Strady C, Jaussaud R, Remy G, Penalba C
Service de médecine interne et des maladies infectieuses, CHU Reims.
Presse Med. 2005 Mar 12;34(5):391-9.
Hantaviruses are cosmopolite anthropozoonosis considered as an emerging disease. Four pathogenic types for humans and part of the Bunyaviridae species are hosted by rodents and have been isolated: the Sin nombre virus responsible for the severe American respiratory form; the Hantaan and Seoul viruses responsible for hemorrhagic fevers with renal syndrome (HFRS) of severe to moderate expression in Asia and also in the Balkans; the Puumala virus responsible for HFRS of moderate expression or the socalled nephropathia epidemica in Europe. The Puumala virus is responsible for a minor form of the disease that is observed in areas of the Occidental sector of the ex-URSS, in Scandinavia and in the rest of Europe, notably in the North-East of France. The epidemic episodes occur every three years. They follow the proliferation of rodents, notably russet voles, the reservoir hosts, and their degree of infection. The concept of an occupation at risk in 20 to 49 year-old men (working in forests, agriculture, living near a forest, contact with wood) in an endemic area has not always been found. Its clinical form can vary greatly in its presentation. Basically it is a severe algic influenza syndrome accompanied by acute myopia in 38% of cases, but is nearly pathognomonic in the context. Respiratory involvement is frequent but benign. The initial syndrome can suggest an abdominal or urological surgical emergency, which is source of diagnostic and therapeutic errors. Early biological examination reveals thrombopenia and proteinuria. Then more or less severe acute kidney failure appears in slightly more than 50% of cases. Although it usually regresses with symptomatic treatment, after effects remain in some patients. The environmental changes, the geographical distribution depending on the biotope, the dynamics and behaviour of rodents and the viral circulation between them and its transmission to human beings and its risk factors must continue to be studied in order to gain further knowledge on the epidemiology of this anthropozoonosis.
汉坦病毒是一种被视为新兴疾病的世界性人畜共患病。啮齿动物携带并已分离出四种对人类致病的类型，属于布尼亚病毒科的一部分：导致严重的美国呼吸型疾病的辛诺柏病毒；导致亚洲以及巴尔干地区严重至中度出血热伴肾综合征（HFRS）的汉滩病毒和汉城病毒；导致欧洲中度出血热伴肾综合征或所谓流行性肾病的普马拉病毒。普马拉病毒导致该病的一种较轻形式，在前苏联西部地区、斯堪的纳维亚半岛以及欧洲其他地区，特别是法国东北部有发现。疫情每三年爆发一次。疫情的发生与啮齿动物，尤其是作为储存宿主的赤褐姬鼠的繁殖及其感染程度有关。在流行地区，20至49岁男性（从事林业、农业、居住在森林附近、接触木材）存在职业风险的观念并非总是成立。其临床表现形式差异很大。基本上它是一种严重的疼痛性流感综合征，38%的病例伴有急性近视，但在这种情况下几乎具有特征性。肺部受累很常见但症状较轻。初始症状可能提示腹部或泌尿外科手术急症，这是诊断和治疗错误的根源。早期生物学检查显示血小板减少和蛋白尿。然后，略多于50%的病例会出现程度不同的严重急性肾衰竭。尽管通常通过对症治疗可恢复，但仍有一些患者会留下后遗症。为了进一步了解这种人畜共患病的流行病学，必须继续研究环境变化、取决于生物群落的地理分布、啮齿动物的动态和行为、它们之间的病毒传播以及病毒向人类的传播及其风险因素。
