Hemorrhagic Fever with Renal Syndrome in Asia: History, Pathogenesis, Diagnosis, Treatment, and Prevention

Analysis of clinical characteristics of hemorrhagic fever with renal syndrome with acute pancreatitis: a retrospective study

OBJECTIVE

This research aimed to analyze the impact of hemorrhagic fever with renal syndrome (HFRS) with acute pancreatitis (AP) on the severity and prognosis of patients, screen the risk factors of HFRS with AP, and establish a nomogram model.

METHODS

Data were collected from HFRS patients at the First Affiliated Hospital of Dali University and Dali Prefecture People's Hospital (2013-2023). Patients were divided into HFRS with AP (n = 34) and HFRS without AP groups (n = 356). Propensity Score Matching (PSM) and logistic regression analyzed the impact of AP on HFRS severity and short-term prognosis. LASSO-Logistic regression was used to screen risk factors and develop a nomogram model.

RESULTS

After PSM, HFRS patients with AP had higher rates of Continuous Renal Replacement Therapy (CRRT) and/or mechanical ventilation use, , ICU admission, and 30-day mortalitycompared with those without AP (p < 0.05). Further analysis revealed that smoking (OR: 3.702), ferritin (OR: 1.002), white blood cell (OR), fibrinogen (OR: 0.463), and platelet (OR: 0.987) were risk factors for HFRS with AP (p < 0.05). A nomogram model was constructed based on these factors, to predict the risk of HFRS with AP, with an Area Under the Curve (AUC) of 0.90 (95% CI: 0.84-0.95). Additionally, the model calibration curve fit well according to the Hosmer-Lemeshow test (χ2=8.51, p = 0.39).

CONCLUSION

Patients with HFRS with AP exhibit higher disease severity and poorer prognosis. Smoking, elevated ferritin and white blood cell levels, decreased fibrinogen and platelet levels are more susceptible to developing AP.

Orthohantavirus seoulense as a cause of acute, dengue-negative febrile illness in southern Vietnam

BACKGROUND

Dengue fever has surged in Vietnam since 2021; however, the aetiology of non-dengue undifferentiated febrile illnesses remains poorly understood.

METHODS

Fifty whole blood samples that tested negative in rapid tests for anti-dengue virus antibodies (IgM and IgG) and NS1 viral antigen at Vung Tau General Hospital, southern Vietnam, were subjected to nucleic acid amplification tests for flaviviruses, hantaviruses, Leptospira spp. and Orientia tsutsugamushi, followed by DNA sequencing. The plasma samples were also tested for anti-hantavirus IgM and IgG antibodies using ELISA.

RESULTS

Of the 50 samples, eight were PCR-positive for flaviviruses and two were positive for hantaviruses. Sequencing analysis revealed that three and five of the eight flavivirus-positive samples were dengue virus type 1 and dengue virus type 2, respectively. The hantavirus species was identified as Orthohantavirus seoulense (SEOV). None of the patients tested positive for Leptospira spp. or O. tsutsugamushi. Anti-hantavirus IgM and IgG antibodies were detected in five and four patients, respectively.

CONCLUSIONS

This study suggests that SEOV is a notable contributor to dengue-negative febrile illnesses in southern Vietnam.

ACCESSION NUMBER

LC822654.

Predictors of Severity in Hemorrhagic Fever with Renal Syndrome

Objective

To explore the risk factors for the severity of hemorrhagic fever with renal syndrome (HFRS) and construct a nomogram model.

Methods

A retrospective analysis was conducted on the data of 191 patients diagnosed with HFRS at the First Affiliated Hospital of Dali University between January 1, 2013, and September 30, 2024. Based on whether severe disease occurred, the patients were divided into a severe HFRS group (n=42) and a mild HFRS group (n=149). The clinical data of the two groups were compared, and after eliminating the influence of collinearity, LASSO-Logistic regression analysis was used to screen for factors influencing the severity of HFRS. Additionally, a nomogram model was constructed to predict the severity of HFRS.

