Serological Evidence of Thailand Virus-Related Hantavirus Infection among Suspected Leptospirosis Patients in Kandy, Sri Lanka

Gamage, Chandika D.; Yasuda, Shumpei P.; Nishio, Sanae; Kularatne, S.A.M.; Weerakoon, Kosala; Rajapakse, Jayanthe; Nwafor-Okoli, Chinyere; Lee, Romeo B.; Obayashi, Yoshi; Yoshimatsu, Kumiko; Arikawa, Jiro; Tamashiro, Hiko

doi:10.7883/yoken.64.72

Cited by 39 publications

(3 citation statements)

References 8 publications

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“…In Sri Lanka, hantavirus was first described in 1988 by Vitarana et al by demonstrating positive serology in four patients among 248 tested who presented with leptospirosis-like illness [23]. In 2011, Gamage et al demonstrated eight cases with previous exposure to hantavirus infection in Peradeniya hospital, Sri Lanka, during an outbreak of leptospirosis [24]. Recently, Ehelepola et al described two atypical cases of hantavirus infection in Sri Lanka, where both had a combination of pulmonary and renal involvement similar to our patient [25].…”

Section: Discussionmentioning

confidence: 99%

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

Dalugama

Nanayakkara²,

Rathnayaka³

et al. 2020

J Med Case Reports

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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.

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Section: Discussionmentioning

confidence: 99%

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

Dalugama

Nanayakkara²,

Rathnayaka³

et al. 2020

J Med Case Reports

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“…The results of the above-mentioned studies clearly demonstrated that exposure to hantavirus was associated with a high risk of developing renal disease in both areas, but the risk was relatively higher in CKDu-endemic Girandurukotte, Badulla district [11]. Hantavirus infection was first described in Sri Lanka by Vitarana and colleagues in 1988 [12] and was subsequently described in three other reports [13–15]. However, all these studies on hantavirus infection in Sri Lanka were based on patients with leptospirosis-like symptoms and suspected leptospirosis clinical investigations because leptospirosis is the most prevalent bacterial zoonotic disease in humans; it is notably endemic in Sri Lanka and shares similar clinical presentations and epidemiological features with hantavirus infection.…”

Section: Introductionmentioning

confidence: 99%

Hantavirus infection as a risk factor for chronic kidney disease of unknown aetiology (CKDu) and its prevalence in endemic areas of Sri Lanka since 2010 according to a retrospective serological analysis

Gamage

Nanayakkara

Sarathkumara

et al. 2022

Journal of Medical Microbiology

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Background. Chronic kidney disease of unknown aetiology (CKDu) is a major public health problem in Sri Lanka, especially among agrarian communities. Although the cause of CKDu is still unknown, hantavirus infection has been proposed as a risk factor. Methods. This study was performed using serological samples collected from two CKDu-endemic areas, Anuradhapura (2010) and Badulla districts (2010 and 2016), and a non-endemic area, Matale (2016) district. The presence of anti-Thailand orthohantavirus IgG antibodies was investigated in serum samples. Hantavirus seroprevalence and demographic data were epidemiologically analysed. Results. Seroprevalence was higher in CKDu patients (40.6–60.0 %) and healthy individuals in CKDu-endemic areas (17.6–25.5 %) than in healthy individuals in non-endemic areas (3.0 %). Statistically significant odds ratios (ORs) for hantavirus infection in CKDu patients were detected in CKDu-endemic areas [ORs: 3.2 and 3.1; 95 % confidence interval (CI): 1.8–5.5 and 1.8–5.2 in Anuradhapura and Badulla districts in 2010; and OR: 4.4, 95 % CI: 2.3–8.5 in 2016 in Badulla district). Furthermore, the OR for hantavirus infection in Badulla district has increased in the last decade from 3.1 (95 % CI: 1.8–5.3) to 4.4 (95 % CI: 2.3–8.5). Conclusion. Hantavirus infection has been prevalent in two distant CKDu-endemic areas since 2010. The observed significant association of hantavirus seropositivity with CKDu indicates a possible role of hantavirus infection in CKDu pathogenesis.

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“…In their study, rats (R. norvegicus) captured in the Colombo Harbour area were reported seropositive for SEOV [26]. Presence of Thailand orthohantavirus infection in suspected leptospirosis patients in Kandy district was reported in 2011 [27]. Further, the presence of serum IgM antibodies reacting against PUUV and Hantaan orthohantavirus (HTNV) found in patients hospitalized with history of leptospirosis like-illness at the North Colombo Teaching Hospital in Gampaha district of Sri Lanka suggests either reactivity or cross-reactivity to both viruses [28].…”

Section: Introductionmentioning

confidence: 99%

Evidence of orthohantavirus and leptospira infections in small mammals in an endemic area of Gampaha district in Sri Lanka

et al. 2022

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Background Orthohantaviruses and leptospira are emerging zoonotic pathogens of high public health significance. The epidemiology of orthohantavirus infections and leptospirosis is similar and presents related clinical pictures in humans. However, a paucity of data on actual reservoir hosts for orthohantaviruses and leptospira exists. Therefore, this study aimed at determining the occurrence of orthohantaviruses and leptospira in small mammals captured in an endemic region of Sri Lanka. Methods Rodents and shrews were morphologically and/or genetically identified using morphological keys and DNA barcoding techniques targeting the cytochrome oxidase b subunit gene (Cytb). Lung tissues and sera were subsequently analyzed for the presence of orthohantavirus RNA using qRT-PCR. Sera of rats were tested for IgG antibodies against orthohantaviruses and leptospira. Results Forty-three (43) small mammals representing: Rattus (R.) rattus (black rat) or R. tanezumi (Asian rat), Suncus murinus (Asian house shrew), R. norvegicus (brown rat) and Mus musculus (house mouse) were investigated. No orthohantavirus RNA was detected from the lung tissue or serum samples of these animals. Elevated levels of IgG antibodies against Puumala orthohantavirus (PUUV) and/or Seoul orthohantavirus (SEOV) antigens were detected in sera of 28 (72%) out of the 39 rats analysed. Interestingly, 36 (92%) of the 39 rats also showed presence of anti leptospira-IgG antibodies in their serum, representing dual infection or dual exposure in 26/39 (66.7%) of examined rats. Conclusions This project targets important public health questions concerning the occupational risk of orthohantavirus infections and/or leptospirosis in an endemic region of Sri Lanka. Most rats (72%) in our study displayed antibodies reacting to orthohantavirus NP antigens, related to PUUV and/or SEOV. No correlation between the orthohantavirus and leptospira IgG antibody levels were noticed. Finally, a combination of both morphological and DNA barcoding approaches revealed that several species of rats may play a role in the maintenance and transmission of orthohantavirus and leptospira in Sri Lanka.

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Serological Evidence of Thailand Virus-Related Hantavirus Infection among Suspected Leptospirosis Patients in Kandy, Sri Lanka

Cited by 39 publications

References 8 publications

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

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

Hantavirus infection as a risk factor for chronic kidney disease of unknown aetiology (CKDu) and its prevalence in endemic areas of Sri Lanka since 2010 according to a retrospective serological analysis

Evidence of orthohantavirus and leptospira infections in small mammals in an endemic area of Gampaha district in Sri Lanka

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