Atypical case of hantavirus infection in Sri Lanka mimicking leptospirosis: a case report

Abstract

Background Hantavirus infection is an emerging zoonotic infection which has two characteristic patterns of presentation: hantavirus pulmonary syndrome and hemorrhagic fever with renal syndrome. The clinical presentation of hantavirus infection closely mimics leptospirosis. Case presentation This case report describes a previously apparently well 36-year-old Sri Lankan Sinhalese man who presented with an acute febrile illness with myalgia, with liver involvement in the form of transaminitis, cardiac involvement in the form of myocarditis, acute kidney injury, and pulmonary involvement. He was initially managed as severe leptospirosis with multiorgan dysfunction with antibiotics, steroids, and N-acetyl cysteine. A diagnosis of acute hantavirus infection was made subsequently. He made an uneventful recovery. Conclusion Hantavirus infections need to considered in the differential diagnosis of patients presenting with acute febrile illness with multiorgan involvement. Larger studies are needed to evaluate the seroprevalence of hantavirus in Sri Lanka because it could be an emerging serious public health problem.

Two Atypical Cases of Hantavirus Infection: Experience from a Tertiary Care Unit in Sri Lanka

“…In 2018, Ehelepola et al described two atypical cases of hantavirus presenting with a combination of pulmonary and renal symptoms similar to the patient in our first case [ 10 ]. Recently in 2020, Dalugama et al reported an atypical case of hantavirus mimicking leptospirosis [ 11 ]. We believe that hantavirus infections are infrequently reported from Sri Lanka and other Asian countries due to nonavailability of diagnostic facilities and since it is being clinically misdiagnosed as leptospirosis.…”

Doenças infecciosas: inovações e aprendizados para área médica

“…Já na fase cardiopulmonar, considerada mais grave, o paciente apresenta sintomas como tosse seca que evolui para produtiva, podendo haver expectoração mucossanguinolenta, insuficiência respiratória e cardiovascular, o que aumenta os riscos de choque (BAR-BOSA et al, 2017). Em alguns casos, broncorreia e miocardite com arritmias são encontradas em decorrência do vazamento capilar em leito pulmonar (DALUGAMA et al, 2020). Ciancaglini et al (2017) descreveram o primeiro caso de SCPH relatado em Tucumán, na Argentina: uma mulher, de 23 anos, com histórico de síndrome antifosfolipídica, procurou atendimento queixando-se de febre, dor de cabeça, mialgia, náuseas, vômitos e dor abdominal.…”

“…A base do diagnóstico da SCPH corresponde ao teste sorológico, como, por exemplo, exame por ensaio imunoenzimático (ELI-SA) e teste de imunofluorescência indireta (IFI), que detectam imunoglobulina M (IgM) em diluições de 1:100 contra o vírus causador da síndrome, além da técnica molecular RT-PCR que também pode ser utilizada para detectar o seu RNA. Em amostras dos pacientes diagnosticados pode-se encontrar leucocitose, com aumento de neutrófilos, acompanhado de aumento de elementos mieloides, trombocitopenia, presença de linfócitos atípicos, aumento de hematócrito, redução na proteína sérica, hematúria microscópica e hiponatremia (DALUGAMA et al, 2020;RUPASINGHE et al, 2021).…”