Mosshammer D, Reichert E, Reichert W
Lehrbereich Allgemeinmedizin, Universitätsklinikum Tübingen.
Dtsch Med Wochenschr. 2010 Dec;135(50):2518-22. doi: 10.1055/s-0030-1269421. Epub 2010 Dec 7.
A 42-year-old man without pre-existing health problems presented to his family practitioner in Baden-Württemberg with fever (up to 39˚ C for two days), headache, abdominal pain, back pain and aching limbs. Ten days before, he had done heavy gardening work. He felt diffuse pain on abdominal palpation. The physical examination of the skin, lymph nodes, the heart, the lungs and the oral mucosa was unremarkable.
Erythrocytes, leukocytes and sporadic bacteria were found in the urine. Urine test strip analysis gave a threefold positive result for protein. The blood test revealed in an elevated C-reactive protein, leukocytosis, elevated creatinine and thrombocytopenia. Enlarged kidneys and an enlarged spleen were found on ultra sound examination. IgG and IgM tested for Hantavirus infection were detected by IFA (Immunofluorescence antibody assay) and by ELISA (enzyme-linked immunosorbent assay).
The blood tests had returned to normal by 15 days after onset of the fever which had persisted for 7 days. Oliguria and/or anuria did not occur. After three weeks of illness, the blood pressure was found to be at hypertensive levels and the patient was treated with antihypertensive drugs.
A history of gardening work (exposure to rodents) and nonspecific symptoms (like headache and fever), in combination with elevated serum creatinine and thrombocytopenia, should raise the suspicion of nephropathia epidemica (hemorrhagic fever with renal syndrome) caused by hantavirus infection. As sequelae of hantavirus infection may persist, patients should subsequently be followed for clinical and laboratory evidence of renal disease. Hospitalization is not generally warranted.
一名42岁既往无健康问题的男子前往巴登-符腾堡州的家庭医生处就诊，伴有发热（两天内体温高达39˚C）、头痛、腹痛、背痛及四肢酸痛。十天前，他从事了繁重的园艺工作。腹部触诊时有弥漫性疼痛。皮肤、淋巴结、心脏、肺部及口腔黏膜的体格检查未见异常。
尿液中发现红细胞、白细胞及散在细菌。尿试纸分析显示蛋白呈三倍阳性。血液检查显示C反应蛋白升高、白细胞增多、肌酐升高及血小板减少。超声检查发现肾脏及脾脏肿大。通过免疫荧光抗体测定法（IFA）和酶联免疫吸附测定法（ELISA）检测到针对汉坦病毒感染的IgG和IgM。
发热持续7天后，发病15天时血液检查结果恢复正常。未出现少尿和/或无尿。患病三周后，发现血压处于高血压水平，患者接受了降压药物治疗。
有园艺工作史（接触啮齿动物）及非特异性症状（如头痛和发热），同时伴有血清肌酐升高和血小板减少，应怀疑由汉坦病毒感染引起的流行性肾病（肾综合征出血热）。由于汉坦病毒感染的后遗症可能持续存在，随后应对患者进行随访，以获取肾脏疾病的临床及实验室证据。一般无需住院治疗。
