Lee HW , Lee PW , Johnson KM , 1978. Isolation of the etiologic agent of Korean hemorrhagic fever. J Infect Dis 137: 298–308.
Kim YS , Ahn C , Han JS , Kim S , Lee JS , Lee PW , 1995. Hemorrhagic fever with renal syndrome caused by the Seoul virus. Nephron 71: 419–427.
Bi Z , Formenty PB , Roth CE , 2008. Hantavirus infection: a review and global update. J Infect Dev Ctries 2: 3–23.
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.
Puljiz I , Kuzman I , Turcinov D , Markotić A , Celjuska E , 2003. Clinical and epidemiologic characteristics of hemorrhagic fever with renal syndrome in patients treated at the Dr. Fran Mihaljević Clinic for Infectious Diseases in Zagreb. Acta Med Croatica 57: 347–353.
Mattar S , Guzman C , Figueiredo LT , 2015. Diagnosis of hantavirus infection in humans. Expert Rev Anti Infect Ther 13: 939–946.
Jakab F , Sebok J , Szanto Z , Hang D , Imre M , Nemeth V , Wittmann I , 2011. Dobrava-Belgrade hantavirus infection mimics acute appendicitis. J Clin Virol 50: 164–166.
Lim MY , Ryou J , Kim SY , Shin EH , Yoo YJ , Yun SM , Ju YR , 2012. Seroprevalence of hantaviruses in small wild mammals trapped in South Korea from 2005 to 2010. J Vector Ecol 37: 97–101.
Klempa B , Fichet-Calvet E , Lecompte E , Auste B , Aniskin V , Meisel H , Denys C , Koivogui L , ter Meulen J , Krüger DH , 2006. Hantavirus in African wood mouse, Guinea. Emerg Infect Dis 12: 838–840.
Braun N , Haap M , Overkamp D , Kimmel M , Alscher MD , Lehnert H , Haas CS , 2010. Characterization and outcome following Puumala virus infection: a retrospective analysis of 75 cases. Nephrol Dial Transplant 25: 2997–3003.
Wang Y , Tian PW , Wang WY , Wang K , Zhang Z , Chen BJ , Li WM , 2016. Noninvasive genotyping and monitoring of anaplastic lymphoma kinase (ALK) rearranged non-small cell lung cancer by capture-based next-generation sequencing. Oncotarget 7: 65208–65217.
Baek LJ , Kariwa H , Lokugamage K , Yoshimatsu K , Arikawa J , Takashima I , Song JW , 2006. Soochong virus: an antigenically and genetically distinct hantavirus isolated from Apodemus peninsulae in Korea. J Med Virol 78: 290–297.
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: 385–391.
Lee HW , 1989. Hemorrhagic fever with renal syndrome in Korea. Rev Infect Dis 11 (Suppl 4 ):S846–S876.
Lee JS , 1991. Clinical features of hemorrhagic fever with renal syndrome in Korea. Kidney Int (Suppl 35 ): S88–S93.
Jakab F , Sebok J , Szanto Z , Hang D , Imre M , Nemeth V , Wittmann I , 2011. Dobrava-Belgrade hantavirus infection mimics acute appendicitis. J Clin Virol 50: 164–166.
Latus J , Fritzenkotter M , Schmidt-Chanasit J , Tenner-Racz K , Leibold T , Kimmel M , Braun N , 2012. Hantavirus and acute appendicitis–the diagnosis behind the diagnosis? J Clin Virol 53: 156–158.
Latus J , Tenner-Racz K , Racz P , Kitterer D , Cadar D , Ott G , Braun N , 2014. Detection of Puumala hantavirus antigen in human intestine during acute hantavirus infection. PLoS One 9: e98397.
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: 255–258.
Lee EY , Choi SO , Choi GB , Kang DH , Yoon KI , 1998. Isolated abducens nerve palsy as a complication of haemorrhagic fever with renal syndrome. Nephrol Dial Transplant 13: 2113–2114.
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Hantaviruses are Bunyaviridae viruses that cause hemorrhagic fever with renal syndrome. Appendicitis caused by Hantaan virus has not been reported previously. An 81-year-old man who underwent laparoscopic appendectomy for suspected appendicitis based on abdominal pain, fever, hypotension, and computed tomography findings. Based on a suspicion of hemorrhagic fever with renal syndrome, the patient’s plasma was simultaneously analyzed using an indirect immunofluorescent antibody assay and nested reverse transcription–polymerase chain reaction (RT-PCR). The appendix tissue was also analyzed using nested RT-PCR and immunohistochemical (IHC) staining to identify the presence of Hantaan virus. Nested RT-PCR detected the presence of Hantaan virus, and indirect immunofluorescent antibody assay results revealed the presence of elevated antibody levels. Furthermore, IHC staining of the appendix tissue confirmed Hantaan virus antigens in the peripheral nerve bundle. Based on these findings, we confirmed the nerve tropism of the Hantaan virus. Hantaan virus in plasma and appendix tissue samples was confirmed using PCR and phylogenetic tree analysis. Moreover, we detected hypertrophy of the submucosa and periappendiceal adipose tissue nerve bundle along with Hantaan virus antigens in peripheral nerve bundles using IHC staining. Hence, we report that Hantaan virus infection may be accompanied by appendicitis.
