Research progress in diagnosis and differential diagnosis of severe fever with thrombocytopenia syndrome and hemorrhagic fever with renal syndrome / 上海交通大学学报（医学版）

Severe fever with thrombocytopenia syndrome(SFTS)and hemorrhagic fever with renal syndrome(HFRS)are infectious diseases.The epidemic of these two diseases can seriously affect human life and health,and is also a public health problem currently facing in the world.Due to the uneven level of medical development around the world,many doctors have insufficient understanding of these two diseases,which is likely to lead to missed diagnosis or misdiagnosis,and the patients are not treated correctly,which leads to aggravation of the disease and affects their prognosis.Clinically,the diagnosis of SFTS and HFRS mainly depends on the results of pathogenic examination and serological examination,but many medical institutions have not carried out these two examinations.Therefore,if epidemiological and clinical characteristics can be used to diagnose and differentiate these two diseases,it will help guide clinical practice.This paper reviews the research progress in the diagnosis and differential diagnosis of SFTS and HFRS at home and abroad in recent years.

Correlation between the HLA-A, B alleles polymorphism and hemorrhagic fever with renal syndrome of Han nationality in Zunyi area / 中华微生物学和免疫学杂志

Objective To explore the correlation between HLA-A, B alleles polymorphism and hemorrhagic fever with renal syndrome (HFRS) among Han nationality in Zunyi area. Methods Using group study, HLA-A, B genotypes were conducted in 100 HFRS cases and 100 controls among Han nationality in Zunyi area with polymerase chain reaction-sequence specific primer (PCR-SSP), gene frequency (GF) and relative risk (RR) were compared and calculated. Results The frequencies of HLA-A * 31 and HLA-B * 58 alleles in HFRS cases (GF=4%,12.5%) were strikingly higher than that in the healthy controls (X2=6.380, 7.792, P<0.05;RR=18.47,2.91). The frequencies of HLA-B * 40 alleles in HFRS cases (GF=11%) were strikingly higher than that in the healthy controls (X2=6.095,P<0.01, RR=O.47). Conclusion HLA-A * 31, B * 58 genes are positively related to HFRS of Han nationality in Zunyi area, HLA-B * 40 gene is negatively related to HFRS of Han nationality in Zunyi area.

Clinical characteristics and predictors of acute oliguric renal failure in hemorrhagic fever with renal syndrome / 대한내과학회지

BACKGROUND: Hemorrhagic fever with renal syndrom (HFRS), caused by hantaviruses infection, develops acute renal failure (ARF) of variable severity. Because oliguric ARF is severe form, associated with more complications and hemodialysis requirement, we investigated the characteristics and predictors of oliguric ARF in HFRS patients. METHODS: From Oct. 2000 to Dec. 2004, Sixty one patients, admitted at Armed Forces Capital Hospital, with typical clinical feature of HFRS and serologically confirmed hantaan virus infection were studied. The medical records were reviewed retrospectively and patients were categorized into oliguric and nonoliguric ARF group according to urine output (or=15x10(9)/L (RR 2.36 [95% CI 1.19-4.67]), platelet countor=110IU/L (RR 3.10 [95% CI 1.43-6.73]) and microscopic hematuria>or=5/HPF (RR 3.68 [95% CI 1.24-10.91]). CONCLUSIONS: HFRS patients with oliguric ARF showed more elevation of serum creatinine and more requirement of hemodialysis than HFRS patients with non-oliguric ARF and leukocyte count, platelet count, AST and microscopic hematuria on admission were helpful to predict the development of oliguric ARF in HFRS patients.

