Recent Increase of Human Granulocytic Anaplasmosis and Co-Infection with Scrub Typhus or Korean Hemorrhagic Fever with Renal Syndrome in Korea

We report 17 patients with human granulocytic anaplasmosis between January 2015 and September 2018 at two tertiary university hospitals in Korea. Monthly incidence peaked in May and June. Among these patients, we identified three who were co-infected with scrub typhus, and one patient with hemorrhagic fever with renal syndrome.

A Case of Myocarditis in Patient with Korean Hemorrhagic Fever / 대한신장학회잡지

Korean hemorrhage fever(KHF) is an acute febrile disease with high fever, hypotension, gastrointestinal symptom, hemorrhagic symptom and renal failure. An adult patient with KHF presented with normal EKG on admission and no hypotensive period, subsequently developed dypnea on 10 th hospital days. Pulmonary edema pattern of the chest x-ray, T inversion of EKG and diffuse ventricular dyskinesia of echocardiography apperaed on 10th hospital days, and then disappered on 2 month. We experienced a rare case of KHF associtaed with myocarditis. This case suggests that the Myocarditis can be associated with KHF.

A Case of Korean Hemorrhagic Fever with Suspected Acute Pancreatitis / 감염

The Korean hemorrhagic fever (KHF) is an acute febrile disease with characteristic of fever, bleeding tendency, and renal failure. There are many complications of Korean hemorrhagic fever such as infection, anemia, internal bleeding, hypopituitarism, respiratory, and neurologic complication. A few cases were reported on acute pancreatitis with hemorrhagic fever abroad, but there was no case about Korean hemorrhagic fever with acute pancreatitis in this country. We experienced a case of Korean hemorrhagic fever associated with suspected acute pancreatits. With review of articles, we report a case of 51 year-old woman with KHF, where acute pancreatitis developed during management.

Genetic Analysis of Hantaviral M Segment Isolated from Patients with Korean Hemorrhagic Fever / 대한신장학회잡지

Hemorrhagic fever with renal syndrome(HFRS) is an infectious disease showing diverse clinical manifestations according to different serotypes of hantavirus. Korean hemorrhagic fever(KHF), HFRS caused by Hantaan or Seoul virus in Korea, shows diverse clinical manifestations even in the same serotype of hantavirus. On the assumption that the antigenicity, nucleotide and amino acid sequence diversity of hantaviruses, as well as immune response diversity of individual KHF patient may be present, this study was performed to analyse the genetic diversity of hantaviruses isolated from patients with KHF. In the 13 samples(9 strains of hantavirus isolated from bloods, urines or autopsy tissue of KHF patients and 4 serums of KHF patients), hantaviral RNAs were extracted, cDNAs of partial M segment were amplified by RT-PCR using genus-reactive primer, amplified cDNAs were analysed by direct sequencing method, and then the nucleotide and deduced amino acid sequences were compared with previously known sequences of four serotypes of hantavirus isolated from rodent hosts and each other by the computer assistance. The results were as follows. The nucleotide and amino acid sequences of 11 samples among the 13 human isolates showed 90.3-95.5%, 86.7-97.9%, the other 1 sample 82.7%, 71.9% homology respectively to those of Hantaan virus 76-118 strain, and another 1 sample showed 83.7%, 75.3% homology respectively to those of Seoul virus B1 strain isolated from rodent host. The nucleotide and amino acid sequences of 7 among 12 Hantaan samples showed differences within 5%, 10% respectively each other and high genetic similarities, but those of the other 5 among 12 Hantaan samples showed low genetic similarities each other. In conclusion, hantaviruses isolated from KHF patients showed genetic diversity compared with previously known hantaviruses isolated from rodent hosts.

A Case of Pregnancy Complicated with Korean Hemorrhagic Fever / 대한산부인과학회잡지

No abstract available.

A Case of Partial Hypopituitarism after Recovery from Korean Hemorrhagic Fever / 대한내분비학회지

Heorrhage and infarct-like necrosis of anterior lobe of the pituitary gland is one of the characteristic pathologic findings of the autopsied cases of Korean Hemorrhagic Fever (KHF) patients, but there has been rare reports of hypopituitarism in patients with KHF. Recently we have experienced a patient with hyponatremia who had recovered from KHF. He was admitted to our hospital due to nausea, vomiting, and epigastric discornfort. To determine the function of the anterior pituitary gland, hormonal levels of target galnds and pituitary gland were measured, and combined pituitary stimulation test was performed. ACTH, GH, and prolactin deficiency were confirmed by combined pituitary stimulation test in this patient. There was no evidence of hypothalamic or other pituitary diseases by brain MRI. Our experience shows that KHF can be a cause of hypopituitarism and these findings should alert physicians the possibility of hypopituitarisrn in patients who had recovered from KHF.

