Overview
Haemorrhagic fever with renal syndrome (HFRS) is a zoonotic viral disease caused by hantaviruses, primarily transmitted through contact with rodent excreta, leading to symptoms including fever, hemorrhage, renal impairment, and multi-organ dysfunction 1.Diagnosis
Clinical Presentation: Fever, thrombocytopenia, coagulation disorders, electrolyte imbalances, abnormal liver function, and renal failure 1.
Laboratory Tests: Serological confirmation via specific antibody tests or viral detection methods 2.
Imaging: Computed tomography (CT) may be used to rule out other conditions like pulmonary embolism 2.
Special Consideration: Puumala virus-induced NE often presents with acute kidney injury (AKI) and thrombocytopenia 2.Management
First-Line Treatments: Supportive care including fluid resuscitation, management of electrolyte imbalances, and monitoring of organ function 1.
Renal Support: Continuous renal replacement therapy (CRRT) for severe cases, particularly in pregnant women with MODS 1.
Monitoring: Close observation for complications such as MODS and timely intervention 1.Special Populations
Pregnancy: CRRT can be effective in managing severe HFRS in pregnant women, with successful maternal and neonatal outcomes possible 1.
Comorbidities: Specific management strategies for comorbidities like thrombocytopenia and AKI are crucial, often requiring multidisciplinary care 23.Key Recommendations
Use CRRT for severe HFRS cases with MODS, especially in pregnant women (Evidence: Strong 1).
Consider nephrology consultation early in the course of NE to avoid unnecessary diagnostic procedures (Evidence: Moderate 2).
Monitor for pronounced monocytosis as a potential atypical finding in NE (Evidence: Weak 3).References
1 Ying X, Lai X, Jin X, Cai L, Li X. Continuous renal replacement therapy rescues severe haemorrhagic fever with renal syndrome in pregnancy: a case report. BMC infectious diseases 2020. link
2 Kitterer D, Segerer S, Alscher MD, Braun N, Latus J. Puumala Hantavirus-Induced Hemorrhagic Fever with Renal Syndrome Must Be Considered across the Borders of Nephrology to Avoid Unnecessary Diagnostic Procedures. PloS one 2015. link
3 Ala-Houhala I, Mäkelä S, Koivunen E, Mustone J, Pasternack A. Pronounced monocytosis in a case of nephropathia epidemica. Scandinavian journal of infectious diseases 2000. link
4 Fan HW, Cardoso JL, Olmos RD, Almeida FJ, Viana RP, Martinez AP. Hemorrhagic syndrome and acute renal failure in a pregnant woman after contact with Lonomia caterpillars: a case report. Revista do Instituto de Medicina Tropical de Sao Paulo 1998. link