Hemorrhagic Fever with Renal Syndrome (Hantaviruses)

Abstract

Hantaviruses are enveloped RNA viruses belonging to the genus Hantavirus, family Bunyaviridae. These agents are usual parasites of wild rodents and insectivores. Many species worldwide are infected with these viruses and each Hantavirus type is carried by its own type specific rodent species. Human transmission occurs accidentally by inhalation of aerosolized virus containing particles, contact with urine, feces or secretions of infected rodents. Hantavirus leads to two type of zoonotic infections; Hemorrhagic fever with renal syndrome (HFRS) and Hantavirus pulmonary syndrome (HPS). Ecological and environmental changes, alterations in rodent population size, viral durability in nature, and changes in human life style that augment rodent exposure are the main causes that may affect the incidence of HFRS infection. The hallmarks of HFRS infection are fever, hypotension, hemorrhage and acute renal failure with acute interstitial nephritis. Clinical course of the disease varies between HFRS virus types. PUUV infection that is mostly seen in Europe has the mildest course and up to 90% of the cases are asymptomatic. Serological tests, molecular tests and virologic cell culture are used for HFRS diagnosis. There is no specific antiviral drug, immunotherapy or vaccine approved by Food and Drug Administration (FDA). Although ribavirin seems to decrease mortality in animal models; there are few data in the literature considering the effect of ribavirin on HFRS infections. Control and management of the symptoms with supportive care is the main modality for HFRS treatment. Reduction of the frequency and intensity of rodent exposure is very important for the prevention.

Keywords

• Hantavirus, hemorrhagic fever with renal syndrome, viral hemorrhagic fever, Turkey

Hemorrhagic Fever with Renal Syndrome (Hantaviruses)

Öz

Hantaviruslar Bunyaviridae ailesinin Hantavirus cinsinde yer alan zarflı RNA viruslarıdır. Bu etkenler vahşi kemirgen ve böcekçigillerin bilinen parazitlerindendir. Dünya genelinde birçok tür bu viruslarla enfektedir. Her Hantavirus tipi kendine özgül kemirgen türü ile taşınır. İnsan bulaşı virus içeren aerosolleşmiş partiküllerin inhalasyonu veya enfekte kemirgenin idrar, dışkı veya sekresyonları ile direkt temas sonucu gerçekleşir. Hantaviruslar iki tip zoonotik enfeksiyona neden olur; Hemorajik ateşle seyreden renal sendrom (HFRS) ve Hantavirus pulmoner sendrom (HPS). Ekolojik ve çevresel değişimler, kemirici populasyonundaki değişiklikler, virusun dış ortama dayanıklığı ve kemirici maruziyetini artıran insan yaşam tarzındaki değişimler HFRS insidansını artıran en önemli nedenlerdendir. HFRS enfeksiyonlarının en belirgin özelliği ateş, hipotansiyon, kanama ve akut tübülointerstisiyal nefritle seyreden akut böbrek yetmezliğidir. Hastalığın kliniği HFRS virus tiplerine göre değişir. Avrupada sık görülen PUUV enfeksiyonu en hafif seyirli tiptir ve olguların 90% kadarı asemptomatiktir. HFRS tanısında serolojik testler, moleküler testler ve virolojik hücre kültürü kullanılmaktadır. HFRS için Food and Drug Administration (FDA) tarafından onaylanmış antiviral ilaç, immünolojik tedavi veya aşı yoktur. Ribavirin hayvan modellerinde mortaliteyi azaltıyor gibi görülse de HFRS enfeksiyonlarında deneyim azdır. HFRS tedavisinde destek tedavisi temel yaklaşımdır. Korunmada kemirgenlerle maruziyetin sıklığı ve şiddetini azaltıcı yöntemler çok önemlidir

Anahtar Kelimeler

• Hantavirus, hemorajik ateşle seyreden renal sendrom, viral hemorajik ateş, Türkiye

Kaynakça

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