Results

Compared with the mild HFRS group, patients in the severe HFRS group had a prolonged length of stay, increased usage rates of Continuous Renal Replacement Therapy (CRRT) and ventilators, and an elevated 30-day mortality rate (P<0.001). Procalcitonin (PCT, OR= 0.86), Albumin (ALB, OR: 0.86), Platelet count-to-Albumin ratio (PAR, OR: 0.64), and pleural effusion (OR: 4.49) were identified as independent risk factors for severe HFRS. The Area Under Curve (AUC) of the nomogram model was 0.890. The Hosmer-Lemeshow test result was χ²=2.92, P=0.94, and in combination with the Calibration curve, it indicated a good fit between the calibration curve and the ideal curve. Most of the Decision Curve Analysis (DCA) curves of the nomogram model were above the two extreme lines, suggesting that using this model to predict severe HFRS patients could clinically benefit those with severe HFRS, demonstrating the clinical practicality of the nomogram model.

Conclusion

PCT, ALB, PAR, and pleural effusion are risk factors for the severity of HFRS. The constructed nomogram model exhibits good discriminatory power, fit, and clinical practicality, enabling early identification of patients with severe HFRS in southwestern China.

Qingqi Guxue Decoction induces S cell cycle arrest to inhibit replication of severe fever with thrombocytopenia syndrome virus

Severe fever with thrombocytopenia syndrome (SFTS) is a novel emerging acute infectious disease caused by severe fever with thrombocytopenia syndrome virus (SFTSV), characterized by high fever and thrombocytopenia. It has been proved that traditional Chinese medicine (TCM) has displayed definite therapeutic effects on viral hemorrhagic fever, indicating its potential to treat SFTS. In this study, SFTS-relative key targets were predicted via Gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. Molecular docking was then used to select stable binders. Molecules matched TCMs were identified, and a new prescription, Qingqi Guxue decoction (QQGX), was formulated to clear heat and nourish blood, with a resulting drug composition network. We explored the optimal drug proportion for QQGX. Through an in-depth study of molecular mechanisms, we found that QQGX induces S phase arrest by promoting the degradation of Cyclin A2 (CCNA2) and Cyclin-dependent kinase 2 (CDK2), thereby inhibiting SFTSV replication. Finally, we verified the effectiveness and safety of QQGX based on the mouse liver bile duct organoid model infected with SFTSV. In summary, our study prepared a TCM decoction using the method of network pharmacology. This decoction has a significant inhibitory effect on the replication of SFTSV and provides a new treatment strategy for hemorrhagic fever with TCM.

Epidemiological Characteristics of Hemorrhagic Fever with Renal Syndrome in Longyou County, China

(1) Background: We aimed to analyze the epidemiological characteristics of hemorrhagic fever with renal syndrome (HFRS) in Longyou County and to provide a basis for the future response to this disease. (2) Methods: Data on hemorrhagic fever and host animals were collected from 2011 to 2023. Descriptive methods were used to analyze the epidemic. The R4.4.1 software was used to show how the host density relates to the virus levels, temperature, and rainfall and to predict the host density. (3) Results: We observed 58 cases of hemorrhagic fever, the majority of which occurred in farmers. There were two incidence peaks each year during the spring and winter seasons, accounting for 22.41% and 43.10% of the total cases, respectively. The outdoor rodent population density was significantly and positively correlated with the outdoor rodent virus prevalence (R2 = 0.9411), serving as a robust predictor of the outdoor rodent virus prevalence. Additionally, the density of outdoor rodents exhibited a strong nonlinear relationship with the temperature and precipitation. (4) Conclusions: After hemorrhagic fever vaccination, rodent population density control, and rodent carrier rodent control from 1995 to 2000, the hemorrhagic fever epidemic was generally stable, and the epidemiological characteristics remained stable. In the future, we should continue to take active and effective comprehensive measures to intervene, further realize the effective control of HFRS, and prevent the recurrence of hemorrhagic fever epidemics.

