Evaluation of clinical and laboratory predictors of fatality in patients with Hantavirus infection

Abstract

Objectives: To determine the clinical and laboratory predictors of fatality among patients with Hantavirus infection. Materials and methods: A retrospective study was conducted on the patients with Hantavirus infection between April 2009and October 2011 at the Black Sea and the Mediterranean regions in Turkey. Demographic, clinical and laboratory findings of fatal cases and non-fatal cases at the admission were compared. Results:Twenty-two patients with confirmed Hantavirus infection were evaluated. Five patients died (22.7%). The cause of death was massive bleeding. The rate of hemorrhage was significantly higher in the fatal cases than non-fatal cases (p<0.001). Massive gastrointestinal hemorrhage was seen in four of these patients, cerebral hemorrhage in two and both gastrointestinal and pulmonary hemorrhage in one. Disseminated intravascular coagulation (DIC) was present in four of the fatal cases and a remarkable cause of the bleeding (p=0.02). White blood cell count (WBC) (p=0.002), creatine phosphokinase (CPK) (p=0.011), blood-urea-nitrogen (BUN) (p=0.014), C reactive protein (CRP) (p=0.005) and D-dimer levels (p=0.001), prothrombin time (PT) (p=0.023), activated partial thromboplastin time (aPTT) (p=0.001) and international normalized ratio (INR) (p=0.021) were significantly higher, and platelet counts (p=0.038) significantly lower in the fatal cases. Optimum diagnostic cut-off points for specific laboratory parameters which may be predictive of fatality were; WBC=16,000 µL-1, PLT=30000 µL-1, PT=19.7 s, aPTT=36 s, INR=1.2, D-dimer=9.3 µg/mL, CPK=600 U/L, BUN=47 mg/dL and CRP=13.4 mg/dL. Conclusions U Kostakoğlu et al. Predictors of fatality in patients with Hantavirus infection 156 J Microbiol Infect Dis

Hantavirus Infections in Light of Current Knowledge

“…A murine monoclonal antibody developed for the treatment of HTNV infections was administered as a single-dose intravenous injection to healthy volunteers in a clinical trial, and was shown to be effective against HTNV both in vitro and in vivo [28] . Thus, it is believed that monoclonal antibodies may be a candidate for effective treatment of HFRS [29,30] . Neutralizing antibodies administered early may also play a protective role against the disease [7] .…”

“…Early diagnosis, intensive care, and supportive therapy have greatly reduced mortality due to hantavirus infections, with rates of less than 1% for certain subtypes [7,30,31] . Maintaining fluid and electrolyte balance is the key principle of treatment [7] .…”

“…Other critical issues are improving renal function, providing adequate oxygenation, and regulating blood pressure [7] . Continuous renal replacement therapy is currently a very important approach in patients with acute respiratory distress syndrome, multiorgan failure, fluid overload, pulmonary edema, severe electrolyte abnormality, cerebropathy, and acute kidney injury (AKI) [7,30] . Intermittent hemodialysis is preferred by clinicians for the treatment of AKI patients without hemodynamic instability, and fatal complications are less common in this approach [7] .…”

“…Intermittent hemodialysis is preferred by clinicians for the treatment of AKI patients without hemodynamic instability, and fatal complications are less common in this approach [7] . Blood products, especially thrombocyte suspensions, can be used for patients with obvious hemorrhage or in severe cases presenting with thrombocytopenia [6,[30][31][32] .…”

Hemorrhagic Fevers with Renal Syndrome Presenting with Pregnancy Interruption

“…Hantaviruses are negative-sense RNA viruses that belong to the Bunyaviridae family [1][2][3]. Epidemiologically HFRS is a rare disease in Albania, but time after time there are cases reported [4].…”