Full length articleHemorrhagic fever with renal syndrome in Albania. Focus on predictors of acute kidney injury in HFRS
Section snippets
Background
HFRS is a rodent borne zoonosis caused by the members of the virus family Bunyaviridae, genus Hantavirus. Infection with Hantavirus may lead to life threatening renal disease. The members of the Hantavirus genus i.e Hantaan, Puumala, Seoul, Dobrava cause different forms of clinical disease [1], [2].
Disease spread and distribution depends on chronic infection of vertebrates or recirculation of the viruses in nature via arthropodes to vertebrates, which in turn are influenced by ecological and
Objectives
To identify, for the first time, characteristic features of HFRS in the Albanian population.
Study design
This is a prospective study. 33 consecutive patients were enrolled in the cohort from April 2011 to April 2016 at Infectious disease Clinic, University Center “Mother Teresa” Tirana, Albania. All patients had laboratory and clinical evidence highly suggestive of viral infection responsible for HFRS. Serology identification was performed by indirect-ELISA using Hantavirus IgG and IgM Dx select ™, catalogue number EL 1600M and EL 1600G. The results were confirmed using real time PCR using ABI
Results
A total of 33 patients were enrolled during a five year time frame from April 2011 to April 2016. Map shows (Fig. 1) annual incidence per 100,000 of Hemorrhagic fever with renal syndrome (HFRS).
The mean (SD) age was 39.7 ± 14.1, ranging from 15 to 59 years. The number of cases peaked from July to August during the whole time span of the study, which corresponds with the usual disease outbreaks of the specific viral strains (Table 1).
Patient distribution (Fig. 2) according to RIFLE classification
Discussion
HFRS is a severe clinical syndrome that requires highly specialized supportive care. The majority of cases were concentrated in the North-East region of the country, typical for the disease distribution. Interestingly, there were few cases, first-time diagnosed from other areas of the country, which may suggest virus habitat changes that should alert the physicians to consider HFRS in the differential diagnoses of patients from non-typical areas with specific symptoms of this condition. Most of
Conclusion
HFRS is a severe viral disease in Albania, associated with high mortality, 9% in our cohort. Early diagnosis is paramount to treatment of HFRS.
In our study, thrombocytopenia, urinary volume, hyponatremia were indicators of more severe disease. Nadir platelet count was an independent predictor for development of AKI.
Interestingly, the two cases of pregnant patients resulted in fetal loss. Further studies are needed in order to elucidate the injury mechanism of the virus to the fetus.
Funding
None
Competing interests
None
Ethical approval
Not required
Acknowledgements
The authors are grateful to the physician and nurses of Infectious Disease Clinic, Hemodialysis Clinic, University Center “Mother Teresa” Tirana, physician of the Institute of Public Health in Albania.
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