Hemorrhagic fever with renal syndrome (HFRS) starts as a flu-like illness and may progress to shock, bleeding and kidney failure. The diagnosis is made by serological studies and PCR. The mortality rate is 6-15%. The sessions are held u. a. iv with ribavirin

Bunyaviridae include hantavirus genus, which consists of at least 4 serogroups 9 viruses and causes great 2, partially overlapping, clinical pictures:

(P. Also Overview nfektionen by arbovirus, Arena virus and filovirus) Bunyaviridae include the genus Hantavirus, which consists of at least four serogroups with 9 viruses and 2 large, partially overlapping, caused diseases: hemorrhagic fever with renal syndrome (HFRS) Hantavirus -bedingtes Pulmonary syndrome (HPS) HFRS by the Hantaan, Seoul-, Dobrava (Belgrade-), and Puumala virus is caused. HPS is caused by Sin-Nombre-, Black Creek Canal-, Bayou- and New York-1 virus. Hantaviruses occur worldwide in wild rodents excrete the virus for life in the urine and feces. The transfer takes place primarily between the rodents. A transmission to humans can occur through inhalation of aerosols containing rodent excreta. Recent studies indicate that there may also be a transmission from person to person in rare cases. Naturally acquired and laboratory infections are increasingly common. The clinical laboratory diagnosis of hantavirus infection is detected by serological investigations and reverse transcriptase PCR (RT-PCR). The serological tests consist of enzyme-linked immunosorbent assay a (ELISA) and confirmation by Western blot or Immunoblotassays. The virus cultivation is technically demanding and requires a laboratory biosafety level 3 (BSL 3). Hemorrhagic fever with renal syndrome (HFRS) (epidemic Nephrosonephritis; Korean hemorrhagic fever, epidemic nephropathy) Hemorrhagic fever with renal syndrome (HFRS) starts as a flu-like illness and may progress to shock, bleeding and kidney failure. The diagnosis is made by serological studies and PCR. The mortality rate is 6-15%. The sessions are held u. a. iv with ribavirin Some forms of HFRS are easy (eg. As epidemic nephropathy caused by Puumala virus that occurs in Scandinavia, the western part of the former Soviet Union and Europe). Others are more difficult (for. Example, those caused by hanta and Dobrava virus and occur in Korea and in the Balkan). The infection is transmitted to humans by inhalation of excreta of rodents. Symptoms and signs The incubation period is about 2 weeks. In mild cases, the infection is often asymptomatic. When symptoms of the onset is sudden, with high fever, headache, back – and abdominal pain. At the 3rd or 4th day can cause subconjunctival hemorrhage, palatal petechiae and a truncal petechial rash. > 90% of patients there is a diffuse redness of the face that resembles a sunburn and associated with Dermographism. A relative bradycardia is present, and in about half of patients experience a slight temporary Hyptension that occurs in a minority with shock. After the fourth day, a kidney failure develops. Approximately 20% of patients have a lethargy. In 1% of patients experience seizures or serious focal neurological symptoms. The rash fades again, patients develop polyuria and recover for several weeks. Proteinuria, hematuria and pyuria may develop. Renal failure may auftreten.Diagnose Serological tests or PCR The suspected HFRS exists in patients with possible exposure if they show fever, bleeding tendency and renal insufficiency. Then blood count, electrolytes, renal function parameters, coagulation parameters and urine values ??are determined. During the hypotensive stage hematocrit rises and there is a leukocytosis and thrombocytopenia. Albuminuria, hematuria and RBC and Leukozytenzylinder may occur, usually between the 2nd and the 5th day. During the diuretic phase often leads to electrolyte imbalance. The final diagnosis of HFRS is based on serological tests or PCR.Prognose during the diuretic phase, it may due to volume depletion, electrolyte imbalance come or secondary infections to deaths. The recovery period usually takes 3-6 weeks, but may take up to 6 months. The overall mortality is 6-15%, almost all deaths occur with severe disease in patients. Consistent renal disorders are rare, except in severe forms Sometimes Dialysis treatment is carried out in the Balkan States auftreten.Therapie Ribavirin Ribavirin iv: initial dose 33 mg / kg (maximum 2.64 g), followed by 16 mg / kg every 6 h (maximum 1.28 g every 6 hours) for 4 days, then 8 mg / kg every 8 h (max, 0.64 g every 8 hours) for 3 days. Especially during the diuretic phase supportive measures are important, possibly incl. Dialysis. Hanta virus pulmonary syndrome conditional (HPS) The Hanta virus-induced pulmonary syndrome occurs mainly in the southwestern United States. It starts as a flu-like illness and causes a non-cardiac pulmonary edema within a few days. The diagnosis is made by serological tests and reverse transcriptase PCR. The mortality rate is 50-75%. Treatment is supportive. Most cases of HPS caused by the Sin-Nombr- Hantavirus (Four Corners virus Muerto Canyon virus) Other caused by the Black Creek Canal virus or Bayou virus in the Southeast, the New York virus from East Coast the Andes virus or Laguna Negra virus in South America the infection is (especially deer mice) transmitted to humans by inhalation of excreta of rodents of the genus Sigmodontinae. Most cases occur west of the Mississippi in spring or summer, especially after heavy rain before. Symptoms and complaints HPS begins as nonspecific flu-like illness with acute fever, headache and gastrointestinal complaints. 2-15 days later (median: 4 days), patients develop rapidly nichtkardiogene pulmonary edema and hypotension. Several patients have a combination of HFRS and HPS. Mild cases of HPS can auftreten.Diagnose Serological tests or PCR The suspicion of HPS, patients with a possible exposure if they have an otherwise unexplainable clinically or radiographically detectable lung edema. In chest X-ray image reinforced vascular drawings Kerley-B lines, bilateral infiltrates or pleural effusions may be visible. On suspicion of HPS echocardiography should be performed to rule out cardiogenic pulmonary edema. Most also a blood count, liver and urine parameters values ??are determined. HPS causes a slight neutrophilic leukocytosis, hemoconcentration and thrombocytopenia. A moderate increase in LDH, AST and ALT, at reduced serum albumin, is characteristic. Urinalysis shows only minimal abnormalities. The diagnosis is made by serological tests or reverse Transkriptease-PCR.Prognose In patients who survive the first few days, is rapidly improvement, and they recover within the next 2-3 weeks back completely, usually without sequelae. The average mortality rate is 36% .Therapie Supportive treatment Treatment is symptomatic and supportive aligned. It may be required mechanical ventilation, exact volume replacement therapy and the use of vasopressor substances. In severe cardiopulmonary insufficiency an extracorporeal mechanical oxygenation (ECMO) can be life saving. Ribavirin i.v. is ineffective.


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