Concomitant hemorrhagic fever with renal syndrome and COVID-19.

Udmurt Republic is an endemic region for hemorrhagic fever with renal syndrome (HFRS). An extremely high incidence of COVID-19 in 2020-2021 worldwide and in Udmurt Republic in particular suggests that patients might bear these two infections simultaneously. In this article, we report a case of mixed COVID-19 plus HFRS infection. Specific clinical manifestations of HFRS in a COVID-19-coinfected patient included long-term fatigue, thrombocytopenia, iso(hypo)sthenuria, polyuria, episodes of sinus tachycardia and hypertension. On the other hand, the main clinical characteristics of COVID-19 in a HFRS-coinfected patient included no clinical signs of respiratory failure and relatively high saturation despite a substantial lung damage. In general, mixed infection is a risk factor that aggravates the disease and can worsen outcome. However, simultaneous infection of a cell with more than one virus probably causes viral interference, which results in suppression of one or both viruses.Copyright © 2023, Dynasty Publishing House. All rights reserved.

Evidence for Human-to-Human Transmission of Hantavirus: A Systematic Review.

BACKGROUND: Hantavirus is known to be transmitted from rodents to humans. However, some reports from Argentina and Chile have claimed that the hantavirus strain Andes virus (ANDV) can cause human-to-human transmission of the disease. The aim of this systematic review was to assess the evidence for human-to-human transmission of hantavirus. METHODS: We searched PubMed (inception to 28 February 2021), Cochrane Central, Embase, LILACS and SciELO (inception to 3 July 2020), and other sources. We included studies that assessed whether interpersonal contact with a person with laboratory-confirmed hantavirus infection led to human-to-human transmission. Two reviewers conducted screening, selection, data extraction, and risk of bias assessment. RESULTS: Twenty-two studies met the inclusion criteria. Meta-analysis was not possible due to heterogeneity. With the exception of 1 prospective cohort study of ANDV in Chile with serious risk of bias, evidence from comparative studies (strongest level of evidence available) does not support human-to-human transmission of hantavirus infection. Noncomparative studies with a critical risk of bias suggest that human-to-human transmission of ANDV may be possible. CONCLUSIONS: The balance of the evidence does not support the claim of human-to-human transmission of ANDV. Well-designed cohort and case-control studies that control for co-exposure to rodents are needed to inform public health recommendations.

Discovering common pathogenic processes between COVID-19 and HFRS by integrating RNA-seq differential expression analysis with machine learning.

Zoonotic virus spillover in human hosts including outbreaks of Hantavirus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) imposes a serious impact on the quality of life of patients. Recent studies provide a shred of evidence that patients with Hantavirus-caused hemorrhagic fever with renal syndrome (HFRS) are at risk of contracting SARS-CoV-2. Both RNA viruses shared a higher degree of clinical features similarity including dry cough, high fever, shortness of breath, and certain reported cases with multiple organ failure. However, there is currently no validated treatment option to tackle this global concern. This study is attributed to the identification of common genes and perturbed pathways by combining differential expression analysis with bioinformatics and machine learning approaches. Initially, the transcriptomic data of hantavirus-infected peripheral blood mononuclear cells (PBMCs) and SARS-CoV-2 infected PBMCs were analyzed through differential gene expression analysis for identification of common differentially expressed genes (DEGs). The functional annotation by enrichment analysis of common genes demonstrated immune and inflammatory response biological processes enriched by DEGs. The protein-protein interaction (PPI) network of DEGs was then constructed and six genes named RAD51, ALDH1A1, UBA52, CUL3, GADD45B, and CDKN1A were identified as the commonly dysregulated hub genes among HFRS and COVID-19. Later, the classification performance of these hub genes were evaluated using Random Forest (RF), Poisson Linear Discriminant Analysis (PLDA), Voom-based Nearest Shrunken Centroids (voomNSC), and Support Vector Machine (SVM) classifiers which demonstrated accuracy >70%, suggesting the biomarker potential of the hub genes. To our knowledge, this is the first study that unveiled biological processes and pathways commonly dysregulated in HFRS and COVID-19, which could be in the next future used for the design of personalized treatment to prevent the linked attacks of COVID-19 and HFRS.

Case report: Hemorrhagic fever with renal syndrome presenting as hemophagocytic lymphohistiocytosis.

Hemophagocytic lymphohistiocytosis may occur in patients with genetic predisposition and in sporadic cases due to malignancy or infection. We describe a 49-year old man with hemorrhagic fever, type 1 respiratory insufficiency and acute kidney injury. Diagnostic work up showed a hyperinflammatory syndrome, hypertriglyceridemia, hemophagocytosis, very high ferritin and significantly elevated sCD25. The findings were compatible with hemophagocytic lymphohistiocytosis based on the HLH-2004 criteria. Serological testing indentified Puumala virus as the causal pathogen. The patient was successfully treated with pulse corticosteroids, intravenous immunoglobins and supportive therapy.

Hemorrhagic Fever with Renal Syndrome Complicated with Rhino Mucormycosis: A Case Report.

