1921
Volume 100, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Hemorrhagic fever with renal syndrome (HFRS) is a febrile disorder caused in Korea by the Hantaan and Seoul viruses. Its characteristic clinical manifestations include fever, hemorrhage, and renal failure, but a primary presentation with acute infectious diarrhea is rare. Owing to decreased urine output and renal function, a 54-year-old patient was transferred to our hospital from a local clinic, where he had been receiving treatment for diarrhea occurring more than 10 times a day. The patient was treated in the Gastroenterology Department at our hospital for acute renal failure secondary to inflammatory diarrhea based on the findings of stool leukocytes. An immunofluorescent antibody assay showed a 4-fold increase in the acute-phase antibody titer to during recovery. A nested reverse transcription polymerase chain reaction (RT-nPCR) assay of plasma yielded negative results, but Hantaan virus positivity was confirmed on an RT-nPCR assay of the buffy coat. Another 60-year-old patient with watery diarrhea was treated conservatively for suspected infectious diarrhea. However, an immunofluorescent antibody assay showed a 4-fold increase in the acute-phase HFRS antibody titer. RT-nPCR using plasma yielded negative results, but Seoul virus was detected on an RT-nPCR buffy coat assay, confirming the diagnosis of HFRS. Hemorrhagic fever with renal syndrome can present with gastrointestinal symptoms such as acute diarrhea alone. This report highlights the importance of considering HFRS in the differential diagnosis of patients with acute diarrhea and the need for additional research on the usefulness of the buffy coat in the PCR diagnosis of HFRS.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.18-0974
2019-03-25
2020-09-29
Loading full text...

Full text loading...

/deliver/fulltext/14761645/100/5/tpmd180974.html?itemId=/content/journals/10.4269/ajtmh.18-0974&mimeType=html&fmt=ahah

References

  1. Jiang H, Du H, Wang LM, Wang PZ, Bai XF, 2016. Hemorrhagic fever with renal syndrome: pathogenesis and clinical picture. Front Cell Infect Microbiol 6: 1.
    [Google Scholar]
  2. Meier M, Kramer J, Jabs WJ, Nolte C, Hofmann J, Krüger DH, Lehnert H, Nitschke M, 2018. Proteinuria and the clinical course of Dobrava-Belgrade Hantavirus infection. Nephron Extra 8: 110.
    [Google Scholar]
  3. Lee HW, Lee PW, Johnson KM, 1978. Isolation of the etiologic agent of Korean hemorrhagic fever. J Infect Dis 137: 298308.
    [Google Scholar]
  4. Korea Centers for Disease control and Prevention (KCDC), 2016. Infectious Disease Surveillance Yearbook, 2016. Available at: http://www.cdc.go.kr/npt/biz/npp/nppMain.do. Accessed November 2018.
  5. Ahn HJ, Chung JH, Kim DM, Yoon NR, Kim CM, 2018. Hemorrhagic fever with renal syndrome accompanied by panhypopituitarism and central diabetes insipidus: a case report. J Neurovirol 24: 382387.
    [Google Scholar]
  6. Baek LJ et al., 2006. Soochong virus: an antigenically and genetically distinct Hantavirus isolated from Apodemus peninsulae in Korea. J Med Virol 78: 290297.
    [Google Scholar]
  7. Park KH, Kang YU, Kang SJ, Jung YS, Jang HC, Jung SI, 2011. Experience with extrarenal manifestations of hemorrhagic fever with renal syndrome in a tertiary care hospital in South Korea. Am J Trop Med Hyg 84: 229233.
    [Google Scholar]
  8. Hong YM, So MS, Kang KP, Kim W, Park SK, Lee S, 2012. A neglected diagnosis in severe diarrhea, thrombocytopenia, and elevated serum creatinine levels. J Clin Virol 55: 13.
    [Google Scholar]
  9. Mustonen J, Mäkelä S, Outinen T, Laine O, Jylhävä J, Arstila PT, Hurme M, Vaheri A, 2013. The pathogenesis of nephropathia epidemica: new knowledge and unanswered questions. Antiviral Res 100: 589604.
    [Google Scholar]
  10. Noh JY, Cheong HJ, Song JY, Kim WJ, Song KJ, Klein TA, Lee SH, Yanagihara R, Song JW, 2013. Clinical and molecular epidemiological features of hemorrhagic fever with renal syndrome in Korea over a 10-year period. J Clin Virol 58: 1117.
    [Google Scholar]
  11. Gut AK, Gut R, Pencuła M, Jarosz MJ, 2013. New cases of suspected HFRS (Hantavirus infection) in south-eastern Poland. Ann Agric Environ Med 20: 544548.
    [Google Scholar]
  12. Herbert ME, 2000. Medical myth: measuring white blood cells in the stools is useful in the management of acute diarrhea. West J Med 172: 414.
    [Google Scholar]
  13. Pettersson L, Klingström J, Hardestam J, Lundkvist A, Ahlm C, Evander M, 2008. Hantavirus RNA in saliva from patients with hemorrhagic fever with renal syndrome. Emerg Infect Dis 14: 406411.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.18-0974
Loading
/content/journals/10.4269/ajtmh.18-0974
Loading

Data & Media loading...

  • Received : 07 Dec 2018
  • Accepted : 28 Jan 2019
  • Published online : 25 Mar 2019
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error