Hantan virus infections A98.5

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 18.12.2020

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Synonym(s)

Hantan virus infections

History
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Lee and Johnson, 1978

Definition
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Hantavirus infection transmitted by rodents, which can cause highly feverish clinical pictures with a tendency to bleed, renal or pulmonary dysfunction.

Pathogen
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Hanta virus, belonging to the family Bunyaviridae. It comprises the groups:

  • Hantaan group: Hantaan virus, Dobrava-Belgrade virus, Seoul virus.
  • Puumala group: Puumala virus, Sin-Nombre virus, Prospect Hill virus, Black Creek Canal virus.

Occurrence/Epidemiology
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The name Hantaan is derived from a river in Korea where thousands of UN soldiers became infected with Hantavirus (type Hantaan) during the Korean War in the 1950s.

Worldwide spread: mainly in Southeast Asia and Northern Europe, but also in Central Europe regions in Lower Saxony, Hesse, Bavaria and Baden-Württemberg as well as in Austria (parts of Styria).

In Northern and Central Europe: Puumala- (mainly in the South), Hantaan- (mainly in the North and East), Sin-Nombre- and Dobrava-Virus (mainly in the North and East).

In 2002, 0.3 cases/100,000 inhabitants were reported in Germany.

Transmission occurs mainly during certain activities such as working in sheds and summerhouses, attics and warehouses, in buildings with rodent infestation, during gardening and various outdoor recreational activities.

Etiopathogenesis
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  • Transmission of viruses of the Hantaan group: by real mice (fire mouse).
  • Transmission of viruses of the Puumala group: by voles (bank vole).
  • Rodents excrete viruses in urine, faeces and saliva to the environment. Transmission is possible through direct contact (rare), oral ingestion and inhalation of infectious material, rarely through bite wounds or human-to-human transmission.

Endothelial cell damage by the virus as well as by immunological host reactions. Vascular dysfunction with intravascular coagulation and coagulation disorders leads to haemorrhages and organ failure. Nephropathy is caused by hemorrhagic interstitial nephritis involving glomeruli and tubules.

Manifestation
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The seasonal maximum of the diseases is between May and August. Working men are mainly affected.

Clinical features
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  • Nephropathia epidemica:
    • Occurring mainly in Central Europe, caused by viruses of the Puumala virus group.
    • Incubation period: 5-35 (-60) days.
    • Asymptomatic and oligosymptomatic courses are possible.
    • Only in 5-10% development of clinical symptoms such as fever, lumbalgia, abdominal pain and headache, proteinuria and/or haematuria, restriction of renal function, oliguria up to acute renal failure (tubular necrosis).
  • Hemorrhagic fever with renal symptoms:
    • Occurring predominantly in East Asia (China, Korea) or in Southeast Asia (Thailand), caused by Hantaan virus group. The serotype Dobrava can cause haemorrhagic fever.
    • Fever, dizziness, headache and backache (toxic phase lasting 4-7 days), leukocytosis and thrombocytopenia, petechiae on trunk and soft palate, capillary leakage syndrome with hypotension. Renal phase with oliguria, polyuria, hypertension (with possible cerebrovascular complications), mucosal bleeding and pulmonary edema.
  • Hantavirus Pulmonary Syndrome (also Hantavirus Adult Respiratory Distress Syndrome):
    • Most severe form of hantavirus pulmonary disease. Isolated cases and outbreaks have so far been described exclusively in America. Caused by viruses of the Puumala virus group. The Puumala virus, which is widespread in Central Europe, can cause pulmonary dysfunction and lung disease (milder courses).
    • Incubation period: 3 days to 6 weeks.
    • Interstitial pneumonia with pulmonary oedema and respiratory insufficiency.

Laboratory
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  • Serum antibodies (IFT, ELISA) (strong cross reactivity between the individual serogroups is possible)
  • Detection of viral antigens (indirect immunofluorescence)
  • RT-PCR
  • Virus cultivation (no longer in use).

Differential diagnosis
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  • Haemorrhagic fever of other genesis
  • Leptospirosis
  • Rickettsialpox

Therapy
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Bed rest, symptomatic therapy (including dialysis), in trial with ribavirin,

Progression/forecast
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  • Nephropathia epidemica:
    • lethality below 0.2%.
    • Healing mostly without residual damage.
  • Haemorrhagic fever:
    • Reconvalescence over months, which goes into complete healing, but permanent damage is possible.
    • Letality rate of 10%.
    • Lifelong serotype-specific immunity.
  • Hantavirus Pulmonary Syndrome: lethality of up to 50%.

Prophylaxis
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Exposure prophylaxis and pest control.

Note(s)
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Remember! Detection of hantaviruses in connection with an acute disease is subject to notification by the head of the laboratory according to §7 IFSG.

Outgoing links (1)

Petechiae;

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 18.12.2020