These authors contributed equally to this work.
These authors contributed equally to this work.
Disclosure: This study was approved by the Ethics in Human Research Committee of Chosun University Hospital (IRB No. 2013-10-001-018). Written informed consent from the patients’ representative was obtained prior to participate in the study.
Authors’ addresses: Sung-Chul Lim, Department of Pathology, Chosun University College of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju, South Korea, E-mail: sclim@chosun.ac.kr. Young Min Lee, Na Ra Yun, and Dong-Min Kim, Department of Internal Medicine, Chosun University College of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju, South Korea, E-mails: topmal@gmail.com, shine@chosun.ac.kr, and drongkim@chosun.ac.kr. Choon-Mee Kim, Premedical Science, College of Medicine, Chosun University, 588 Seosuk-dong, Dong-gu, Gwangju, South Korea, E-mail: choonmee@chosun.ac.kr.
Lee HW , Lee PW , Johnson KM , 1978. Isolation of the etiologic agent of Korean hemorrhagic fever. J Infect Dis 137: 298–308.
Kim YS , Ahn C , Han JS , Kim S , Lee JS , Lee PW , 1995. Hemorrhagic fever with renal syndrome caused by the Seoul virus. Nephron 71: 419–427.
Bi Z , Formenty PB , Roth CE , 2008. Hantavirus infection: a review and global update. J Infect Dev Ctries 2: 3–23.
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.
Puljiz I , Kuzman I , Turcinov D , Markotić A , Celjuska E , 2003. Clinical and epidemiologic characteristics of hemorrhagic fever with renal syndrome in patients treated at the Dr. Fran Mihaljević Clinic for Infectious Diseases in Zagreb. Acta Med Croatica 57: 347–353.
Mattar S , Guzman C , Figueiredo LT , 2015. Diagnosis of hantavirus infection in humans. Expert Rev Anti Infect Ther 13: 939–946.
Jakab F , Sebok J , Szanto Z , Hang D , Imre M , Nemeth V , Wittmann I , 2011. Dobrava-Belgrade hantavirus infection mimics acute appendicitis. J Clin Virol 50: 164–166.
Lim MY , Ryou J , Kim SY , Shin EH , Yoo YJ , Yun SM , Ju YR , 2012. Seroprevalence of hantaviruses in small wild mammals trapped in South Korea from 2005 to 2010. J Vector Ecol 37: 97–101.
Klempa B , Fichet-Calvet E , Lecompte E , Auste B , Aniskin V , Meisel H , Denys C , Koivogui L , ter Meulen J , Krüger DH , 2006. Hantavirus in African wood mouse, Guinea. Emerg Infect Dis 12: 838–840.
Braun N , Haap M , Overkamp D , Kimmel M , Alscher MD , Lehnert H , Haas CS , 2010. Characterization and outcome following Puumala virus infection: a retrospective analysis of 75 cases. Nephrol Dial Transplant 25: 2997–3003.
Wang Y , Tian PW , Wang WY , Wang K , Zhang Z , Chen BJ , Li WM , 2016. Noninvasive genotyping and monitoring of anaplastic lymphoma kinase (ALK) rearranged non-small cell lung cancer by capture-based next-generation sequencing. Oncotarget 7: 65208–65217.
Baek LJ , Kariwa H , Lokugamage K , Yoshimatsu K , Arikawa J , Takashima I , Song JW , 2006. Soochong virus: an antigenically and genetically distinct hantavirus isolated from Apodemus peninsulae in Korea. J Med Virol 78: 290–297.
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: 385–391.
Lee HW , 1989. Hemorrhagic fever with renal syndrome in Korea. Rev Infect Dis 11 (Suppl 4 ):S846–S876.
Lee JS , 1991. Clinical features of hemorrhagic fever with renal syndrome in Korea. Kidney Int (Suppl 35 ): S88–S93.
Jakab F , Sebok J , Szanto Z , Hang D , Imre M , Nemeth V , Wittmann I , 2011. Dobrava-Belgrade hantavirus infection mimics acute appendicitis. J Clin Virol 50: 164–166.
Latus J , Fritzenkotter M , Schmidt-Chanasit J , Tenner-Racz K , Leibold T , Kimmel M , Braun N , 2012. Hantavirus and acute appendicitis–the diagnosis behind the diagnosis? J Clin Virol 53: 156–158.
Latus J , Tenner-Racz K , Racz P , Kitterer D , Cadar D , Ott G , Braun N , 2014. Detection of Puumala hantavirus antigen in human intestine during acute hantavirus infection. PLoS One 9: e98397.
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: 255–258.
Lee EY , Choi SO , Choi GB , Kang DH , Yoon KI , 1998. Isolated abducens nerve palsy as a complication of haemorrhagic fever with renal syndrome. Nephrol Dial Transplant 13: 2113–2114.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 2069 | 1204 | 51 |
Full Text Views | 204 | 29 | 0 |
PDF Downloads | 167 | 19 | 0 |