Mucormycosis (MCR) is a rare but aggressive fungal disease. Rhino-orbito-cerebral mucormycosis is the most common clinical form of MCR infection, and sinonasal inoculation is the primary site of infection. The morbidity and mortality rates associated with MCR remain high. In this case report, we describe the successful use of amphotericin B in a 40-year-old male with hemorrhagic fever with renal syndrome (HFRS) complicated by rhinomucormycosis. This case report provides evidence for the successful treatment of HFRS.

Role of IFN-?, TNF-a, IL-6 and C-reactive protein in newly diagnosed Iraqi corona patients

The exceptional conditions sweeping the world due to the Corona virus epidemic have prompted researchers to race to study each of the symptoms, phenomena and relevant clinical biochemical parameters to provide science and scientists with valuable information to achieve victory over the virus. The aim of this investigation is to study the early inflammatory features caused by the immune system before a cell storm occurs in Iraqi Corona patients. The investigation was conducted at Yarmouk Teaching Hospital, Baghdad, Iraq, during the period from January 2021 until the end of March 2021. Our team obtained five milliliters of venous blood from 50 participants newly diagnosed with the Coronavirus (24 males and 26 females). Their ages ranged between (25-55) years compared to 38 individuals (18 males and 20 females). Corona virus patients had statistically significant higher (P<0.01) with Low density lipoproteins-cholesterol (LDL-C), urea, C-Reactive Protein (CRP), and (P<0.001) with D-dimer when they were compared with control group. There was a significant increase in the value of Interleukin-6(IL-6) in people infected with the virus compared to the reviewers whose swab results showed that they were not infected with the virus. For both interferon-? (IFN) and Tumor necrosis factor -a (TNF- a), the data showed a significant decrease in morale of reviewers diagnosed with acute respiratory syndrome (COVID-19) against their non-infected peers. These data indicate that early intervention for IFN antiviral infection could be fundamental in inhibiting fibrosis to improve functional recovery. Any source of cytokine control, such as interferon-? and Tumor necrosis factor -a combined with combination therapies for clinical treatment, will be important in the future for COVID-19 infection.

Bat and bat-borne hantaviruses

Hantaviruses are important pathogenes of natural focal diseases that causes hemorrhagic fever with renal syndrome and Hantavirus pulmonary syndrome. According to the latest classification of the International Committee on Taxonomy of Viruses, hantaviruses can be divided into 53 species, 7 genera, and 4 subfamilies. Hantaviruses are widely found in Rodentia, Chiroptera, and Insectivora, and later also found in reptile, Actinopterygii, and Agnatha. There are many species of bats, which are the second largest group of mammals in the world after rodents. At present, 1 446 species have been reported, accounting for about 22% of global mammals. In addition, bats have strong flight ability and are widely distributed in all continents except Antarctica. As the host animal of viruses, bats bear a variety of viruses, and many emerging infectious pathogens such as Marburg virus, Hendra virus, and Nipah virus have been confirmed to come from bats. Bats have also been associated to Ebola virus, severe acute respiratory syndrome coronavirus, Middle East respiratory syndrome coronavirus, and severe acute respiratory syndrome coronavirus 2. In recent decades, more and more bat-borne hantaviruses have been discovered. Bats and bat-borne hantaviruses have an important research value. Therefore, this paper reviews the latest classification of Hantavirus and bat-borne hantaviruses.

Fatal cases of hemorrhagic fever with renal syndrome in Udmurtia, Russia, 2010 to 2019.

Hemorrhagic fever with renal syndrome (HFRS) continues to be a cause of death in Europe. Our aim was to describe the clinical and histopathological features of fatal HFRS in the Udmurt Republic (Udmurtia), located in the European part of Russia. This retrospective observational study included all fatal cases of HFRS that occurred in Udmurtia from January 2010 through December 2019. The most relevant clinical and autopsy data of these cases were recorded through a review of the patients' medical records and autopsy reports. During 2010-2019, Udmurtia had 41 fatal cases of HFRS of a total of 10,312 confirmed cases (case-fatality rate of 0.4%). Twenty-seven patients died in hypotensive and oliguric phases of HFRS due to refractory septic shock and acute respiratory distress syndrome. Fourteen patients died in the polyuric phase of the disease from complications of acute kidney injury or because of hospital-acquired bacterial infections. Multiorgan involvement was noted in all autopsies with variable degrees of generalized venous congestion, interstitial edema, capillary wall thickening, perivascular deposition of plasma proteins, microthrombosis formation, and perivascular hemorrhage. The more prominent histopathological features were seen in kidneys, lungs, and hypophysis.

Evaluation of Serum Ferritin, Procalcitonin, and C-Reactive Protein for the Prediction of Severity and Mortality in Hemorrhagic Fever With Renal Syndrome.