Clinical Characteristics and a Novel Prediction Nomogram (EASTAR) for Patients with Hemorrhagic Fever with Renal Syndrome: A Multicenter Retrospective Study

BACKGROUND

The fatality rate of hemorrhagic fever with renal syndrome (HFRS), due to hantavirus transmitted by rodents, ranges from 1% to 12%. This study aims to delineate the clinical and laboratory characteristics of HFRS, identify factors associated with disease severity, and construct and validate a nomogram for prognosis prediction of HFRS in the central part of China.

METHODS

Out of 598 HFRS patients diagnosed via serology tests from four hospitals in Hubei Province, 551 were included. Clinical data were gathered and analyzed, followed by logistic univariate and multivariate analyses to identify independent prognostic factors. A nomogram was developed and validated to forecast the patient's prognosis.

RESULTS

Vaccination led to a notable drop in HFRS incidence from 2018 to 2019, and seasonal trends exhibited bimodal changes with peaks from May to July and November to January. The 30-day mortality rate was 4.17% (23/551). Red blood cell count (RBC), age, two-stage overlap, qSOFA ≥ 2, aspartate aminotransferase (AST), and three-stage overlap were identified as independent prognostic factors. A predictive risk classification system using a nomogram chart was developed, and Kaplan-Meier curves indicated that the new system accurately distinguished 30-day mortality among the three risk groups.

CONCLUSIONS

The risk score (EASTAR) system demonstrated good predictive performance for prognostic prediction, and it can be applied to quickly screen patients who require ICU admission.

List of occupational diseases among farmers in Korea: a literature review

A comprehensive list of occupational diseases among farmers is crucial for both compensation and prevention efforts. In Korea, most farmers are self-employed, and some occupational diseases are compensated through farmer safety insurance. However, it is not harmonized with industrial accident compensation insurance and does not adequately reflect the true burden of occupational diseases among farmers. To address this gap, the authors compiled a list of occupational diseases tailored to Korean farmers by reviewing the International Labor Organization's list of occupational diseases, the Korean Industrial Accident Compensation Insurance List, the occupational disease lists of other countries, and relevant literature on farmers' work-related diseases.

Hantavirus antibody seroprevalence and risk factors among adults in West Kazakhstan, 2023

Background

Orthohantaviruses (also known as hantaviruses) are pathogens, primarily transmitted by rodents, that can cause hemorrhagic fever with renal syndrome (HFRS). In endemic regions of Kazakhstan, no confirmed HFRS cases were detected between 2020 and 2022 raising concerns about detection. Estimate antibody seroprevalence for hantaviruses and identify associated risk factors among high-risk adults in western Kazakhstan in 2023.

Methods

In this cross-sectional study, adults were randomly sampled from public clinic registries in 14 villages in West Kazakhstan during June-July 2023. We interviewed 921 participants and collected serum samples which were tested for presence of hantavirus specific IgG antibodies using enzyme-linked immunosorbent assay (ELISA). Socio-demographic, clinical characteristics, and residential risk-factor data were self-reported. We assessed factors associated with seropositivity using multivariable Poisson regression, adjusting for key variables such as age and gender.

Results

Among 921 participants, 63.0% were female, median age was 53 years, 72.0% resided in single houses and 38.0% reported encounters with rodents. Among 921 participants we found 3.1% (n = 28) hantavirus seroprevalence (95% confidence interval [CI]: 2.1-4.3). No seropositive participants had prior hospitalization or symptoms consistent with hantavirus. Three seronegative participants had previous hospitalization for hemorrhagic fever with renal syndrome. Over one-third (38%) of participants encountered rodents or droppings in the past year in their homes or workplaces. Higher seroprevalence was found among office occupational workers than unemployed people (prevalence ratio [PR]:7.3, 95%CI: 1.3-53.5), and among those who lived near ponds than those who did not (PR:11.5, 95%CI: 1.6-54.7).

