%（30/361）,鼠血清抗体阳性率为7.43%（26/350）,优势鼠种为褐家鼠。结论广州市HFRS疫情形势较为平稳,但仍然存在病例数上升的压力,应加强疫情监测,落实防鼠灭鼠为主的综合性预防控制措施。     

Increased plasma levels of soluble CD23 in haemorrhagic fever with renal syndrome; relation to virus-specific IgE

In 15 consecutive patients hospitalized with nephropathia epidemica, a European form of haemorrhagic fever with renal syndrome (HFRS) caused by Puumala virus, plasma concentrations of soluble CD23 (sCD23) and Puumala virus-specific IgE were determined. In the acute phase of illness, 11/15 patients had increased sCD23 levels (> 91 U/ml), whereas in convalescence, values of 8/10 patients were normalized. Maximal sCD23 values were correlated to maximal concentrations of Puumala virus-specific serum IgE (r= 0.597; P= 0.025). The results are compatible with a known ability of sCD23 to augment IgE production.     

上海地区肾综合征出血热尸检肾组织病毒检测

目的：研究上海地区肾综合征出血热（ＨＦＲＳ）尸检病例肾脏组织中病毒ＲＮＡ及抗原的分布及定位，方法：用核酸原位分子杂交方法和细胞免疫组化方法，检测了１７例ＨＦＲＳ尸检肾组织中病毒，结果：１７例肾组织中１５例可检测到病毒ＲＮＡ及抗原，病毒ＲＮＡ主要位于肾组织血管壁，毛细血管内皮细胞脉冲有小球毛细血管内皮细胞，病毒抗原主要分布于肾间质管内皮细胞和血管壁中，部分位于肾曲管上皮细胞，以病毒包涵体样颗粒出现。     

2001-2010年广州市肾综合征出血热监测分析

目的通过分析2001-2010年监测资料,研究广州市肾综合征出血热（HFRS）的流行特征和变化趋势。方法应用描述性流行病学方法分析人间疫情监测、宿主动物监测资料,实验室应用间接免疫荧光法检测鼠血清HV特异性IgG抗体,直接免疫荧光法检测鼠肺汉坦病毒（HV）抗原。结果 2001-2010年共报告HFRS743例,死亡4例,发病率为0.81/10万,病死率为0.54%。发病人数和发病率呈现上升趋势,发病高峰在10月至次年6月,病例集中在天河区、海珠区和白云区,职业分布以工人、家务及待业、商业服务为主,其次是民工和农民。男女比例为3.10∶1,年龄集中在20～50岁。鼠密度为9.64%,鼠血清HV特异性IgG抗体阳性率为4.94%,鼠肺HV抗原阳性率为5.56%。鼠密度和鼠种构成相对稳定,但2004-2010年鼠血清HV特异性IgG抗体阳性率和鼠肺HV抗原阳性率均处于持续上升趋势。鼠种构成主要以褐家鼠（70.01%）为主,其血清HV特异性IgG抗体阳性率（6.02%）和肺HV抗原阳性率（6.58%）在各鼠种中最高。结论广州市HFRS疫情呈现一定的上升趋势,发病风险不断增大,应加强预防控制工作;另外,广州市可能已经由家鼠型疫区演变为混合型疫区,应寻找进一步的相关证据。     

应用圆形分布法分析深圳市肾综合征出血热季节性特征

目的探讨深圳市肾综合征出血热（HFRS）发生的季节性特征,为制定防治策略提供依据。方法应用圆形分布法对深圳市2005-2009年肾综合征出血热疫情资料进行统计分析。结果 2005-2009年深圳市共报告肾综合征出血热145例,年发病率0.18/10万～0.49/10万。圆形分布统计结果显示发病高峰日为3月2日,季节性分布不明显（r=0.2329,P〉0.05）。结论深圳市近几年HFRS的发病呈散在分布,无明显的季节性,应制定相应的防控措施。     

