Renal sendrom ile seyreden kanamalı ateş: İki olgu sunumu

Öz

Hantavirüsler Bunyaviridae ailesine ait olup insanlarda iki tip enfeksiyona neden olmaktadır: Renal sendrom ile seyreden kanamalı ateş RSKA ve hantavirüs kardiyopulmoner sendrom HKPS . Ülkemizde ilk kez 2009 yılında görülen RSKA; akut başlangıçlı renal yetmezlik, hipotansiyon, kanama ve damar geçirgenliğindeki artma ile seyreden bir hastalıktır. Kliniğimize Kastamonu’nun kırsalından ateş, baş ve göz ağrısı, karın ağrısı, halsizlik ve iştahsızlık şikayeti ile başvuran iki hastada ateş, trombositopeni, yüksekliği saptanmıştır. Hastaların ayırıcı tanısında geldikleri bölge nedeni ile Kırım-Kongo kanamalı ateşi, leptospirozis ve RSKA düşünülmüştür. Hastalarda serum anti-hantavirüs IgM indirekt immünfloresan testi IFA ve hantavirüs immunblot testi pozitif saptanmıştır. Takiplerinde genel durumları düzelen hastalar şifa ile taburcu edilmiştir.RSKA ülkemizde sıklıkla Karadeniz Bölgesinde görülmesine rağmen daha önce Kastamonu’dan bildirilen olgu mevcut değildir. Kırsal alandan gelen hastalarda ani gelişen ateş, trombositopeni ve akut böbrek yetmezliği durumlarında RSKA ayırıcı tanılar arasında yer almalıdır

Anahtar Kelimeler

• Hantavirus, Bunyaviridae enfeksiyonları, renal sendrom

Hemorrhagic fever with renal syndrome: Two case reports

Abstract

Hantavirus, a member of the family Bunyaviridae, causes two types of infection in humans: hemorrhagic fever with renal syndrome HFRS and Hantavirus cardiopulmonary syndrome HCPS . HFRS, first reported in Turkey in 2009, is related with renal insufficiency, hypotension, bleeding and increase in vascular permeability. Two patients were admitted from Kastamonu with fever, abdominal pain, headache, eye pain, weakness and decrease in appetite. Fever, thrombocytopenia, elevated creatinine and CRP were detected. Crimean-Congo hemorrhagic fever, leptospirosis and HFRS were considered in the differential diagnosis. In the sera of patients, anti-hantavirus IgM detected with indirect immunofluorescent antibody IFA test and hantavirus immunoblotting assay were positive. In their follow-up, patients recovered from their illness and were discharged. In Turkey, although cases of HFRS were usually reported in the Black Sea region, there was not any case reported from Kastamonu province. HFRS should be considered in the differential diagnosis of cases referred from rural parts of our country with presentation of rapid onset fever, thrombocytopenia and acute renal insufficiency

Keywords

• Hantavirus, Bunyaviridae infections, renal syndrom

References

1. Köksal F. Hantavirüsler. Klinik Mikrobiyoloji (9. Baskı), Ankara: Atlas Kitabevi, 2008; 1501–09.
2. Muranyi W, Bahr U, Zeier M, van der Woude FJ. Hantavirus infection. J Am Soc Nephrol, 2005;16(12): 3669–79.
3. Vapalahti O, Mustonen J, Lundkvist A, Henttonen H, Plyusnin A, Vaheri A. Hantavirus infections in Europe. Lancet Infect Dis, 2003; 3(10): 653–61.
4. Klempa B, Tkachenko EA, Dzagurova TK, Yunicheva YV, Morozov VG, Okulova NM, et al. Hemorrhagic fever with renal syndrome caused by 2 lineages of Dobrava hantavirus, Russia. Emerg Infect Dis, 2008; 14(4): 617–25.
5. Çelebi G, Sözen M. Türkiye’de Hantavirüs enfeksiyonları. Flora, 2009; 14: 145–52.
6. Kaya S, Yılmaz G, Erensoy S, Yağçı Çağlayık D, Uyar Y, Köksal I. Hantavirus infection: two case reports from a province in the Eastern Blacksea Region, Turkey, Mikrobiyol Bul, 2010; 44(3): 479–87.
7. Oncul O, Atalay Y, Onem Y, Turhan V, Acar A, Uyar Y, et al. Hantavirus infection in İstanbul, Turkey, Emerg Infect Dis, 2011; 17(2): 303–04.
8. Kavukçu S, Türkmen M, Salman Ş, Soylu A, Çamsan T. Ege bölgesinde Hantavirüs ile ilişkili nefropati riski nedir? Türk Nefrol Diyal Transplant Derg, 1997; 3–4: 131–35.

9. Ertek M, Buzgan T. Refik Saydam National Public Health Agency; Ministry of Health, Ankara, Turkey. An outbreak caused by hantavirüs in the Black Sea region of Turkey, January-May 2009, Euro Surveill, 2009; 14(20): 1–2.
10. Ferluga D, Vizjak A. Hantavirus nephropathy. J Am Soc Nephrol, 2008; 19(9): 1653–58.
11. Colson P, Damoiseaux P, Brisbois J, Duvivier E, Levecque P, Roger JM, et al. Epidemic of hantavirüs disease in Entre-Sambre-et-Meuse: year 1992–1993. Clinical and biological aspects. Acta Clin Belg, 1995; 50(4): 197–06.
12. Strady C, Jaussaud R, Remy G, Penalba C. Hantavirüs infections, Presse Med, 2005; 34(5): 391–99.
13. Rasche FM, Uhel B, Krüger DH, Karges W, Czock D, Hampl W, et al. Thrombocytopenia and acute renal failure in Puumala hantavirüs infections. Emerg Infect Dis, 2004;10(8): 1420–25.
14. Mäkelä S, Ala-Houhala I, Mustonen J, Koivisto AM, Kouri T, Turjanmaa V, et al. Renal function and blood pressure five years after puumala virüs-induced nephropathy. Kidney Int, 2000; 58(4):1711–18.
15. Laakkonen J, Kallio-Kokko H, Öktem MA, Blasdell K, Plyusnina A, Niemimaa J, et al: Serological survey for viral pathogens in Turkish rodents, J Wild Dis, 2006; 42(3): 672–76.