hemorrhagic fever with renal syndrome uk

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  • Feb 08, 2020

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1Department Infection, Hospital Castle Hill, Cottingham, East Yorkshire, UK

2Rare and Imported Pathogens Laboratory, Salisbury, Wiltshire, UK

1Department Infection, Home sick castle Hill, Cottingham, East Yorkshire, UK

2Rare and Imported Pathogens Laboratory, Salisbury, Wiltshire, UK

We present a case of undifferentiated febrile illness in a 59-year- old man from East Yorkshire. He was initially treated for leptospirosis due to the fact that it has exposure to agriculture and the findings of acute kidney injury (AKI), thrombocytopenia and raised alanine transferase (ALT) in its initial blood results. Serologic tests later proved he has a rodent-borne diseases are: Hantavirus. An investigation by the British Society of Health (formerly known as the Health Protection Agency) (PHE) continue to prove the presence of the same serotype hantavirus in rats caught in the property of the patient. After the initial disturbance, the patient made a relatively smooth recovery and all his blood tests return to normal levels.

Hantavirus is a recognized cause of acute kidney injury (AKI) and has been listed as one of 15 major factors that cause an increase in the absolute incidence of AKI in the entire Western world. Although common in Europe, there have been relatively few reported cases of hantavirus in the UK newest addition to dealing with overseas exposure. With no history of diagnosis is rarely if ever think about or tested by general practitioners (GPs) or hospital doctor. It is our opinion that the hantavirus underdiagnosed in the UK and should be considered in the differential diagnosis whenever leptospirosis considered. Our case report in conjunction with the isolation of the virus from rats caught in the property patient hantavirus UK strongly supports the presence of pathogens. It is our hope that this case report will raise awareness of hantavirus as a potential diagnosis in the UK. Experience from other endemic countries show that early diagnosis of hantavirus provide multiple benefits: (1) reduce the cost of unnecessary treatments, and (2) improved clinical outcomes for patients. Where high clinical awareness of the need for dialysis as a treatment for hantavirus-induced AKI had fallen to less than 5%. Complications such as hyperkalemia and severe uremia often be avoided by careful fluid balance. In Europe, patients with early and correct diagnosis were significantly less likely to be hospitalized and given antibiotics that are not treatment compared to those with delayed diagnosis.

In December 2011, a 59-year man presented to the Royal Infirmary in Hull 2-day history of fever, chills, anorexia and a dry cough. He lives in a small farm in East Yorkshire detained. About 2 weeks before admission, he had been treated with oral flucloxacillin by his GP for mild cellulitis after a cut to his wrist on some metals in the field of pig. Luka initially went unnoticed by the patient and therefore there is some dirt and exposure of the wound untreated water in pigs. Along with pigs, there are horses and cows on the farm and with hindsight the patient and his wife noted that there has been an increase in the number of rats seen around the ranch in the weeks prior to his illness. She had a medical history of psoriasis and pulmonary sarcoidosis, which is silent and he was in no regular medication. He did not have a trip outside the UK for at least three years. Regardless of the temperature of 38.1 ° C, the admission examination is normal. The wound on his wrist has completely healed with no signs of any residual cellulitis. the patient was transferred to the infectious disease ward at Castle Hill hospital where further tests done.

initial blood results show AKI, liver enzyme crazy, lymphopenia and thrombocytopenia (). His chest X-ray (CXR) is clear. Three sets of blood cultures were negative, such as throat swabs for respiratory viruses and Legionella urinary antigen

Selected results of blood

APTT, activated partial thromboplastin time .; CRP, C-reactive protein.

During the entry of hepatitis A, B, C and E and Leptospira serology checked and all the negatives. Because the clinical picture and history of the farm, blood is sent to Rare and Imported Pathogens, Public Health England (PHE), PortonDown to hantavirus serology. Serum confirmed very positive, especially to Seoul and Hantaan IgM (strip-immunoassay) and IgG (immunofluorescence assay, IFA) as stated in the. Serology was repeated 12 days later and pointed it into serotypes Seoul (1:40 000) by IFA. No RNA was detected hantavirus found in either blood or urine samples. However, further evidence that this infection caused by Seoul hantavirus patient is given when the next PHE investigation isolated a new strain of Seoul hantavirus English of rats on the property of the patient.

The results of serologic hantavirus patients

In the case of fever is generally distinguished as there are wide differential diagnosis including bacterial and viral infections, autoimmune processes and malignancy. Given this patient’s previous history of sarcoidosis flare-ups also need to be considered. However, he exposure to agriculture and in particular the history of his wrist injury in conjunction with AKI, thrombocytopenia and liver enzyme mad mean that the main differential diagnosis is leptospirosis.