Detection of Hantaan and Seoul Viruses by Reverse Transcriptase-Polymerase Chain Reaction(RT-PCR) and Restriction Fragment Length Polymorphism(RFLP) in Korean Hemorrhagic Fever Patients / 대한신장학회잡지

BACKGROUND: Korean hemorrhagic fever(KHF), a severe from of hemorrhagic fever with renal syndrome(HFRS), is the most common cause of acute renal failure in far east. Two serotypes of hantavirus, Hantaan and Seoul viruses, were identified as pathogens for KHF in Korea. To elucidate the diagnostic applicability for the serotype diagnosis in KHF patients, using a nested reverse transcriptase-PCR and restriction fragment length polymorphism(nRT-PCR /RFLP), we screened 4 prototype viruses, 11 virus isolates from KHF patients, and 69 specimens obtained from 30 KHF patients. METHODS: The nRT-PCR was performed using serotype specific primers for G1 segments for Hantaan(HF3 1140-1163, HB14 1363-1342) and Seoul(SF2 809-832, SB3 1200-1177) viruses. The PCR product was further amplified using nested primers for Hantaan(HF4, 1141-1164, HB13, 1360-1339) and Seoul(SF7 863-884, SB1 1165-1142) viruses. Amplified segments were digested with restriction enzymes specific for either Hantaan(Cla I) or Seoul(Sac I) virus sequences. In all cultured viruses, serotypes identified by nRT-PCR/RFLP were consistent with those of PRNT. RESULTS: In KHF patients, nRT-PCR/RFLP results were compatible with Hantaan virus in 10 patients and with Seoul virus in 13 patients. In 3 patients both Hantaan and Seoul specific amplified bands were visualized in serially collected samples, and in 4 patients no detectable amplicons were detected. Among 69 specimens, 55 specimens obtained from 3 to 33 day of illness were positive. The positive rate was affected by the hospital where specimens were collected, but not by clinical phases, the day of illness, or severity of HFRS. CONCLUSIONS: In general, nRT-PCR/RFLP was a rapid and convenient method for serotype diagnosis in most of the KHF patients. The presented method also make it possible to detect genetic variation of hantavirus within the same serotype. But unlike the viruses in culture, in testing patients' sera, the sensitivity of this methods needed to be improved especially by adequate sample handling.

Male Infertility secondary to Pituitary Apoplexy after Korean Hemorrhagic Fever / 대한비뇨기과학회지

We report a case of male infertility secondary to pituitary apoplexy, which occurred as a sequela of korean hemorrhagic fever. A 32 years old male patient with past history of korean hemorrhagic fever was studied because of infertility and erectile impotence. The size of his testicles were about 8ml in Rt. and Lt. Semen analysis, endocrinologic studies, and brain MRI demonstrated hypogonadotrophic hypogonadism due to panhypopituitarism. The patient was treated with HCG (2,000 IU) administered intramuscularly three times per week for 6 months. After the treatment, improvement of male secondary sex characteristics such as hair growth and testicle size was noted. Promotion of sexual potency and improvement of semen quality were also noted. Following the treatment, his wife conceived after 6 months.

Early ocular manifestations of Korean hemorrhagic fever

Korean hemorrhagic fever is an acute febrile illness which causes hemorrhagic nerrosis of multiple internal organs. Some orular symptoms are described by physicians without ophthalmic examination. The authors evaluated early ocular manifestations in 21 patients (42 eyes) with Korean hemorrhagic fever, who were admitted from Oct. to Nov. in 1984. The results are summarized as follows: 1. In eleven patients (22 eyes, 52.4%), visual disturbances caused by transitory myopia were observed. 2. During the period of transitory myopic change, the intraocular pressure in the group of refrartive change was significantly raised compared to that in the group of non-refrartive change. 3. In the group of refractive change, increasing intraocular pressure and a shallowing of the anterior chamber were observed accompanied by transitory myopic change. 4. During the earIy phase of the illness, lid edema, chemosis, conjunctival injection, subconjunctival hemorrhage, and macular edema were observed.

Coagulopathy in patients with hemorrhagic fever with renal syndrome

Hemorrhagic fever with renal syndrome in Korea (Korean hemorrhagic fever) is an acute viral disease characterized by fever, hemorrhage and renal failure. In Korean patients, the disease manifests more distinctive bleeding tendencies than those of hemorrhagic fever with renal syndrome found in western countries. To investigate the nature and role of the coagulation, fibrinolysis, kinin and immune system in the pathogenesis of such a hemorrhagic manifestation, alterations of these systems were assessed from the early phase of the disease. Decreased platelet count and shortened platelet survival were observed with giant platelets in the peripheral blood. The marked prolongations of bleeding time, prothrombin time and partial thromboplastin time were noticed with the decreased plasma activities of coagulation factors II, V, VIII, IX and X. Shortened half life of fibrinogen, increased fibrinogen-fibrin degradation product, with decreased plasma levels and activities of plasminogen, alpha 2-plasmin inhibitor and antithrombin III were found. On thrombelastogram, the existence of procoagulant activity was confirmed, and prolonged reaction time and clot formation time with decreased maximum amplitude were observed. The appearance of circulating immune complexes was found along with decreased C3 and normal C4 in the serum. Significant decrease of serum C3 was evident in the patients with disseminated intravascular coagulation. These findings of coagulopathy were normalized within ten days of the illness in most cases. Therefore, it can be concluded that disseminated intravascular coagulation and thrombocytopenia in the early phase, and azotemia developing later might play an important role in the pathogenesis of bleeding tendency in Korean hemorrhagic fever.

Procoagulant activity and thrombelastography in korean hemorrhagic fever

Twenty male patients with Korean hemorrhagic fever were evaluated with thrombelastography (TEG) to assess the changes in coagulation system, and the results were compared with those of conventional coagulation tests. Procoagulant activity in the plasma was determined by comparing the reaction time "r" of the normal plasma and that of the mixture of equal parts of the normal plasma and the patient's plasma. The TEG was found to be a useful measure of the changes in the coagulation profile, and provided instant accurate assessment of the patient's hemostatic function. Presence of the procoagulant activity was demonstrated in the plasma of the patients and indicated occurrence of active intravascular coagulation during the early stage of the disease.