DETERMINATION OF URINE TUMOR NECROSIS FACTOR, IL-6, IL-8 AND SERUM IL-6 IN PATIENTS WITH HEMORRHAGIC FEVERS WITH RENAL SYNDROME / 药物分析学报

Objective To explore the roles of cytokines in the pathogenesis of hemorrhagic fever with renal syndrome(HFRS). Methods Double-antibody sandwich ELISA was used to determine serum interleukin (IL)-6, urine tumor necrosis factor (TNF), IL-6 and IL-8 levels in 56 patients with HFRS. Results Serum IL-6, urine TNF, IL-6 and IL-8 concentrations in HFRS patients were significantly higher than those in control group, respectively (P＜0.001). The concentrations increased at fever stage, then continued to increase during hypotension stage and peaked at oliguria stage. The concentrations of serum IL-6, urine TNF, IL-6 and IL-8 increased in accord with the severity of the disease and differed greatly among different types of the disease. Serum IL-6 had remarkable relationships with serum specific antibodies. It was positively related to serum β2-microglobulin (β2-MG), blood ureanitrogen (BUN) and creatinine (Cr). Significant positive relationships were also found both between urine IL-6 and TNF, and between IL-6 and IL-8 (r=0.5768, P＜0.05; r=0.3760, P＜0.01). Conclusion TNF, IL-6 and IL-8 activated during the course of the disease. IL-6 is associated with the immunopathological lesions caused by the hyperfunction of humoral immune response. IL-6, IL-8 and TNF are involved in the renal immune impairment. Determining them might, in certain extent, be used in predicting the prognosis and outcome of patients with HFRS.

Hemorrhagic Fever with Renal Syndrome: Historical Aspects / 의사학

A mysterious disease was first reported from Korea when it had been observed during late spring 1951 in UN Forces operating in the central area close to the 38th parallel. The disease showed distinctive features which included high fever, low blood pressure, hemorrhagic tendency and acute renal failure. Historically it was apparently a similar disease to a clinical entity designated as Epidemic hemorrhagic fever in Manchuria or Hemorrhagic nephrosonephritis in Far Eastern Russia. After Lee Ho-Wang succeeded in demonstrating Hantaan virus which caused hemorrhagic fever with renal syndrome (HFRS), many studies has revealed various biological and epidemiological aspects of the disease. But the origin of the disease in Korea still remains unknown. This article tests some hypotheses which explain the origin of the disease and reviews the relation between the Korean War and HFRS. It is concluded that the emerging of HFRS would be closely related with the establishment of the munitions supply network in early 1951 in Chinese troop.

Seroepidemiologic Analysis of Acute Febrile Illness in Korea during 1997~1998

Hemorrhagic fever with renal syndrome (HFRS), scrub typhus, murine typhus and leptospirosis have been the principal acute febrile diseases in Korea for many years. To evaluate the seroepidemiologic patterns of the acute febrile illness, sera collected from 4,503 patients in 1997~1998 were examined for antibodies against Hantaan virus, Orientia tsutsugamushi and Rickettsia typhi by indirect immunofluorescent antibody technique (IFA) and macroscopic agglutination test for Leptospira interogans. Seropositive cases for Orientia tsutsugamushi, Rickettsia typhi, Leptospira interogans and Hantaan virus were 261 (12.4%), 242 (11.5%), 11 (0.5%), and 250 (11.9%) in 1997, and 415 (17.3%), 273 (11.4%), 16 (0.7%), and 357 (14.9%) in 1998, respectively. Male was affected more frequently by HFRS and leptospirosis while scrub typhus was more prevalent in female. Old age group was more susceptible to the acute febrile diseases. Most positive cases were occurred during October and November for scrub typhus, and during November and December for HFRS. These results showed similar patterns with previous epidemiological data obtained during recent several years, except the single scrub typhus epidemic in 1998, and implied that no significant changes occurred in ecologic system for acute febrile diseases in Korea.

A case of retroperitoneal hematoma by spontaneous rupture of renal capsule in hemorrhagic fever with renal syndrome presented with anuria and unilateral flank pain / 대한내과학회지

The hemorrhage in hemorrhagic fever with renal syndrome (HFRS) varies from transient petechial lesions to fulminant and massive bleeding. Also in vital organ such as lung, kidney, spleen, brain and pituitary, hemorrhage occasionally occurs spontaneously or by minor trauma. We report a case of retroperitoneal hematoma by spontaneous rupture of renal capsule in HFRS presented with anuria and right flank pain. A 34-year-old male was admitted to our hospital presenting anuria and right flank pain for 3 days. He also had suffered from fever and myalgia since 5 days ago. Sonography and computed tomography were performed at the day of hospitalization and showed massive perirenal hematoma with ruptured renal capsule and spurtting subcapsular renal artery on the right kidney. He was diagnosed as HFRS and treated with hemodialysis, fluid infusion and transfusion. After conservative treatment, he recovered from HFRS without further blood loss.