As leptospirosis is a working diagnosis he was given intravenous benzyl penicillin and ciprofloxacin orally. Initially, he remained healthy with spiking temperatures and deteriorating renal function (see). On day 4 the body temperature to settle and soon tests his blood began to improve. Antibiotics were stopped and at his request he was discharged home for outpatient follow-up close. Shortly after discharge, he complained of increasing lower abdominal pain and its C-reactive protein (CRP) increased sharply. A repeat CXR remains unclear, negative urine culture and a CT scan of the abdomen and pelvis was reported as normal. abdominal pain and CRP persist for several days in the future without further intervention.

Over the next few weeks, he continued to make a smooth recovery. In late February 2012, two months after the initial illness, all his blood tests were normalized. Interestingly, as part of an investigation PHE follow this case, all family members and farm workers have conducted serological test for hantavirus and all this then came back negative.

Hantaviruses is a group of more than 40 rodent-borne virus, which is globally widespread. Most hantaviruses can only be transmitted to humans by direct contact with rodents or material contaminated with rodent waste (urine and feces). Gift disease in different forms with the severity and target organs is largely dependent on the serotypes: Hantavirus cardiopulmonary syndrome (HCP) in the United States are caused primarily by infection with serotype Sin Nombre (SINV) and Andes (ANDV) and hemorrhagic fever with renal syndrome (HFRS ) caused primarily by infection of Hantaan (HTNV) and Seoul (SEOV) in Asia and Dobrava (DOBV) and Puumala (PUUV) in Europe. Cerotype carried by different rodent. Most serotype carried by various species of mice or rats. Instead, SEOV done by brown rat Rattus norvegicus, which is widespread throughout Europe including the UK. Although there are several serological evidence of infection SEOV in Europe there have been very few human cases outside Asia proven. , To the best of our knowledge, our case is the first reported case of infection SEOV of wild rodent populations in the UK

The clinical course HFRS is classically divided into five phases: febrile, hypotensive, oliguric, diuretic and cured. However, some or all of these phases may not be clear as HFRS can be present as a spectrum from subclinical to fatal. Generally, an infection caused by HTNV and DOBV clinically more severe than those caused by SEOV. PUUV considered to cause only mild or subclinical disease. A large Chinese study of different clinical characteristics of infection HTNV and SEOV find mortality rates are significantly higher and higher requirements for dialysis on HTNV group. Interestingly, however, they found that patients with infection SEOV have a longer duration of fever and more likely to have liver enzyme disorder, sometimes even in the absence of AKI. HFRS lack of distinctive features of infected patients SEOV also means that they are more likely to be initially misdiagnosed. In addition to Southeast Asia, where intravenous ribavirin has been proven efficacious when administered early, therethere is no specific treatment for HFRS.
Management of fluid management and careful support is very important. Severe cases may require renal replacement therapy.

Despite widespread in Europe, there are only sporadic reports of cases of hantavirus customs in Scotland and England. Since the 1980s there has been increasing evidence for hantavirus infection is endemic in the UK. Has recently been no reported cases of hantavirus infection in patients in Wales. Interestingly serology of this case also points towards it being SEOV. Furthermore, SEOV RNA was detected from a patient two pet rats and some others of the larger breeding packs in Britain that pet rats had come from. Evidence from our case and the case of Welsh would seem to indicate that SEOV present both in the wild and pet rat population in the UK and therefore there can be little doubt that it may also cause infections in humans. With recent reports of SEOV detected in France and Sweden pet rat us interesting findings outside the UK.

Although hantavirus is rare if ever considered a diagnosis or tested by a doctor or hospital in England. This case demonstrates the need for all doctors to be aware of hantavirus front line as a potential diagnosis in patients with fever, MMR and thrombocytopenia, particularly if there is a history of contact potential rodent. It should also be considered in cases of febrile illness with liver enzyme mess with or without AKI. Indeed, it should be thought about and tested for each time leptospirosis is a differential diagnosis.

Hantaviruses is a group of more than 40 rodent-borne virus, which can spread to humans through close contact with rodents or material contaminated with rodent waste.

There seems to be a new Seoul hantavirus serotypes, which are present in the UK and the wild rat populations have the potential to cause human infections.

Seoul hantavirus serotypes cause a clinical picture of dengue fever with renal syndrome.

hantavirus should be considered as part of the differential diagnosis in patients with fever, acute kidney injury and thrombocytopenia, particularly if there is a history of contact possibilities rodents.

hantavirus management support and careful fluid balance is. Crucial

Contributors: KA responsible for this patient and he drafted the manuscript and approved the final draft. LJ drafted the manuscript and approved the final draft. RM is involved in this case and approved the final draft. TB is involved in the analysis of specimens of this case at Porton Down and approved the final draft

Competing interests: .. No

Patients approval :. Grabbing

Provenance and peer review: Not commissioned; externally peer reviewed.

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