Clinical and molecular epidemiological features of hemorrhagic fever with renal syndrome in Korea over a 10-year period

Abstract

Background Laboratory diagnosis of hemorrhagic fever with renal syndrome (HFRS), an infectious disease caused by rodent-borne hantaviruses in Asia and Europe, depends primarily on serological methods. Since the advent of such serodiagnostic tests, few reports are available about the clinical and molecular epidemiological features of HFRS. Objectives To investigate the epidemioclinical features of HFRS treated at a tertiary-care teaching hospital in Seoul over a 10-year period. Study design Medical records of HFRS patients, visited to a tertiary-care teaching hospital during February 2002 to February 2012, were reviewed. Sera from patients were tested for Hantaan virus (HTNV) and Seoul virus (SEOV) RNA using RT-PCR. Results Among 35 HFRS patients (mean age was 44.2 ± 14.7 years), 29 were male (82.9%). Acute renal failure developed in 27 patients (77.1%), and 12 patients (34.3%) were admitted to the intensive care unit (ICU). Conjunctival injection (OR 10.32, 95% CI 1.09–97.77, P = .04) and initial serum albumin less than 3 g/dL (OR 22.83, 95% CI 1.45–359.93, P = .03) were risk factors for ICU admission. Of 35 acute-phase sera, 11 (31.4%) were positive for HTNV RNA. None were positive for SEOV RNA. Conclusions HFRS was characterized by the clinical triad of fever, renal insufficiency and gastrointestinal symptoms. Conjunctival injection and serum albumin level were related to severity. Large scaled multi-center study is needed to enhance an insight to epidemioclinical characteristics of HFRS in Korea.

Hantavirus infection: a global zoonotic challenge

“…Farmers account for the largest proportion of HFRS (35.6%) cases, most of which were detected during the months of October, November, and December Noh et al, 2013). Although HTNV is the main cause of HFRS in Korea, SEOV (the second most significant cause) is predominant in Korea (Noh et al, 2013).…”

“…Farmers account for the largest proportion of HFRS (35.6%) cases, most of which were detected during the months of October, November, and December Noh et al, 2013). Although HTNV is the main cause of HFRS in Korea, SEOV (the second most significant cause) is predominant in Korea (Noh et al, 2013). Some acute-phase cases in Korea have shown a higher IgM antibody titer to PUUV than to HTNV, despite the fact that PUUV has not been detected in Korea (Noh et al, 2013).…”

“…Although HTNV is the main cause of HFRS in Korea, SEOV (the second most significant cause) is predominant in Korea (Noh et al, 2013). Some acute-phase cases in Korea have shown a higher IgM antibody titer to PUUV than to HTNV, despite the fact that PUUV has not been detected in Korea (Noh et al, 2013). In North Korea, literature on hantaviruses is scarce.…”

Life-Threatening Sochi Virus Infections, Russia

“…With a calculated CFR of 14.5%, Sochi virus might be the most deadly hantavirus outside the Americas, where 35%–50% of hantavirus infections are fatal ( 1 , 9 ). Even Asian Hantaan virus is estimated to be less deadly; recent studies show CFRs of 1%–3% in China and South Korea, where Hantaan virus infections play an important role in HFRS morbidity ( 10 , 11 ). On the other hand, increased awareness in diagnostics, treatment, and prevention by local physicians and public health authorities is expected to improve survival rates for Sochi virus infections.…”

Expanded Host Diversity and Global Distribution of Hantaviruses: Implications for Identifying and Investigating Previously Unrecognized Hantaviral Diseases

“…Febrile phase, which begins abruptly; hypotensive phase, on the fi fth day of illness; oliguric phase, on the ninth day of illness, with associated thrombocytopenia, proteinuria, hemorrhage and plasma leakage; diuretic phase, usually between days 12 and 14; and convalescent phase, which is gradual over several months. Depending on the severity of disease, not all HFRS patients exhibit all phases, or the phases may overlap [ 147 ]. The early stage of HCPS, which resembles the febrile phase of HFRS, is somewhat nondescript and can be easily confused with other, more common, acute-onset febrile infectious diseases.…”