ESPN 50th Annual Meeting

ESPN 2017


 
EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS OF PATIENTS WITH HEMORRHAGIC FEVER WITH RENAL SYNDROME
NATASA STAJIC 1 JOVANA PUTNIK 1 ALEKSANDRA PARIPOVIC 1 RADOVAN BOGDANOVIC 1

1- Institute of Mother and Child Health Care of Serbia "Dr Vukan Cupic", Belgrade
 
Introduction:

hemorrhagic fever with renal syndrome (HFRS) is a rare viral disease caused by Hanta viruses. It occurs sporadically in Europe. Pathogenic mechanism is based on the increased permeability of the endothelial cells and results in hemorrhagic diathesis. Acute kidney injury is the main clinical manifestation. The aim of our study was to analyze clinical features of HFRS in patients treated in tertiary care center, between 1990 and 2016 year.

Material and methods:

we retrieved data of patients diagnosed with HFRS and analyzed their epidemiological characteristics (place of origin, sex, age, serotype of the virus), clinical course of the disease (presentation, duration of symptoms, laboratory findings, stage of acute kidney injury, necessity of dialysis) and the outcome.

Results:

12 patients, 7 from northern Montenegro and eastern Bosnia and Herzegovina and 5 from western Serbia, 8 males and 4 females, at the age 8 to 15 (12,6±2,1) years. Indirect immunofluorescence for Hantaviruses was positive for serotypes Hantaan, Puumala, Seoul and Dobrava/Belgrade in 7 patients and for Hantaan, Seoul and Dobrava/Belgrade in 5 patients. Initial symptoms were fever and abdominal pain in 100%, lumbar pain and myalgia in 91%, vomiting in 73% and headache in 64%. External symptoms of hemorrhagic diathesis were rare (petechia 24%, subconjunctival suffusions 14% and epistaxis in 9%). Arterial hypertension and oliguria was found in 55%, bradycardia not related to hypervolemia 45%, anuria 25%, macroscopic hematuria in 16% of patients. Thrombocytopenia and proteinuria were in 90%, microscopic hematuria in 55%, low C3 in 36%. Serum creatinine level was from 186 to 839 (486±204) μmoll/l. Continuous renal replacement therapy was performed in 3 patients. Time for the normalization of renal function was 6 to 21 (mean 11,7±4,4) days. Complete restoration of renal function was verified in 86%. All patients survived (100%).

Conclusions:

Hemorrhagic fever with renal syndrome in our region had sporadic nature with endemic characteristics. All patients had fever and abdominal pain, half of them arterial hypertension, bradycardia, and oliguria. Dialysis was necessary in one fourth of the patients. Survival was absolute