Clinical course of hantavirus-induced nephropathia epidemica in children compared to adults in Germany-analysis of 317 patients.
Abdominal Pain
/ virology
Acute Kidney Injury
/ virology
Adolescent
Adult
Aged
Aged, 80 and over
Arthralgia
/ virology
Back Pain
/ virology
Child
Female
Fever
/ virology
Hemorrhagic Fever with Renal Syndrome
/ complications
Humans
Male
Middle Aged
Nausea
/ virology
Puumala virus
Retrospective Studies
Thrombocytopenia
/ virology
Vision Disorders
/ virology
Vomiting
/ virology
Young Adult
Acute kidney injury
Children
Haemodialysis
Hantavirus
Nephropathia epidemica
Journal
Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
received:
13
12
2018
accepted:
11
02
2019
revised:
13
01
2019
pubmed:
16
3
2019
medline:
3
6
2020
entrez:
16
3
2019
Statut:
ppublish
Résumé
Hantavirus infections are endemic worldwide, and its incidence in Europe has been steadily increasing. In Western Europe, hantavirus infections are typically caused by Puumala hantavirus and cause nephropathia epidemica (NE), a mild form of haemorrhagic fever with renal syndrome. Up to now, there is only little data about the course of acute NE in children, but it has been suggested that hantavirus infections take a lighter course in children when compared to adults. We performed a retrospective analysis of adults and children diagnosed with acute NE in two counties in South-Western Germany to investigate if there are differences in the course of the disease. We reviewed the medical records of 295 adults and 22 children with acute NE regarding clinical presentation, laboratory findings, complications and outcome. Acute kidney injury (AKI) and thrombocytopenia occurred at similar frequencies and severity in both groups. Sudden onset of fever and back/loin pain were two of the three most common symptoms in both adults and children. However, adults presented more frequently with arthralgia and visual disturbances, whereas abdominal pain and nausea/vomiting could be detected more often in children. No significant differences were found in the incidence of complications (haemodialysis, long-term outcome of kidney function, length of hospital stay). The clinical course of acute NE was similar in adults and children with high frequency of AKI as well as thrombocytopenia, but with full recovery of all patients.
Sections du résumé
BACKGROUND
Hantavirus infections are endemic worldwide, and its incidence in Europe has been steadily increasing. In Western Europe, hantavirus infections are typically caused by Puumala hantavirus and cause nephropathia epidemica (NE), a mild form of haemorrhagic fever with renal syndrome. Up to now, there is only little data about the course of acute NE in children, but it has been suggested that hantavirus infections take a lighter course in children when compared to adults. We performed a retrospective analysis of adults and children diagnosed with acute NE in two counties in South-Western Germany to investigate if there are differences in the course of the disease.
METHODS
We reviewed the medical records of 295 adults and 22 children with acute NE regarding clinical presentation, laboratory findings, complications and outcome.
RESULTS
Acute kidney injury (AKI) and thrombocytopenia occurred at similar frequencies and severity in both groups. Sudden onset of fever and back/loin pain were two of the three most common symptoms in both adults and children. However, adults presented more frequently with arthralgia and visual disturbances, whereas abdominal pain and nausea/vomiting could be detected more often in children. No significant differences were found in the incidence of complications (haemodialysis, long-term outcome of kidney function, length of hospital stay).
CONCLUSIONS
The clinical course of acute NE was similar in adults and children with high frequency of AKI as well as thrombocytopenia, but with full recovery of all patients.