Conclusion

Overall, the seroprevalence was low, but indicated some risk of infection among the adult population. Our results highlight potential occupational and residential risk factors for hantavirus infection in West Kazakhstan. Relevant public health interventions should include educating the population about promoting preventive practices, workplace hygiene, rodent control measures, and enhanced case diagnosis and management.

Infectious exanthemas in clinical practice

OBJECTIVE

Aim: Analyze the causes and mechanisms of development of exanthems, provide a classification of the morphological elements and characterize clinical manifestations of rash in patients with infectious diseases based on a review of available literature data.

PATIENTS AND METHODS

Materials and Methods: The authors analyzed the current literature sources, including a description of exanthema syndrome and a discussion of the features of rashes in various infectious diseases.

CONCLUSION

Conclusions: As a result of the analysis of existing literature data, it was established that exanthema syndrome is associated with various diseases, disorders and pathological conditions, characterized by a variety of clinical manifestations, which requires clinical differential diagnosis and subsequent laboratory confirmation. Comprehensive knowledge of the causes, mechanisms of development, as well as the clinical manifestations of skin rash will contribute to the development of an improved algorithm for diagnosis and treatment of the diseases accompanied by exanthema syndrome, as well as optimization of therapeutic tactics.

Acute Pancreatitis and Leukemoid Reaction as the Presenting Manifestation of Hemorrhagic Fever with Renal Syndrome: A Case Report

Background

Hemorrhagic fever with renal syndrome (HFRS), caused by Orthohantavirus hantanense (HTNV) infection, is characterized by a range of symptom including fever, hemorrhage, and renal impairment. Acute pancreatitis and leukemoid reaction associated with HFRS have been less frequently reported.

Case Presentation

A 20-year-old male presented with fever, dizziness, and gastrointestinal symptom, which progressed to acute pancreatitis and leukemoid reaction. Despite initial treatment, his condition worsened, necessitating transfer to a tertiary care facility. Upon admission, the patient exhibited signs of organ dysfunction, and laboratory tests confirmed leukocytosis and thrombocytopenia, with imaging suggestive of pancreatitis. HTNV antibody test results were positive.

Discussion

This case illustrates the complexity of diagnosing HFRS when the disease presents atypically. The symptom that are shared with other conditions can lead to misdiagnosis. Treatment of HFRS patients requires a multidisciplinary approach, with particular attention to the timing and type of therapy to manage complications effectively.

Conclusion

This report emphasizes the importance of recognizing atypical presentations of HFRS and the benefits of a prompt and comprehensive treatment strategy. Early diagnosis and a tailored therapeutic approach are crucial for improving patient outcomes in such rare and complex cases. The case underscores the necessity for clinicians to be vigilant for secondary symptom of HFRS, particularly in high-incidence regions, and the role of early diagnosis and treatment in improving outcomes.

A Comprehensive Analysis Exploring the Vital Role of the Systemic Immune-Inflammatory Index Upon Admission in Severe Hemorrhagic Fever with Renal Syndrome

Objective

To explore the value of the systemic immune-inflammatory index (SII) and the systemic inflammatory response index (SIRI) in patients with severe hemorrhagic fever with renal syndrome (HFRS) upon admission.

Methods

This study included a total of 165 patients with HFRS, who were divided into mild and severe groups based on the severity of the disease. By reviewing medical records, we collected the white blood cell (WBC), SII, and SIRI values of patients upon admission. Univariate and multivariate logistics regression analyses were performed to identify risk factors for severe HFRS. The receiver operating characteristic (ROC) curve was applied to calculate the area under the ROC curve (AUC) to analyze the predictive value of SII and SIRI for severe HFRS, and the results were compared with WBC and SIRI.

