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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.
-
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: 1–10.
-
3.
Lee HW, Lee PW, Johnson KM, 1978. Isolation of the etiologic agent of Korean hemorrhagic fever. J Infect Dis 137: 298–308.
-
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.
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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: 382–387.
-
6.
Baek LJ et al. 2006. Soochong virus: an antigenically and genetically distinct Hantavirus isolated from Apodemus peninsulae in Korea. J Med Virol 78: 290–297.
-
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: 229–233.
-
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: 1–3.
-
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: 589–604.
-
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: 11–17.
-
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: 544–548.
-
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.
-
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: 406–411.
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Hemorrhagic Fever with Renal Syndrome as a Cause of Acute Diarrhea
Hyun Kuk Kim
Hyun Kuk Kim
Department of Pulmonary and Critical Care Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea;
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Jong-Hoon Chung
Jong-Hoon Chung
Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea;
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Dong-Min Kim
Dong-Min Kim
Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea;
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Na-Ra Yun
Na-Ra Yun
Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea;
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Choon-Mee Kim
Choon-Mee Kim
Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea;
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Sehrish Jalal
Sehrish Jalal
Department of Bio-Medical Sciences, College of Medicine, Chosun University, Gwangju, Republic of Korea
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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 Hantavirus 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.
Author Notes
Financial support: This study was supported by research fund from Chosun University, 2017.
Disclosure: This study was approved by the IRB of Chosun University. A written consent to participate in this study was obtained from the patient. Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient.
Authors’ addresses: Hyun Kuk Kim, Department of Pulmonary and Critical Care Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea, E-mail: khkmd1205@hanmail.net.Jong-Hoon Chung, Dong-Min Kim, and Na-Ra Yun, Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, South Korea, E-mails: jhchung@chosun.ac.kr, drongkim@chosun.ac.kr, and shine@chosun.ac.kr. Choon-Mee Kim, Premedical Science, College of Medicine, Chosun University, Gwangju, South Korea, E-mail: choonmee@chosun.ac.kr. Sehrish Jalal, Department of Bio-Medical Sciences, College of Medicine, Chosun University, Gwangju, Republic of Korea, E-mail: jalalsehrish@gmail.com.
These authors contributed equally to this work.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
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.
-
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: 1–10.
-
3.
Lee HW, Lee PW, Johnson KM, 1978. Isolation of the etiologic agent of Korean hemorrhagic fever. J Infect Dis 137: 298–308.
-
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: 382–387.
-
6.
Baek LJ et al. 2006. Soochong virus: an antigenically and genetically distinct Hantavirus isolated from Apodemus peninsulae in Korea. J Med Virol 78: 290–297.
-
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: 229–233.
-
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: 1–3.
-
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: 589–604.
-
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: 11–17.
-
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: 544–548.
-
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.
-
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: 406–411.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 38 | 38 | 13 |
| Full Text Views | 559 | 82 | 0 |
| PDF Downloads | 150 | 19 | 0 |