Identifiants
pubmed: 30874941
doi: 10.1007/s00467-019-04215-9
pii: 10.1007/s00467-019-04215-9
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1247-1252Références
Watson DC, Sargianou M, Papa A, Chra P, Starakis I, Panos G (2014) Epidemiology of hantavirus infections in humans: a comprehensive, global overview. Crit Rev Microbiol 40:261–272. https://doi.org/10.3109/1040841X.2013.783555
doi: 10.3109/1040841X.2013.783555
pubmed: 23607444
Peters CJ, Simpson GL, Levy H (1999) Spectrum of hantavirus infection: hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome. Annu Rev Med 50:531–545. https://doi.org/10.1146/annurev.med.50.1.531
doi: 10.1146/annurev.med.50.1.531
pubmed: 10073292
Vapalahti O, Mustonen J, Lundkvist A, Henttonen H, Plyusnin A, Vaheri A (2003) Hantavirus infections in Europe. Lancet Infect Dis 3:653–661
doi: 10.1016/S1473-3099(03)00774-6
pubmed: 14522264
Vaheri A, Henttonen H, Voutilainen L, Mustonen J, Sironen T, Vapalahti O (2013) Hantavirus infections in Europe and their impact on public health. Rev Med Virol 23:35–49. https://doi.org/10.1002/rmv.1722
doi: 10.1002/rmv.1722
pubmed: 22761056
Ettinger J, Hofmann J, Enders M, Tewald F, Oehme RM, Rosenfeld UM, Ali HS, Schlegel M, Essbauer S, Osterberg A, Jacob J, Reil D, Klempa B, Ulrich RG, Kruger DH (2012) Multiple synchronous outbreaks of Puumala virus, Germany, 2010. Emerg Infect Dis 18:1461–1464. https://doi.org/10.3201/eid1809.111447
doi: 10.3201/eid1809.111447
pubmed: 22932394
pmcid: 3437711
Kruger DH, Ulrich RG, Hofmann J (2013) Hantaviruses as zoonotic pathogens in Germany. Dtsch Arztebl Int 110:461–467. https://doi.org/10.3238/arztebl.2013.0461
doi: 10.3238/arztebl.2013.0461
pubmed: 23964302
pmcid: 3722641
Latus J, Schwab M, Tacconelli E, Pieper FM, Wegener D, Dippon J, Muller S, Zakim D, Segerer S, Kitterer D, Priwitzer M, Mezger B, Walter-Frank B, Corea A, Wiedenmann A, Brockmann S, Pohlmann C, Alscher MD, Braun N (2015) Clinical course and long-term outcome of hantavirus-associated nephropathia epidemica, Germany. Emerg Infect Dis 21:76–83. https://doi.org/10.3201/eid2101.140861
doi: 10.3201/eid2101.140861
pubmed: 25533268
pmcid: 4285283
Outinen TK, Makela S, Clement J, Paakkala A, Porsti I, Mustonen J (2015) Community acquired severe acute kidney injury caused by hantavirus-induced hemorrhagic fever with renal syndrome has a favorable outcome. Nephron 130:182–190. https://doi.org/10.1159/000433563
doi: 10.1159/000433563
pubmed: 26139246
Mustonen J, Brummer-Korvenkontio M, Hedman K, Pasternack A, Pietila K, Vaheri A (1994) Nephropathia epidemica in Finland: a retrospective study of 126 cases. Scand J Infect Dis 26:7–13
doi: 10.3109/00365549409008583
pubmed: 7910705
Braun N, Haap M, Overkamp D, Kimmel M, Alscher MD, Lehnert H, Haas CS (2010) Characterization and outcome following Puumala virus infection: a retrospective analysis of 75 cases. Nephrol Dial Transplant 25:2997–3003. https://doi.org/10.1093/ndt/gfq118
doi: 10.1093/ndt/gfq118
pubmed: 20223893
Mustonen J, Huttunen NP, Brummer-Korvenkontio M, Vaheri A (1994) Clinical picture of nephropathia epidemica in children. Acta Paediatr 83:526–529
doi: 10.1111/j.1651-2227.1994.tb13073.x
pubmed: 7916222
Ahlm C, Settergren B, Gothefors L, Juto P (1994) Nephropathia epidemica (hemorrhagic fever with renal syndrome) in children: clinical characteristics. Pediatr Infect Dis J 13:45–49
doi: 10.1097/00006454-199401000-00010
pubmed: 7909597
Lautala P, Uhari M (1991) Epidemic nephropathy in children. Am J Dis Child 145:1181–1183
pubmed: 1681724
Huttunen NP, Makela S, Pokka T, Mustonen J, Uhari M (2011) Systematic literature review of symptoms, signs and severity of serologically confirmed nephropathia epidemica in paediatric and adult patients. Scand J Infect Dis 43:405–410. https://doi.org/10.3109/00365548.2011.559666
doi: 10.3109/00365548.2011.559666
pubmed: 21341977
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, Network AKI (2007) Acute kidney injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31. https://doi.org/10.1186/cc5713
doi: 10.1186/cc5713
pubmed: 2206446
pmcid: 2206446
Outinen TK, Laine OK, Makela S, Porsti I, Huhtala H, Vaheri A, Mustonen J (2016) Thrombocytopenia associates with the severity of inflammation and variables reflecting capillary leakage in Puumala hantavirus infection, an analysis of 546 Finnish patients. Infect Dis (Lond) 48:682–687. https://doi.org/10.1080/23744235.2016.1192719
doi: 10.1080/23744235.2016.1192719
Acham-Roschitz B, Aberle SW, Pirker N, Kaulfersch W, Boehm M, Roedl S, Zenz W, Ring E, Mache CJ (2010) Nephropathia epidemica (puumala virus infection) in Austrian children. Pediatr Infect Dis J 29:874–876. https://doi.org/10.1097/INF.0b013e3181dfbbe5
doi: 10.1097/INF.0b013e3181dfbbe5
pubmed: 20400926
Makary P, Kanerva M, Ollgren J, Virtanen MJ, Vapalahti O, Lyytikainen O (2010) Disease burden of Puumala virus infections, 1995-2008. Epidemiol Infect 138:1484–1492. https://doi.org/10.1017/S0950268810000087
doi: 10.1017/S0950268810000087
pubmed: 20109263