Serologic Investigation of Hantavirus Infection in Patients with Previous Thrombocytopenia, and Elevated Urea and Creatinine Levels in an Epidemic Region of Turkey

Abstract

SUMMARY:The first cases of Hantavirus infection in Turkey were reported in early 2009 in the Zonguldak and Bartin provinces. The aim of this study was to investigate the presence of Hantavirus antibodies in patients who had clinical and laboratory findings that were potentially associated with Hantavirus infection prior to the epidemic in Bartin in 2009. After screening 314,577 medical records from between 2007 and 2009, the clinical and laboratory data for 442 patients meeting the criteria of coexistent thrombocytopenia, and elevated urea and creatinine levels were transferred to a statistical program. Home visits were made to 170 patients, 84 of whom consented to participate in the study. The participants completed a questionnaire and provided a blood sample. Commercial anti-Hantavirus IgG and IgM ELISA and immunoblotting assays were used, with seropositive samples being confirmed by focus reduction neutralization tests (FRNT). ELISA and/or immunoblotting assays detected 10 positive samples; however, only 7 of these were recorded as positive by FRNT. FRNT positivity was significantly associated with female sex, the presence of a barn near to the house, and working in a forest (P ＜ 0.05). In a Hantavirus endemic region, physicians must keep in mind that thrombocytopenia, and elevated urea and creatinine levels may indicate Hantavirus infection.

Dynamics of Puumala hantavirus outbreak in Black Sea Region, Turkey

“…In the current outbreak, dealing with rodent control activities in gardens or in annexes of the house and being male were found to be significant risk factors for human hantavirus infection. In two seroprevalence studies—one performed at the outbreak area and the other at the Giresun Province situated at the Eastern part of the Black Sea Region—being male, the presence of a barn near one's house, living in the woods or an adobe house and working in a forest were found to be statistically significant risk factors for hantavirus infection (Gozalan et al, ; Sevencan et al, ).…”

Serological investigation of orthohantaviruses in patients with fever of unknown origin in Kazakhstan

“…Moreover, orthohantavirus IgM levels were investigated instead to determine suspected acute cases among patients with FUO. Generally, this study showed that IgM‐positive patients were more females than males, but this was not statistically significant as given by the small case numbers (Latronico et al, ; Sevencan et al, ). We did not find a relationship with some risk factors such as living place, garden or fieldwork or the observation of rodents with IgM‐positive cases (Botros et al, ).…”

“…In our study, the high rate of positive IgG antibodies by ELISA shown here could be false‐positive, originating from the sensitivity of the screening test. Moreover, the difference between ELISA and confirmatory assays has been shown in several orthohantavirus seroprevalence studies (Engler et al, ; Sevancan et al, ). The different results by immunoblotting and IIFT can be explained by sensitivity (immunoblotting—96.1%, IIFT—99%) and specificity (immunoblotting—100%, IIFT—98%) of the used assays (mikrogen.de, euroimmun.de).…”

“…Unfortunately, no information concerning other regions of Kazakhstan is available. Orthohantavirus infections are expected to be underdiagnosed as these do not uncommonly lead to atypical or mild illness and diagnostic testing is difficult (Bi, Formently, & Roth, ; Sevencan et al, ). The exact prevalence of orthohantavirus infections in cases of FUO within Kazakhstan is unknown.…”

Immuno-Colorimetric Neutralization Test: A Surrogate for Widely Used Plaque Reduction Neutralization Tests in Public Health Virology

“…Previously, many sero-epidemiological investigations of viruses of public health importance, i.e., DENV, CCHFV, Rift Valley fever virus, WNV, Usutu virus, CHIKV, Bourbon virus, Hantavirus, ZIKV, and SARS-CoV-2, have been carried out to confirm the presence of virus-specific IgM and IgG antibodies, and subsequently, case confirmation using gold standard PRNTs or by virus isolation [74][75][76][77][78][79][80][81][82][83][84]. Due to cross-reactivity amongst the arboviruses, cell culture-based NTs are the preferred serological tool for case confirmation.…”