1/34. Enhancing laboratory detection of disease. Part 3: Detecting a hantavirus disease event: a case study. A purposive syndromic classification diagnostic system, with known means to ends, has been developed that extracts bits of structural information from endogenous laboratory data. An edifice of structural information for organization, regulation, and decision-making was built for determining future pathophysiological events by asking the fewest questions to define the next event uniquely. The structural information is based on laboratory ordering patterns of physicians for patient populations they serve. Patient history and a physical examination may be included as hardware and software evolves for linking more aspects of the medical record. ( info) |
2/34. Acute Sin Nombre hantavirus infection without pulmonary syndrome, united states. hantavirus pulmonary syndrome (HPS) occurs in most infections with sin nombre virus and other North American hantaviruses. We report five cases of acute hantavirus infection that did not fit the HPS case definition. The patients had characteristic prodromal symptoms without severe pulmonary involvement. These cases suggest that surveillance for HPS may need to be expanded. ( info) |
3/34. Acute infection with Sin Nombre hantavirus without pulmonary edema. Acute infection with sin nombre virus has been associated with development of hantavirus cardiopulmonary syndrome (HCPS), a severe cardiopulmonary illness with respiratory failure and shock. We present two cases of Sin Nombre hantavirus infections that did not lead to marked pulmonary complications in two otherwise healthy young adults from utah and california. sin nombre virus causes a wider spectrum of disease severity than has been previously reported. ( info) |
4/34. Chronic renal failure after puumala virus infection. Chronic renal failure has never been described after Puumala hantavirus infection, which usually causes acute renal failure with spontaneous full recovery. We report a 15-year-old boy who presented with Puumala hantavirus infection and initial severe acute renal failure. His renal function gradually improved, but more than 2 years after the acute episode it was still moderately impaired, with a creatinine clearance of about 60 ml/min per 1.73 m(2) ( info) |
5/34. Pronounced monocytosis in a case of nephropathia epidemica. Nephropathia epidemica is a mild form of haemorrhagic fever with renal syndrome. thrombocytopenia is common and characteristic. We report here a case of a young man with nephropathia epidemica and marked transient monocytosis. ( info) |
| The first two recognized cases of rapidly fatal hantavirus pulmonary syndrome in pennsylvania occurred within an 8-month period in 1997. Illness in the two patients was confirmed by immunohistochemical techniques on autopsy material. reverse transcription-polymerase chain reaction analysis of tissue from one patient and environmentally associated peromyscus leucopus (white-footed mouse) identified the Monongahela virus variant. physicians should be vigilant for such Monongahela virus-associated cases in the eastern united states and canada, particularly in the appalachian region. ( info) |
| In 1993 sin nombre virus was recognized as the cause of hantavirus pulmonary syndrome (HPS) and the deer mouse (peromyscus maniculatus) was identified as the reservoir host. Surveillance by the Centers for disease Control and Prevention and state health departments includes investigation to determine the likely site(s) and activities that led to infection, an environmental assessment of the home and workplace, and possibly rodent trappings at these sites. As of December 31, 1998, there were 200 confirmed cases from 30 states (43% case-fatality ratio). The national HPS case registry was examined to determine the incubation period of HPS. review of 11 case-patients with well-defined and isolated exposure to rodents suggests that the incubation period of HPS is 9 to 33 days, with a median of 14-17 days. Case investigations allow a better understanding of the incubation time of HPS and may define high-risk behaviors that can be targeted for intervention. ( info) |
| There is increasing evidence that Dobrava (DOBV) but not Hantaan (HTNV) hantavirus is a hemorrhagic fever with renal syndrome (HFRS) causing agent in Central europe. However, only single clinical cases of HFRS due to acute DOBV infection have been described so far. We report on three male patients from a non-endemic hantavirus focus in Northern germany who suffered from mild to moderate HFRS strongly resembling nephropathia epidemica. serotyping by detection of hantavirus species-specific neutralizing antibodies revealed acute infections by the HTNV-related hantavirus DOBV in all three cases. Since DOBV infections in the Balkans frequently present as severe HFRS, our cases suggest that Central-European DOBV infections have a different, less severe clinical outcome. These differences in DOBV virulence towards humans might be due to the existence of different genetic lineages of DOBV. ( info) |
9/34. Acute disseminated encephalomyelitis following nephropathia epidemica. Acute disseminated encephalomyelitis (ADEM) is an acute monophasic inflammatory and demyelinating disease of the central nervous system (CNS) occurring days to weeks after a virus infection or vaccination. Nephropathia epidemica (NE) is a haemorrhagic fever with renal syndrome caused by puumala virus, with endemic regions in europe, especially scandinavia and Western russia. We describe a case of severe nephropathia epidemica requiring dialysis, followed by severe CNS symptoms caused by ADEM. To our best knowledge this is the first case in the literature in which NE caused ADEM. ( info) |
10/34. Tula virus infection associated with fever and exanthema after a wild rodent bite. Reported here is the first case of human acute infection with Tula virus, which occurred in a 12-year-old boy in switzerland. This hantavirus had been considered apathogenic to humans, and in switzerland only TULV-genome sequences have been demonstrated in wild rodents to date. In this case, paronychia, fever and exanthema occurred after the patient was bitten by a wild rodent, indicating an unusual route of hantavirus transmission. Thus, Tula virus infection should be taken into account in patients with appropriate clinical symptoms and contact with rodents. ( info) |