肾综合征出血热病毒宫内感染的临床研究

目的 研究肾综合征出血热(HFRS)病毒宫内感染情况及其对婴儿的影响。方法 对妊娠期感染HFRS病毒者，于其分娩时留取母血和脐带血进行抗—HFRS IgG检测，同时对顺产新生儿采取静脉血进行抗—HFRS IgM检测，并应用血凝抑制试验(HI)对HFRS病毒进行分型，另外对顺产的新生儿进行全面查体和定期随访观察。结果 母血抗—HFRS IgG均阳性，死胎的27例脐带血抗—HFRS IgG阳性23例，孕妇痊愈后自然分娩的12例中脐带血和静脉血有2例抗—HFRS IgG阳性，而抗—HFRS IgM阴性。并发现14例顺产新生儿生长发育全部正常。结论 HFRS病毒存在宫内感染，并易致死胎，但对顺产婴儿未发现致畸作用。     

应用免疫金银直接染色法诊断肾综合征出血热

应用免疫金银直接染色法（Ｄ－ＩＧＳＳ）对肾综合征出血热病毒（ＨＦＲＳＶ）感染的Ｖｅｒｏ－Ｅ６细胞进行ＨＦＲＳＶ抗原检测，发现Ｅ６细胞的胞浆和细胞膜上能清楚地观察到黑色均匀的银颗粒，而用ＨＦＲＳＶ免疫兔血清ＩｇＧ作阻断试验，却未见银颗粒。在此基础上对３２例ＨＦＲＳ患者检测外周血白细胞中的ＨＦＲＳＶ抗原，并和间接免疫荧光法（Ｉ－ＩＦＡ）进行对照，结果病程１０天以内Ｄ－ＩＧＳＳ法阳性率达到１０００％，个别病例病程２３天仍能检出ＨＦＲＳＶ抗原，而ＩＦＡ法在病程１１天以后阳性率明显下降，病程１４天后未检出ＨＦＲＳＶ抗原。说明Ｄ－ＩＧＳＳ法敏感性明显高于ＩＦＡ法。为对比外周静脉血和手指末稍血白细胞中ＨＦＲＳＶ抗原检出率，对３２例患者进行同步采血，结果ＨＦＲＳＶ抗原检出率无显著性差异（Ｐ＜００５）。我们认为Ｄ－ＩＧＳＳ法检测ＨＦＲＳ患者末稍血中的ＨＦＲＳＶ抗原，是简而易行的方法，可用于ＨＦＲＳ早期诊断。     

北京市肾综合征出血热聚集疫情分析

目的 描述分析北京市一起肾综合征出血热聚集性疫情,探讨低发病率地区聚集性疫情的流行病学特征.方法 2007-2014年肾综合征出血热病例数据来源于中国疾病预防控制信息系统中现住址为北京市的病例.疫情数据来源于流行病学调查和疫情防控记录.病例血清汉坦病毒抗原和抗体检测采用ELISA法.啮齿类动物使用夹夜法捕捉,其血清汉坦病毒抗原抗体使用间接免疫荧光方法检测.结果 2007-2014年北京市平均每年报告肾综合征出血热病例18例,年发病率在0.09/105-0.16/105.聚集疫情共涉及2名实验室确诊病例和1名无症状感染者.病例临床症状相对较轻,居住地灭鼠前鼠密度为10.0％,灭鼠后密度为1.3％.家鼠肺标本汉坦病毒抗体阳性率为12.5％(1/8),宠物鼠中未检出汉坦病毒.结论 北京市仍存在发生肾综合征出血热聚集疫情的可能,这起涉及3名感染者的疫情为“城中村”家鼠传播.     

广西家鼠型肾综合征出血热病毒的发现和鉴定

目的 从广西各地捕获的鼠肺标本检测汉坦病毒并鉴定其型别.方法 结合广西鼠疫监测采集啮齿类宿主动物,用ELISA法检测鼠肺标本,对汉坦病毒抗原阳性标本通过RT-PCR法扩增部分M片段上的核苷酸序列并测序,将扩增片段的核苷酸序列与已知病毒序列进行比对并分型.结果 在306份鼠肺标本中检测到1株SEO型的出血热病毒,阳性标本为广西沿海地区钦州市捕获的褐家鼠.结论 在广西沿海地区检测到SEO型汉坦病毒,其流行病学意义有待进一步研究.     

