Volume 84, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Reports on the clinical entity of hemorrhagic fever with renal syndrome (HFRS) have focused on acute renal failure. Data on the extrarenal manifestations are limited primarily to case reports. In this study, protean extrarenal manifestations involving the major organs occurred in one-third of patients with HFRS during various stages (i.e., febrile phase through diuretic phase). Pancreatobiliary manifestations and major bleeding occurred in 11% and 10% of patients, respectively. Cardiovascular and central nervous system manifestations developed during the febrile or oliguric phase, whereas pancreatobiliary manifestations and major bleeding were detected even in the diuretic phase. Thus, close monitoring of and additional knowledge about various extrarenal manifestations are needed.


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  1. Song JY, Chun BC, Kim SD, Baek LJ, Kim SH, Sohn JW, Cheong HJ, Kim WJ, Park SC, Kim MJ, , 2006. Epidemiology of hemorrhagic fever with renal syndrome in endemic area of the Republic of Korea, 1995–1998. J Korean Med Sci 21: 614620.[Crossref] [Google Scholar]
  2. McCaughey C, Hart CA, , 2000. Hantaviruses. J Med Microbiol 49: 587599.[Crossref] [Google Scholar]
  3. Sirotin BZ, Keiser NP, , 2001. On the history of the study of hemorrhagic fever with renal syndrome in eastern Russia. Nephrol Dial Transplant 16: 12881290.[Crossref] [Google Scholar]
  4. Lednicky JA, , 2003. Hantaviruses. A short review. Arch Pathol Lab Med 127: 3035. [Google Scholar]
  5. Muranyi W, Bahr U, Zeier M, van der Woude FJ, , 2005. Hantavirus infection. J Am Soc Nephrol 16: 36693679.[Crossref] [Google Scholar]
  6. Alexeyev OA, Morozov VG, , 1995. Neurological manifestations of hemorrhagic fever with renal syndrome caused by Puumala virus: review of 811 cases. Clin Infect Dis 20: 255258.[Crossref] [Google Scholar]
  7. Bruno P, Hassell LH, Brown J, Tanner W, Lau A, , 1990. The protean manifestations of hemorrhagic fever with renal syndrome. A retrospective review of 26 cases from Korea. Ann Intern Med 113: 385391.[Crossref] [Google Scholar]
  8. Wichmann D, Slenczka W, Alter P, Boehm S, Feldmann H, , 2001. Hemorrhagic fever with renal syndrome: diagnostic problems with a known disease. J Clin Microbiol 39: 34143416.[Crossref] [Google Scholar]
  9. Forsmark CE, Baillie J, , 2007. AGA Institute technical review on acute pancreatitis. Gastroenterology 132: 20222044.[Crossref] [Google Scholar]
  10. Dervenis C, Johnson CD, Bassi C, Bradley E, Imrie CW, McMahon MJ, Modlin I, , 1999. Diagnosis, objective assessment of severity, and management of acute pancreatitis. Santorini consensus conference. Int J Pancreatol 25: 195210. [Google Scholar]
  11. Hirota M, Takada T, Kawarada Y, Miura F, Hirata K, Mayumi T, Yoshida M, Strasberg S, Pitt H, Gadacz TR, de Santibanes E, Gouma DJ, Solomkin JS, Belghiti J, Neuhaus H, Büchler MW, Fan ST, Ker CG, Padbury RT, Liau KH, Hilvano SC, Belli G, Windsor JA, Dervenis C, , 2007. Dignostic criteria and severity assessment of acute cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg 14: 7882.[Crossref] [Google Scholar]
  12. Wada K, Takada T, Kawarada Y, Miura F, Yoshida M, Mayumi T, Strasberg S, Pitt HA, Gadacz TR, Büchler MW, Belghiti J, De Santibanes E, Gouma DJ, Neuhaus H, Dervenis C, Fan ST, Chen MF, Ker CG, Bornman PC, Hilvano SC, Kim SW, Liau KH, Kim MH, , 2007. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg 14: 5258.[Crossref] [Google Scholar]
  13. Henter JI, Tondini C, Pritchard J, , 2004. Histiocyte disorders. Crit Rev Oncol Hematol 50: 157174.[Crossref] [Google Scholar]