A Case of Massive Perirenal Hematoma in a Patient with Hemorrhagic Fever with Renal Syndrome / 대한신장학회잡지

Hemorrhagic fever with renal syndrome is characterized clinically by the triad of fever, hemorrhage and renal failure. The hemorrhage in hemorrhagic fever with renal syndrome(HFRS) varies from transient petechial lesions to fulminant and massive bleeding. The latter can be an important cause of death in HFRS. We here report a case of massive perirenal hematoma in a patient with HFRS. A 17-year-old male was admited to our hospital presenting with fever, sore throat, nausea and oliuria. Computed tomography was performed at the 2nd day of hospitalization due to abruptly developing right flank pain and anemia and showed perirenal hematoma on the right kidney. He was diagnosed as HFRS and treated with hemodialysis, fluid infusion, and transfusion. There was no evidence of further blood loss at the 7th day of hospitalization. After conservative treatment, he recovered from HFRS.

A Case of Prolonged Oliguric Phase over One Month in a Patient with Hemorrhagic Fever with Renal Syndrome / 대한신장학회잡지

Hemorrhagic fever with renal syndrome(HFRS) is characterized clinically by five distinct phases; febrile, hypotensive, oliguric, diuretic and convalescent phases. The oliguric phase usually lasts for three to six days. We here report a case of prolonged oliguric phase over one month in a patient with HFRS. A 36-year-old man developed oliguric acute renal failure due to HFRS. He commenced hemodialysis on the 2nd days of hospitalization. The oliguric phase was prolonged over one month. The endocrinologic study showed nomal range of plasma ACTH, cortisol, thyroid hormone and slight elevation of plasma atrial natriuretic peptide at oliguric phase. Kidney biopsy showed mononuclear cell infiltrate and associated edema in the interstitium. Diuresis appeared at the 43th days of hospitalization, but it was inadequate. To enhance diuresis and recovery of renal function, he was treated with steroid. Five days after steroid treatment, massive diuresis appeared and serum creatinine decreased to 1.2mg/dL at the 5 months after onset of the disease.

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.

Clinical Efficacy of Xuebijing Injection for Hemorrhagic Fever with Renal Syndrome Complicating Acute Renal Failure:Observation of 42 Cases / 中国药房

OBJECTIVE:To observe the clinical efficacy of Xuebijing injection for hemorrhagic fever with renal syndrome(HFRS) complicating acute renal failure(ARF). METHODS:A total of 72 patients with HFRS complicating ARF were randomly assigned to receive combined therapy of western medicines(control group,n=30) or combined therapy of western medicines in combination with Xuebijing injection(trial group,n=42). RESUTLS:There were significant differences between the trial group and the control group in total effective rate (95.24% vs.80.00%) (P

DIRECT ELISA FOR THE EARLY DIAGNOSIS OF HFRS / 西安交通大学学报(医学版)

The antigen of hemorrhagic fever with renal syndrome (HFRS) virus in the infected suckling mouse brains was purified by a combined method—Protamin sulfate sedimentation and sucrose cushion uhracentrifugation. The Purified antigen was labeled with horseradish peroxidase (HRP). A kind of IgM antibody capture ELISA that used HRP—labeled antigen of HFRS Virus, i.e, direct ELISA, was successfully established for the detection of specific IgM antibody in sera from patients with HFRS. Compared with IgM antibody capture ELISA that used HRP—labeled IgG antibody to HFRS virus ,direct ELISA was similar in sensitivity to it,but direct ELISA could completely avoid the interference caused by rheumatoid factor (RF) as well as could reduce one step immune reaction. 87 serum samples from patients with HFRS(diagnosed clinically) in various stages, including 37 from Patients with HFRS in early stage(from 1 to 5 days after the onset of HFRS)were detected by direct ELISA . The positive rates of specific IgM antibody were 96.5% and 91.8%, respectively. We think that direct ELISA that uses HRP—labeled antigen provides a more specific,simpler and faster method for early di—agnosis of HFRS.