This study aimed to analyze the clinical significance of serum ferritin, procalcitonin (PCT), and C-reactive protein (CRP) in patients with hemorrhagic fever with renal syndrome (HFRS). The demographical, clinical, and laboratory data of 373 patients with HFRS in northeastern China were retrospectively analyzed. The levels of serum ferritin and PCT in severe patients (n = 108) were significantly higher than those in mild patients (n = 265, p < 0.001) and associated with HFRS severity. The area under the receiver operating characteristic curve (AUC) values of serum ferritin and PCT for predicting the severity of HFRS were 0.732 (95% CI 0.678-0.786, p < 0.001) and 0.824 (95% CI 0.773-0.875, p < 0.001), respectively, showing sensitivity and specificity of 0.75 and 0.88 for serum ferritin, and 0.76 and 0.60 for PCT. The CRP level in HFRS with bacterial co-infection (n = 115) was higher than that without bacterial co-infection (n = 258, p < 0.001). The AUC value of CRP for predicting bacterial co-infection was 0.588 (95% CI 0.525-0.652, p < 0.001), showing sensitivity and specificity of 0.43 and 0.76, respectively. The serum ferritin level in non-survivors (n = 14) was significantly higher than in survivors (n = 359, p < 0.001). The AUC value of serum ferritin for predicting mortality was 0.853 (95% CI 0.774-0.933, p < 0.001), showing sensitivity and specificity of 0.933 and 0.739. Serum ferritin and PCT have a robust association with HFRS severity and mortality, which may be promising predictors, and CRP is an effective biomarker to assess bacterial co-infection in HFRS.

Advantages of integrated Chinese and western medicine in prevention and treatment of viral diseases

Many viral diseases are highly contagious, and correlated with poor prognosis and great harm. Chinese medicine(CM) has played an important role in the prevention and treatment of viral diseases, including epidemic encephalitis B, epidemic hemorrhagic fever, viral hepatitis A, SARS, H1 N1 influenza and COVID-19, and performs better in improving symptoms, shorting the course of disease, delaying disease progression, increasing clinical cure rate and reducing mortality compared with symptomatic and supportive treatment alone. We retrospectively analyze the role of CM in the prevention and treatment of viral diseases, thus to provide reference for clinical practice.

Risk assessment of public health emergencies concerned in the mainland of China, January 2022

Objective: To assess the risk of public health emergencies, both the indigenous ones and the imported ones, which might occur in the mainland of China in January 2022.

Long-Term Consequences of Puumala Hantavirus Infection.

Several viral infections are associated with acute and long-term complications. During the past two years, there have been many reports on post-infectious symptoms of the patients suffering from COVID-19 disease. Serious complications occasionally occur during the acute phase of Puumala orthohantavirus caused nephropathia epidemica. Severe long-term consequences are rare. Fatigue for several weeks is quite common. Hormonal insufficiencies should be excluded if the patient does not recover normally.

Triage-HF plus: 12-month study of remote monitoring pathway for triage of heart failure risk initiated during the Covid-19 pandemic

Background: The Covid-19 pandemic necessitated rapid adoption of remote monitoring across cardiovascular patient cohorts. Most patients with cardiac implantable electronic devices (CIEDs) are now able to be remotely monitored using either scheduled, patient- or threshold-triggered transmissions. The validated Triage Heart Failure Risk Score (Triage-HFRS) is a medical algorithm within company-specific CIEDs that can risk-stratify patients as low-, medium- or high-risk of worsening heart failure (WHF) in the next 30 days based on integrated monitoring of physiological parameters. Building on a previous proof-of-concept of the Triage-HF Plus pathway, we integrated remote data with simple 5-question telephone triage within a clinical pathway to identify WHF during the first year of the Covid-19 pandemic. Purpose: Prospective evaluation of clinical remote monitoring pathway integrating Triage-HFRS with protocolised telephone triage (Triage-HF Plus pathway). Methods: Prospective, real-world evaluation of clinical pathway serving a large urban region over a 12-month period, using data from April 2020 to April 2021 (initiated during the first wave of Covid-19 pandemic in the UK). From a population of 435 patients with CIEDs, 87 high Triage-HFRS alerts were received and patients contacted for telephone triage assessment. Screening questions were designed to identify episodes of WHF and non-HF events. Intervention was at discretion of the clinical practitioner and in line with guideline-directed practice. A consecutive sample of 115 medium risk scores received the same triage. Results: Successful contact was made with 72 (82.8%) high-risk patients. Classification for high scoring patients confirmed on triage included isolated heart failure (18.3%), heart failure concurrent to medical problem (5.7%), alternative medical problem (10.3%), and recent hospital admission (8.0%);triage reassured absence of acute cause of high score in 40.2%. The sensitivity and specificity for detection of WHF was 87.9% (0.77-0.99) and 59.4% (0.50-0.69) respectively. Positive and negative predictive values were 40.3% and 94.0%, respectively. Overall accuracy was 66.2%. Conclusions: The Triage-HF Plus pathway served as a useful remote monitoring tool for identifying patients with WHF whose care had been otherwise disrupted by the Covid-19 pandemic, allowing timely intervention and cementing the longer-term role for such models of care delivery. Crucially, in this multimorbid, high-cost population, relevant non-HF issues were also identified. The high negative predictive value further highlights the potential of proactive surveillance over conventional, periodic follow up.