连续性静脉-静脉血液透析在重症肾综合征出血热合并急性呼吸窘迫综合征治疗中的应用

目的探讨连续性静脉-静脉血液透析(CVVHD)在重症肾综合征出血热(HFRS)合并急性呼吸窘迫综合征(ARDS)治疗中的作用。方法 15例重症HFRS合并ARDS病人,其中男性11例,女性4例;年龄22~68岁,平均年龄45岁。在一般治疗、机械通气基础上采用CVVHD治疗,治疗前及治疗过程中检测血气指标(pH、氧分压、二氧化碳分压、氧分压/吸入氧浓度、氧饱和度)、肿瘤坏死因子(TNF-α)、白细胞介素6(IL-6)、白细胞介素10(IL-10),治疗前后检测肾功能。结果 15例病人存活12例,存活率80%(12/15)。治疗过程中血气指标平稳改善,治疗前后细胞因子TNF-α、IL-6、IL-10明显下降,肾功能改善明显。结论 CVVHD治疗可通过有效清除异常分泌的细胞因子改善ARDS,对HFRS合并ARDS有一定的治疗作用。     

免疫酶斑点法检测汉坦病毒抗原的研究

目的 建立一种新的诊断肾综合征出血热(HFRS)的实验手段。方法 采用R22株、陈株和湖北株3种汉坦病毒接种家兔，制备兔抗汉坦病毒多克隆抗体(抗HTV-IgG)。然后采用混合的3种抗体进行免疫酶斑点法实验(IEDA)，检测患者血清和尿液中的汉坦病毒抗原。同时采用间接免疫荧光法(IFA)检测患者血清中抗汉坦病毒-IgM作对照。结果 经用相关分析，IEDA与IFA检测的结果高度相关。血中汉坦病毒抗原检出率为73．68％，尿中为65．00％。发病5d内，血中检出率为94．34％，尿中检出率为83．33％。5病日内的早期诊断率前者明显高于后者。结论 IEDA与IFA相比，阳性率比后者有较大提高，特别是5病日内的早期阳性率的提高明显，值得用于临床HFRS的早期诊断。     

Hantaviruses in small mammals and humans in the coastal region of Zhejiang Province,China

To gain more insights into the epidemiology of hantaviruses in the coastal region of Zhejiang Province, China, the morbidity and mortality of hemorrhagic fever with renal syndrome (HFRS) were analyzed in two coastal areas: Cixi (hilly terrain) and Wenzhou (mountainous terrain). More HFRS cases have been reported in Cixi than in Wenzhou. Annual incidence rate of HFRS in Cixi had been on the level of approximately 1.5/100,000 from 1968 (when the first HFRS case was reported) to 2007, with the highest incidence rate of 8.54/100,000 in 1999. The annual incidence rate in Wenzhou has been relatively low, less than 0.5/100,000 since the first HFRS case was reported in 1981. A total of 461 rodents and 199 shrews were captured in these two areas. Hantavirus antibodies were detected in 16 of 241 (6.64%) Rattus norvegicus and 13 of 122 (10.66%) R. flavipectus. Interestingly, hantavirus antigens were identified in 6 of 196 (3.06%) Suncus murinus. Genetic analysis showed that partial M and S segment sequences recovered from rats in the two regions belong to Seoul virus (SEOV) and can be assigned into two genetic lineages. SEOV variants that belong to these two lineages of viruses are distributed widely in China and have been found outside China. As most trapped rodents were rats and SEOV was the only hantavirus detected, these results suggested that SEOV plays an important role in human hantavirus infections. They also reinforce the need for vigilance in preventing HFRS caused by hantaviruses in the coastal region. J. Med. Virol. 82:987–995, 2010. © 2010 Wiley‐Liss, Inc.