hemorrhagic fever with renal syndrome amboss

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  • Feb 13, 2020

The AMBOSS 100-Day Study Plan
The AMBOSS 100-Day Study Plan

Hemorrhagic fever with renal syndrome (HFRS) is a group of clinically similar illnesses caused by hantaviruses from the family Bunyaviridae. HFRS includes diseases such as Korean hemorrhagic fever, dengue fever epidemic, and nephropathia epidemica. Viruses that cause HFRS include Hantaan, Dobrava, Saaremaa, and Puumala.

HFRS is found throughout the world. Haantan virus is widespread in East Asia, particularly in China, Russia, and Korea. Puumala virus is found in Scandinavia, Western Europe and western Russia. Dobrava virus is found mainly in the Balkans, and Seoul virus is found worldwide. Saaremaa discovered in Central Europe and Scandinavia. In America, hantaviruses cause a different disease known as.

Hantaviruses carried and transmitted by rodents. People can be infected with this virus and develop HFRS after aerosol exposure to urine, droppings, or saliva of infected rodents or after exposure to dust from their nests. Transmission can also occur when infected urine or other materials directly introduced into broken skin or mucous membranes of the eyes, nose, or mouth. Additionally, individuals who work with rodents can live mice exposed to hantaviruses through the bite of an infected animal. Transmission from one human being to another can occur, but are extremely rare.

Rodents are the natural reservoir for hantaviruses. Known carriers include the striped field mouse (Apodemus agrarius), a reservoir for the virus and Hantaan Saaremaa; brown or Norway rat (Rattus norvegicus), a reservoir for Seoul virus; the bank mice (Clethrionomys glareolus), a reservoir for Puumala virus; and the yellow-necked field mouse (Apodemus flavicollis), which carry the virus Dobrava.

HFRS symptoms usually develop within 1 to 2 weeks after exposure to infectious materials, but in rare cases, they can take up to 8 weeks to develop. The initial symptoms start suddenly and include intense headache, back and abdominal pain, fever, chills, nausea, and blurred vision. Individuals may have facial flushing, inflammation or redness of the eye, or a rash. Later symptoms can include low blood pressure, shock, acute vascular leakage, and acute renal failure, which can cause severe fluid overload. The severity of this disease varies depending on the virus that causes the infection. Hantaan and Dobrava virus infections usually cause severe symptoms, while Seoul virus infection, Saaremaa, and Puumala usually more moderate. Full recovery can take weeks or months.

Several laboratory tests were used to confirm the diagnosis of HFRS in patients with a clinical history compatible with this disease. The patient was determined to have HFRS if they have positive serology infected with hantavirus, evidence of hantavirus antigens in tissue by immunohistochemical staining and microscopic examination, or evidence of hantavirus RNA sequences in blood or tissue.

Supporting therapy is the mainstay of treatment for patients with hantavirus infection. Treatment includes careful management of patients fluids (hydration) and electrolytes (eg, sodium, potassium, chloride) levels, the maintenance of proper oxygen and blood pressure levels, and appropriate treatment of secondary infections. Dialysis may be required to correct the severe fluid overload. Intravenous ribavirin, an antiviral drug, has been shown to reduce disease and death associated with HFRS if used very early in the disease.

Depending on the viruses that cause HFRS, death occurs in less than 1% to as much as 15% of patients. the range of 5-15% mortality for HFRS caused by Hantaan virus, and less than 1% for the diseases caused by Puumala virus.

Rodent control is the primary strategy for preventing hantavirus infection. Rodent populations near human communities must be controlled, and rats must be removed from the home. Individuals should avoid contact with rodent urine, feces, saliva, and nesting material, and the security measures described below should be followed when cleaning the mice-infested area.

health officials CDC assisted in investigating an outbreak infected 17 people and found 31 ratteries infected in 11 states, including Colorado, Georgia, Illinois, Iowa, Minnesota, Missouri, Pennsylvania, South Carolina, Tennessee, Utah, and Wisconsin. Investigation by the CDC and partner state and local health departments showed that potentially infected rodents may have been distributed or received in Colorado, Delaware, Georgia, Illinois, Idaho, Iowa, Minnesota, Missouri, New Jersey, Pennsylvania, South Carolina, Tennessee, Utah, and Wisconsin.

The investigation includes testing of mice and humans. In addition to testing provided by the CDC for mice and people associated with ratteries with confirmed infections, commercial testing for rats is also available. In the initial evaluation, the test kit developed by a commercial laboratory and the Charles River Laboratory IDEXX * produce test results with the same accuracy with the CDC tests.

As part of the health program, monitoring rat owners and breeders may want to test to determine infection status of the mice before admitting new animals into an existing colony.

Khan A, Ksiazek TG, CJ Peters. Viral Hemorrhagic Fever. Seminars in Pediatric Infectious Diseases 1997; 8 (Suppl 1) :. 64-73

Linderholm M, Elgh F. Clinical characteristics of Hantavirus Infection in the Eurasian Continent. Current topics in Microbiology and Immunology. 2001; 256 :. 135-51

CJ Peters. Viral Hemorrhagic Fever. Viral pathogenesis. New York City. Lippincott-Raven Publishers, 1997, 779-94

CJ Peters, GL Simpson, H. Levy spectrum of Hantavirus Infection: Hemorrhagic Fever Renal Syndrome and Hantavirus Pulmonary Syndrome. The annual review Medicine 1999; 50 :. 531-45

Schmaljohn C, Hjelle B. Hantaviruses: Global Disease Issues. Emerging Infectious Diseases 1997; 3: 95-104 .

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