Clinical analysis of patients with acute pancreatitis complicated with hemorrhagic fever with renal syndrome and acute biliary pancreatitis

Abstract

Acute pancreatitis (AP) is a rare complication of hemorrhagic fever with renal syndrome (HFRS), and is difficult to diagnose. In this study, we retrospectively analyzed the clinical characteristics of 7 cases of HFRS complicated with AP and 105 cases of acute biliary pancreatitis (ABP). Medical records of 83 hospitalized patients with HFRS and 105 hospitalized patients with ABP in the affiliated Yijishan Hospital of Wannan Medical College were reviewed. The comparative analysis of patients between the 2 groups was conducted in terms of sex, age, duration of hospital stay, fever, hemorrhage, proteinuria, oliguria, laboratory results, radiologic examinations, and prognosis. A total of 83 patients were diagnosed with HFRS during study period. Only 8.43% (7/83) of the total HFRS patients were diagnosed with AP. The differences in the gender, age, and duration of hospital stay between the 2 investigated groups of patients were not statistically significant. The major symptoms for all 7 patients with HFRS complicated with AP and 105 patients with ABP were fever and upper abdominal pain. During the disease course of HFRS complicated with AP, 6 patients experienced hemorrhaging, and 7 patients underwent an oliguric stage, but none of the ABP patients experienced hemorrhaging and oliguria. Among the laboratory results of all patients, the differences in alanine aminotransferase and glycemia were not statistically significant. The other laboratory results (leucocyte count, platelet count, amylase, lipase, total bilirubin, direct bilirubin, creatinine, blood urea nitrogen, prothrombin time, activated partial thromboplastin time, and serum calcium level) were significantly different during hospitalization. All 7 patients with HFRS complicated with AP received conservative medical treatment and hemodialysis. In the patients with ABP, 21 patients were discharged from the hospital after conservative treatment, 53 patients were treated by endoscopic invasive treatment after stabilization, and 31 patients were treated by surgery after stabilization. AP is not a frequent complication in patients with HFRS. There are differences in clinical manifestations and laboratory findings between the HFRS complicated with AP group and the ABP group; these differences may help in the differential diagnosis and treatment of these 2 types of pancreatitis.

Alcohol Consumption and Its Influence on the Clinical Picture of Puumala Hantavirus Infection

“…The highest trypsinogen value in this cohort reached 33 ng/mL, also ruling out cases of acute pancreatitis. There are reports of Hantaan, Dobrava, and Seoul virus-induced HFRS accompanied with acute pancreatitis [ 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. In Europe, one study of 166 PUUV infected patients did not show any cases of pancreatitis [ 30 ].…”

“…The results concerning pancreatic involvement in HFRS have been contradictory in previous studies. There are reports of a small series of HFRS accompanied by acute pancreatitis [ 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. In these studies, different hantaviruses are presented.…”

Hyperamylasemia Caused by the Hantaan Virus: A Retrospective Study of 101 Patients with Hemorrhagic Fever with Renal Syndrome in West China

“…Because HA is often related to AP but not limited to it, we were interested in the influence of HA on HFRS patients with and without AP. We found that a previous study analyzed HFRS complicated with AP in the Anhui Province of mid China showed that the incidence of AP in local HFRS patients was 8.43% [ 20 ], but in Albania, another country with a high incidence of HFRS, some researchers reported it was 11.1% [ 18 ]. In our study, this figure was 8.91%, which was similar to the former but not in accordance with the latter.…”

“…We inferred that this was probably due to the difference in the Hantavirus serotypes, socioeconomic situation, climatic factors, contact rate between rodents and humans, and the hygiene status between different regions. In the Anhui Province, the main serotypes of Hantaviruses were HTNV and the Seoul virus [ 20 ]; in Albania, it was the Dobrava-Belgrade virus [ 18 ], but in the Shaanxi Province (including Baoji city), it was HTNV only [ 11 ]. This means that compared with other Hantaviruses, HTNV may lead to a similar incidence of AP in west China as in mid China.…”

“…Previous studies have reported cases of HFRS with AP induced by different Hantaviruses [18][19][20][21], but no research focused on the characteristics of HA in HFRS caused by HTNV in Baoji city, Shaanxi province of West China. The reason behind of this is that s-AMY is not a routine laboratory test item in clinical practice of HFRS, and only those patients who have exact abdominal pain will be advised to measure s-AMY.…”