  14. Lee JJ, Chung IJ, Shin DH, Cho SH, Cho D, Ryang DW, Khan AS, Kim HJ, , 2002. Hemorrhagic fever with renal syndrome presenting with hemophagocytic lymphohistiocytosis. Emerg Infect Dis 8: 209210.[Crossref] [Google Scholar]
  15. Schmaljohn C, Hjelle B, , 1997. Hantaviruses: a global disease problem. Emerg Infect Dis 3: 95104.[Crossref] [Google Scholar]
  16. Hullinghorst RL, Steer A, , 1953. Pathology of epidemic hemorrhagic fever. Ann Intern Med 38: 77101.[Crossref] [Google Scholar]
  17. Kim YO, Chun KA, Choi JY, Yoon SA, Yang CW, Kim KT, Bang BK, , 2001. Sonographic evaluation of gallbladder-wall thickening in hemorrhagic fever with renal syndrome: prediction of disease severity. J Clin Ultrasound 29: 286289.[Crossref] [Google Scholar]
  18. Huffman JL, Schenker S, , 2010. Acute acalculous cholecystitis: a review. Clin Gastroenterol Hepatol 8: 1522.[Crossref] [Google Scholar]
  19. Puljiz I, Kuzman I, , 2005. Electrocardiographic changes in patient with haemorrhagic fever with renal syndrome. Scand J Infect Dis 37: 594598.[Crossref] [Google Scholar]
  20. Woodward TE, McCrumb FR, Jr Carey TN, Togo Y, , 1960. Viral and rickettsial causes of cardiac disease, including the Coxsackie virus etiology of pericarditis and myocarditis. Ann Intern Med 53: 11301150.[Crossref] [Google Scholar]
  21. Giles RB, Sheedy JA, , 1954. The sequelae of epidemic hemorrhagic fever. Am J Med 16: 629638.[Crossref] [Google Scholar]
  22. Myron S, Cohen MD, , 1983. CNS manifestations of epidemic hemorrhagic fever. Arch Intern Med 143: 20702072.[Crossref] [Google Scholar]
  23. Guang MY, Liu GZ, Cosgriff TM, , 1989. Hemorrhage in hemorrhagic fever with renal syndrome in China. Rev Infect Dis 11: S884S890.[Crossref] [Google Scholar]
  24. Lee JS, , 1991. Clinical features of hemorrhagic fever with renal syndrome in Korea. Kidney Int Suppl 35: S88S93. [Google Scholar]
  25. Nuutinen H, Vuoristo M, Färkkilä M, Kahri A, Seppälä K, Valtonen V, Joutsiniemi T, Miettinen T, , 1992. Hemorrhagic gastropathy in epidemic nephropathy. Gastrointest Endosc 38: 476480.[Crossref] [Google Scholar]
  26. Koh CS, Kim WD, Lee JS, Lee M, , 1972. Clinical study of Korea hemorrhagic fever. Korean J Intern Med 15: 757776. [Google Scholar]
  27. Mackow ER, Gavrilovskaya IN, , 2009. Hantavirus regulation of endothelial cell functions. Thromb Haemost 102: 10301041. [Google Scholar]
  28. Duchin JS, Koster FT, Peters CJ, Simpson GL, Tempest B, Zaki SR, Ksiazek TG, Rollin PE, Nichol S, Umaland ET, , 1994. Hantavirus pulmonary syndrome: a clinical description of 17 patients with a newly recognized disease. N Engl J Med 330: 949955.[Crossref] [Google Scholar]
  29. Moghtaderi A, Alavi-Naini R, Azimi H, , 2005. Compartment syndrome: an unusual course for a rare disease. Am J Trop Med Hyg 73: 450452. [Google Scholar]
  30. Baty V, Schuhmacher H, Bourgoin C, Latger V, Buisine J, May T, Canton P, , 1998. Hemophagocytic syndrome and hemorrhagic fever with renal syndrome. Presse Med 27: 1577. [Google Scholar]
  31. Hujakka H, Koistinen V, Kuronen I, Eerikäinen P, Parviainen M, Lundkvist A, Vaheri A, Vapalahti O, Närvänen A, , 2003. Diagnostic rapid tests for acute hantavirus infections: specific tests for Hantaan, Dobrava and Puumala viruses versus a hantavirus combination test. J Virol Methods 108: 117122.[Crossref] [Google Scholar]
  32. Woo GJ, Chun EY, Kim KH, Kim W, , 2005. Analysis of immune responses against nucleocapsid protein of the Hantaan virus elicited by virus infection or DNA vaccination. J Microbiol 43: 537545. [Google Scholar]

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  • Received : 13 Jan 2010
  • Accepted : 02 Nov 2010
  • Published online : 04 Feb 2011

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