Liver involvement in epidemic haemorrhagic fever: in situ hybridization, immunohistochemical and pathological studies

Comparison of Hantaan and Seoul viral infections among patients with hemorrhagic fever with renal syndrome (HFRS) in Heilongjiang, China

BACKGROUND

Hemorrhagic fever with renal syndrome (HFRS) is a serious public health problem in China, and is primarily caused by either the Hantaan virus (HTNV) or Seoul virus (SEOV) strains. However, the causative hantavirus has only been definitively identified in a few HFRS cases, and detailed comparisons of patient data for the 2 strains are limited.

METHODS

We conducted a 1-y prospective study in Heilongjiang Province, China. A total of 152 patients from 3 hospitals met the HFRS diagnostic criteria used in China. The diagnosis was further confirmed by specific immunoglobulin M to HTNV or SEOV. In addition, serum samples were tested for the presence of HTNV or SEOV using a reverse transcription-polymerase chain reaction (RT-PCR). Clinical manifestations and laboratory findings in patients with the 2 hantaviruses were subsequently compared.

RESULTS

Eighty (61.1%) HTNV and 51 (38.9%) SEOV infections were identified. Fever and proteinuria, key to the diagnosis of HFRS, were observed in all patients. The clinical manifestations of hemorrhage and renal injury from SEOV infection were milder than those of HTNV infection. Interestingly, compared to patients with HTNV infection, patients with SEOV presented with a significantly longer febrile period, more normal white blood cell counts or even transient leukocytopenia, a higher incidence of liver injury related to disease severity, and a lower occurrence of the 5 typical phases of HFRS. The mortality was 6.3% in HTNV infections and 0% in SEOV infections.

CONCLUSIONS

Clinical manifestations of SEOV infection appear to be milder and less typical than HTNV. This information may help us to improve the diagnosis of SEOV-infected patients.

Low levels of serum vitronectin associated with clinical phases in patients with hemorrhagic fever with renal syndrome

beta(3) integrin has been identified as a cellular receptor for Hantaan virus which causes hemorrhagic fever with renal syndrome (HFRS). As one of the ligands of beta(3) integrin, vitronectin (VN) may be altered in HFRS. In this study, changes of serum VN levels were determined in 112 patients with HFRS and 30 age- and sex-matched healthy controls by quantitative sandwich enzyme immunoassay. The levels of serum VN were analyzed in patients at various phases of HFRS and with different severity of clinical types. Serum VN levels in patients with HFRS, at all clinical phases except the convalescent phase, were significantly decreased compared with those in the controls (P < 0.01). The serum levels of VN decreased at febrile phase, maintained at the lowest status during hypotensive and oliguric phases, started to increase from polyuric phase and reached almost normal condition till convalescent phase. The levels of serum VN between patients with milder and more severe clinical types showed no significant difference at each phase (P > 0.05). These results suggest that VN level was altered during the course of HFRS and chronological changes of serum levels of VN may correlate with the evolution of the disease.