Exposure to Hantavirus is a Risk Factor Associated with Kidney Diseases in Sri Lanka: A Cross Sectional Study

Abstract

Chronic kidney disease of unknown etiology (CKDu) imposes a substantial burden on public health in Sri Lankan agricultural communities. High seroprevalences of hantavirus have been reported in CKDu patients in several locations of Sri Lanka. We carried out a cross-sectional study followed by an unmatched case-control comparison in two geographically distinct areas of Sri Lanka, Girandurukotte (CKDu endemic) and Kandy (CKDu non-endemic) to determine whether exposure to hantaviruses is a potential risk factor in patients with kidney disease. An indirect immunofluorescent antibody assay using two antigens, Thailand orthohantavirus-infected and recombinant N protein-expressing Vero E6 cells, were used for serodiagnosis. Participants’ demographic and other socio-economic data were collected through a structured questionnaire. Fifty kidney disease patients and 270 controls from Kandy and 104 kidney disease patients and 242 controls from Girandurukotte were examined. Seropositivities were 50% and 17.4% in kidney patients and controls, respectively, in Girandurukotte, and they were 18% and 7% in Kandy. The odds of exposure to hantaviruses were higher for kidney disease patients than for controls in both Girandurukotte (OR:3.66, 95% CI:2.01 to 6.64) and Kandy (OR:2.64, 95% CI:1.07 to 6.54) in binary logistic regression models. According to statistical analysis, individuals exposed to hantaviruses had a higher risk of developing renal impairment. Therefore, hantavirus infection might be an important risk factor for development of kidney disease in Sri Lanka.

Understanding leptospirosis eco-epidemiology by environmental DNA metabarcoding of irrigation water from two agro-ecological regions of Sri Lanka

“…In 2018, 124 cases in Kandy and 189 in Badulla, of which, 12 and 21 were reported on December for Kandy and Badulla (GK), respectively. The higher number of human leptospirosis cases in the intermediate region than in the wet region is not correlated with our environmental metabarcoding findings, but we can hypothesized that the higher incidence of leptospirosis-like acute febrile diseases (such as hantavirus infection) in GK than in Kandy is a factor that led to an overestimation of clinical suspected cases of leptospirosis in this particular area [56][57]. Our study emphasizes the need to have an accurate laboratory-based diagnostic system in Sri Lanka to properly control both infectious diseases.…”

Association of Hantavirus Infections and Leptospirosis With the Occurrence of Chronic Kidney Disease of Uncertain Etiology in the North Central Province of Sri Lanka: A Prospective Study With Patients and Healthy Persons

“…However, the assessment of past infections by hantaviruses, leptospira, asymptomatic bacteriuria in CKDu patients would be important to establish the association of infective etiology for CKDu. Another group of researchers has previously investigated the possibility of hantavirus infection as a risk factor for the occurrence of CKDu in Sri Lanka (Gamage et al, 2017 ; Sarathkumara et al, 2019 ).…”

“…In contrast to the previous work (Gamage et al, 2017 ; Sarathkumara et al, 2019 ), here we have studied the past exposure to both hantavirus infections and leptospirosis in CKDu patients from high CKDu prevalent areas with that of healthy persons living in both high and low CKDu prevalent areas in the same district; notably with same living and environment conditions.…”

Identification of Novel Rodent-Borne Orthohantaviruses in an Endemic Area of Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka

“…Similarly, high levels of antibodies against the hantavirus were reported among CKDu patients from a CKDu hotspot in Polonnaruwa District in the North Central Province of Sri Lanka [ 23 ]. In addition, a cross-sectional study carried out with case-control comparisons in two geographically distinct CKDu endemic areas vs. a nonendemic area in Sri Lanka demonstrated that exposure to the hantavirus was an independent risk factor associated with renal disease in the CKDu endemic regions [ 24 ]. An ecoepidemiological study in Girandurukotte serologically confirmed that THAIV-like hantavirus species were highly prevalent among the Rattus rattus lineage [ 25 ].…”