Clinical and laboratory findings in patients with oliguric and non-oliguric Hantavirus haemorrhagic fever with renal syndrome: an analysis of 128 patients

Abstract

Patients with haemorrhagic fever with renal syndrome (HFRS) may present without significant oliguria. We compared different initial clinical symptoms and laboratory findings in patients who developed oliguric acute renal failure (ARF) with those in patients who did not develop oliguric ARF. Overall, 128 patients with serologically confirmed HFRS were hospitalized at the University Hospital for Infectious Disease, Zagreb, Croatia between January 1999 and December 2010. Clinical signs and laboratory findings were extracted from medical charts, and were assessed for their relationship to the development of oliguric ARF. Puumala virus infection was diagnosed in 101 (79%) patients, and Dobrava-Belgrade virus infection in 27 (21%). Oliguria or anuria developed in 30% of patients. We identified the following risk factors for the development of oliguria and anuria on multivariable analysis: conjunctival hyperaemia or bleeding (relative risk (RR) 1.84, 95% CI 1.09-3.10; p 0.023), diarrhoea (RR 1.45, 95% CI 1.07-1.97; p 0.017), serum sodium of ≤133 mM (RR 2.21, 95% CI 1.34-3.64; p 0.002), and dipstick protein value of >1.5 g/L (RR 1.59, 95% CI 1.09-2.33; p 0.016), as well as hiking in the forest (RR 1.92, 95% CI 1.13-3.26; p 0.016). Our findings may help physicians in the earlier identification of patients with a more severe form of HFRS caused by Puumala and Dobrava-Belgrade viruses. Particular attention should be given to findings such as conjunctival hyperaemia or bleeding, diarrhoea, a low serum sodium level, and proteinuria.

Clinical Course and Long-Term Outcome of Hantavirus-Associated Nephropathia Epidemica, Germany

“…Of interest, none of the patients required platelet transfusion, and only mild hemorrhagic symptoms, mostly epistaxis, occurred in a small percentage (7%) of all patients, and the hemorrhagic symptoms occurred independently of thrombocyte counts. Previous smaller studies reported higher rates of bleeding complications in patients with NE ( 32 , 33 ). At hospital admission, the thrombocyte nadir had been reached in 90% of the patients; this finding supports the hypothesis that thrombocytopenia occurs in early stages of the disease.…”

Inflammatory cytokines kinetics define the severity and phase of nephropathia epidemica

“…The mild form often goes undiagnosed due to the lesser symptoms, which often include slight headache and low-grade fever. The hemorrhagic symptoms are restricted to small petechiae on the mucosa and skin, while laboratory findings regarding blood-formed elements are typically mild and include t hrombocytopenia and proteinuria [8,10].…”

“…The moderate form of the disease has similar but more subtle symptoms. Blood tests also reveal high BUN and creatinine levels and leukocytosis, as well as thrombocytopenia are commonly reported [8,11]. The mild form often goes undiagnosed due to the lesser symptoms, which often include slight headache and low-grade fever.…”

“…Headache, nausea, vomiting and high fever, as well as prominent hemorrhagic symptoms including petechiae, nasal and internal bleeding typically characterize the severe form. Laboratory findings include elevated blood urea and creatinine levels and leukocytosis with left shift and severe thrompocytopenia [8][9][10]. The moderate form of the disease has similar but more subtle symptoms.…”

Hantaviruses—Infections, Epidemiology and Hosts

“…Risk factors are not only defined by contact to nature and rodents, but could depend on the environment of the study sites, the annual and local epidemic situation and other parameters. It was shown that staying or living close to a forest, leisure activities in a forest such as camping, jogging, noticing rodents or droppings, going on a mushroom foray might be risk factors Crowcroft et al 1999;Siffczyk et al 2006;Turcinov et al 2013). Besides, cleaning utility rooms such as sheds, attics, cellars and garages, or disturbing carrier nests by renovation, cleaning, etc.…”