Dobrava–Belgrade hantavirus infection mimics acute appendicitis

Jakab, Ferenc; Sebők, Judit; Szántó, Zalán; Hang, Dóra; Imre, Marianna; Németh, Viktória; Madai, Mónika; Oldal, Miklós; Kovács, Tamás; Wittmann, István

doi:10.1016/j.jcv.2010.10.009

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…This study has some limitations including small sample sizes and possible selection bias. A larger sample size would allow more confidence in the correlations observed however these observations are in agreement with other published studies [42,48]. The risk of endotoxin contamination was reduced by using depyrogenated glassware, endotoxin free LAL reagent water and tips.…”

Section: Discussionsupporting

confidence: 89%

“…DENV replication in intestinal macrophages may lead to a pro-inflammatory environment in which the epithelial cells are disrupted allowing the passage of soluble factors from the gut into the blood [47]. Some hantavirus infections can have clinical presentations like acute appendicitis suggesting replication in the human intestine [48,49,50]. The detection of hantavirus antigen in the gut epithelium [49,50] raised the possibility of MT occurring during acute hantavirus infection but a correlation of MT and disease severity was later confirmed in Argentine HPS patients [42].…”

Section: Introductionmentioning

confidence: 99%

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Serum LPS Associated with Hantavirus and Dengue Disease Severity in Barbados

Douglas

Samuels

Hilaire

2019

Viruses

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Hantavirus and dengue virus (DENV) infections are caused by RNA viruses which infect immune systems’ cells including monocytes, macrophages and dendritic cells and occur year-round in Barbados. A retrospective serological study (2008–2015) was conducted on hantavirus and dengue patient sera confirmed by IgM and IgG ELISA, NS1 and RT-PCR using Limulus amoebocyte lysate (LAL) kinetic turbidimetric method to determine serum endotoxin levels. Hantavirus patients were categorized into two groups, namely (a) hospitalized and (b) non-hospitalized. Dengue patients were categorized into 3 groups using 2009 WHO dengue guidelines (a) severe dengue (SD), (b) hospitalized non-severe dengue (non-SD) and (c) non-hospitalized non-SD. Statistical analyses were conducted to determine the association of endotoxin levels with hantavirus disease severity based on hospitalization and dengue disease severity. Serum endotoxin levels are associated with hantavirus disease severity and hospitalization and dengue disease severity (p < 0.01). Similar studies have found an association of serum endotoxin levels with dengue disease severity but never with hantavirus infection. Co-detection of hantavirus- and DENV-specific IgM in some patients were observed with elevated serum endotoxin levels. In addition, previous studies observed hantavirus replication in the gut of patients, gastrointestinal tract as a possible entry route of infection and evidence of microbial translocation and its impact on hantavirus disease severity. A significant correlation of serum endotoxin and hantavirus disease severity and hospitalization in hantavirus infected patients is reported for the first time ever. In addition, serum endotoxin levels correlated with dengue disease severity. This study adds further support to the role of endotoxin in both hantavirus and dengue virus infection and disease severity and its role as a possible therapeutic target for viral haemorrhagic fevers (VHFs).

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Serum LPS Associated with Hantavirus and Dengue Disease Severity in Barbados

Douglas

Samuels

Hilaire

2019

Viruses

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“…6 Gastrointestinal manifestations such as nausea, vomiting, and abdominal pain are common, and infections accompanied by such symptoms are often misdiagnosed as surgical abdomen. Although cases of appendicitis caused by the Dobrava-Belgrade virus and Puumala viruses have been reported, 7 to the best of our knowledge, there are no published reports of appendicitis caused by Hantaan virus infection. Here, we report a rare case of an elderly man with HFRS that manifested as appendicitis.…”

Section: Introductionmentioning

confidence: 92%

Acute Appendicitis Associated with Hantaan Virus Infection

Lim

Lee

Kim

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Hantaviruses are Bunyaviridae viruses that cause hemorrhagic fever with renal syndrome (HFRS). Appendicitis caused by Hantaan virus has not been reported previously. An 81-year-old man who underwent laparoscopic appendectomy for suspected appendicitis based on abdominal pain, fever, hypotension, and computed tomography findings. Based on a suspicion of hemorrhagic fever with renal syndrome, the patient’s plasma was simultaneously analyzed using an indirect immunofluorescent antibody assay and nested reverse transcription–polymerase chain reaction (RT-PCR). The appendix tissue was also analyzed using nested RT-PCR and immunohistochemical (IHC) staining to identify the presence of Hantaan virus. Nested RT-PCR detected the presence of Hantaan virus, and indirect immunofluorescent antibody assay results revealed the presence of elevated antibody levels. Furthermore, IHC staining of the appendix tissue confirmed Hantaan virus antigens in the peripheral nerve bundle. Based on these findings, we confirmed the nerve tropism of the Hantaan virus. Hantaan virus in plasma and appendix tissue samples was confirmed using PCR and phylogenetic tree analysis. Moreover, we detected hypertrophy of the submucosa and periappendiceal adipose tissue nerve bundle along with Hantaan virus antigens in peripheral nerve bundles using IHC staining. Hence, we report that Hantaan virus infection may be accompanied by appendicitis.

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“…Although it is rare, HFRS presenting with symptoms mimicking acute appendicitis has been reported. 1 Serologic testing of the hantaan virus finally unraveled the mystery, and the outcome of the patient was excellent. Thus, testing for hantaan virus should always be considered in cases of thrombocytopenia, fever of unknown origin, and decreased renal function, especially in areas endemic for the infection, such as Eastern Asian countries.…”

Section: Evidence-based Opinionmentioning

confidence: 98%