Christova I, Pishmisheva M, Trifonova I, Vatev N, Stoycheva M, Tiholova M, Igova D, Baev M, Karagyaurova R, Prokopova U
National Center of Infectious and Parasitic Diseases, Blvd. Yanko Sakazov 26, 1504, Sofia, Bulgaria.
Department of Infectious Diseases, Regional Hospital Pazardzhik, Pazardzhik, Bulgaria.
Wien Klin Wochenschr. 2017 Aug;129(15-16):572-578. doi: 10.1007/s00508-017-1174-2. Epub 2017 Feb 22.
Hantaviruses cause two distinct human diseases: hemorrhagic fever with renal syndrome (HFRS) in Asia and Europe and hantavirus pulmonary syndrome (HPS) in America. In Europe, mainly Puumala, Dobrava and Seoul viruses cause HFRS. A total of 23 cases of HFRS were detected in Bulgaria over a 2‑year period 2013-2014. The aim of the study was to present epidemiology, clinical manifestations and laboratory findings of these patients.
Patients with HFRS were diagnosed using PCR, ELISA and immunoblotting tests.
Dobrava-Belgrade virus (DOBV) was revealed as etiological agent in 16 (69.6%) patients and Puumala virus (PUUV) in 7 (30.4%) patients. All 23 patients were men aged 22-66 years of which 6 (26.1%) patients originated from regions in northern and western Bulgaria previously thought to be non-endemic. Patients with HFRS, despite the infecting hantavirus, manifested acute renal failure, asthenia and less pronounced hemorrhagic syndrome. Patients with DOBV infection were much more likely to present with arthromyalgia, severe headache, severe to moderately severe asthenoadynamia, abdominal pain, vomiting, hypotension, nervous system disorders as well as kidney enlargement, leucopenia and higher levels of blood creatinine, requiring hemodialysis procedures more often and for a longer period of time than patients with PUUV infection.
The present report describes for the first time comparative analysis of epidemiological features, clinical manifestations and laboratory findings of DOBV and PUUV infections in Bulgaria.
汉坦病毒可引发两种不同的人类疾病：在亚洲和欧洲为肾综合征出血热（HFRS），在美国为汉坦病毒肺综合征（HPS）。在欧洲，主要是普马拉病毒、多布拉伐病毒和汉城病毒导致HFRS。2013年至2014年的两年间，保加利亚共检测出23例HFRS病例。本研究的目的是介绍这些患者的流行病学、临床表现和实验室检查结果。
采用聚合酶链反应（PCR）、酶联免疫吸附测定（ELISA）和免疫印迹试验诊断HFRS患者。
16例（69.6%）患者的病原体为多布拉伐-贝尔格莱德病毒（DOBV），7例（30.4%）患者的病原体为普马拉病毒（PUUV）。所有23例患者均为男性，年龄在22至66岁之间，其中6例（26.1%）患者来自保加利亚北部和西部以前被认为是非流行区的地区。HFRS患者尽管感染了汉坦病毒，但均表现为急性肾衰竭、乏力，出血综合征较轻。与感染PUUV的患者相比，感染DOBV的患者更易出现关节痛、严重头痛、重度至中度重度乏力、腹痛、呕吐、低血压、神经系统紊乱以及肾脏肿大、白细胞减少和血肌酐水平升高，更常需要进行血液透析，且透析时间更长。
本报告首次描述了保加利亚DOBV和PUUV感染的流行病学特征、临床表现和实验室检查结果的对比分析。
