National Consultation Laboratory for Hantavirus infections, Institute of Medical Virology, Helmut Ruska Building, Charité Universitätsmedizin Berlin and Department of Virology at Labor Berlin-Charité Vivantes GmbH, Berlin, Germany.
Dtsch Arztebl Int. 2013 Jul;110(27-28):461-7. doi: 10.3238/arztebl.2013.0461. Epub 2013 Jul 8.
Hantavirus disease is a zoonosis of increasing clinical importance. A new incidence peak was reached in Germany in 2012, with more than 2800 reported cases. These viruses are transmitted from small mammals to human beings. The disease begins with high fever and non-pathognomonic manifestations that can end in shock and organ failure.
This article is based on a selective literature search, on the authors' experiences at the National Referral Laboratory for Hantavirus Infections (Nationales Konsiliarlaboratorium für Hantaviren), and on published recommendations from Germany and abroad.
Two hantavirus species cause clinically relevant infections in Germany. Puumala virus, which is transmitted by bank voles, causes large outbreaks of disease every 2 to 3 years in the southwestern and western regions of Germany and in the Bavarian Forest. Dobrava-Belgrad virus, transmitted by striped field mice, causes infections in the north and east of the country. Serological tests are available for primary and confirmatory diagnosis; moreover, viral nucleic acids can be amplified in the early phase of illness and compared with the viral nucleic acids from the reservoir hosts of the corresponding type of infection. Infections with American types of hantavirus have ca. 35% case fatality, and hantaviruses from southeastern Europe and Asia are also highly pathogenic; in contrast, the febrile illnesses caused by hantaviruses in Germany are usually relatively mild.
When persons living in high-risk areas present with fever of unknown origin or with renal dysfunction of unknown origin, physicians should consider the possibility of a hantavirus infection and should initiate the appropriate diagnostic evaluation.
汉坦病毒病是一种临床重要性日益增加的动物源性传染病。2012 年德国达到新的发病高峰，报告病例超过 2800 例。这些病毒从小型哺乳动物传播给人类。疾病开始表现为高热和非特征性症状，最终可导致休克和器官衰竭。
本文基于选择性文献检索、作者在国家汉坦病毒感染咨询实验室（Nationales Konsiliarlaboratorium für Hantaviren）的经验以及德国和国际上发表的建议。
在德国，有两种汉坦病毒可引起有临床意义的感染。由鼩鼱传播的普马拉病毒每隔 2-3 年在德国西南部和西部以及巴伐利亚森林地区引起大型疾病暴发；由黄胸鼠传播的多布拉伐-贝尔格莱德病毒在德国北部和东部引起感染。有用于初步和确认诊断的血清学检测；此外，在疾病早期可以扩增病毒核酸，并与相应感染类型的宿主病毒核酸进行比较。感染美国型汉坦病毒的病死率约为 35%，来自东南欧和亚洲的汉坦病毒也具有高致病性；相比之下，德国汉坦病毒引起的发热性疾病通常相对较轻。
当居住在高风险地区的人出现不明原因发热或不明原因肾功能障碍时，医生应考虑汉坦病毒感染的可能性，并应开始进行适当的诊断评估。