Results

Compared with the mild HFRS group, patients in the severe HFRS group had a longer duration of illness (P < 0.05), higher levels of WBC, neutrophil (NEUT), lymphocyte (LYMP), monocyte (MONO), procalcitonin (PCT), SIRI, alanine transaminase (ALT), and creatinine (Scr) (P < 0.05), while lower levels of ALB, platelet (PLT), platelet-to-lymphocyte rate (PLR), and SII, with statistically significant differences (P < 0.05). Binary logistics regression analysis indicated that WBC (OR: 1.190, 95% CI: 1.032-1.371), SII (OR: 0.967, 95% CI: 0.951-0.984), and SIRI (OR: 4.743, 95% CI: 2.077-10.830) were risk factors for severe HFRS. The AUCs of WBC, SII, and SIRI for predicting severe HFRS were 0.765, 0.803, and 0.785, respectively.

Conclusion

Low levels of SII and high levels of WBC and SIRI upon admission are risk factors for severe HFRS and have certain value in predicting the progression of HFRS to severe cases, among which SII exhibits the best predictive value.

A comprehensive investigation of Glycoprotein-based nucleic acid vaccines for Hantaan Virus

Hemorrhagic fever with renal syndrome (HFRS) occurs throughout Eurasia with considerable morbidity and mortality. Currently, the absence of specific treatments or effective antiviral drugs for hantavirus infection makes developing safe and effective vaccines a high priority. Here, we report the development of three novel nucleic acid vaccine candidates, mRNA, naked DNA, and DNA encapsulated in lipid nanoparticles, encoding the glycoproteins of the Hantaan virus (HTNV). To comprehensively evaluate the potential of candidate HTNV nucleic acid vaccines in preventing HFRS, we focus on evaluating their immunogenicity and efficacy in mice and comparing them with an inactivated vaccine as the benchmark. Our findings reveal that all candidate vaccines activated instant and sustained immune responses, offering comparable in vivo protective efficacy to the inactivated vaccines. Notably, compared to the inactivated vaccine, mRNA vaccine induced stronger virus-specific T-helper 1 cell immune response, while DNA-LNP elicited higher levels of neutralizing antibodies in mice. These results mark a significant step in developing nucleic acid vaccines for HTNV, suggesting that sequential immunization with DNA and mRNA vaccines could further amplify the advantages of nucleic acid vaccines.

Incidence rate of hemorrhagic fever with renal syndrome complicated with acute pancreatitis: a meta-analysis

Background

Acute pancreatitis (AP) is a rare but serious complication in patients diagnosed with hemorrhagic fever with renal syndrome (HFRS). When AP complicates HFRS, the clinical outcome significantly worsens and the risk of mortality increases. However, the incidence of AP in HFRS patients and its associated mortality risk remain unclear. To address this knowledge gap, we conducted a meta-analysis to determine the AP incidence rate in HFRS patients and assess the impact of AP on mortality in these patients.

Methods

We systematically searched seven databases (PubMed, Web of Science, EMBase, Sinomed, Chinese National Knowledge Infrastructure, WanFang Data, and Chongqing VIP) for relevant studies on HFRS complicated by AP. The studies were selected using predefined inclusion and exclusion criteria based on the Population, Intervention, Comparison, Outcome, and Study design principle. Two independent reviewers screened the studies, and the quality of the included studies was assessed using the Agency for Healthcare Research and Quality and the Newcastle-Ottawa Evaluation Scale (NOS).

Results

In total, 11 studies, encompassing 1,218 HFRS patients, met the inclusion criteria. The overall incidence of HFRS complicated by AP was 8.5% (95% CI for r 5.9-11.1%). The HFRS patients with AP had a significantly higher risk of mortality than those without AP (OR = 3.668, 95% CI for OR 1.112-12.031). No statistically significant differences were observed in the subgroup and meta-regression analyses.

Conclusion

Although the incidence of AP in HFRS patients is not high, it significantly increases the risk of mortality in these patients. Future large-scale prospective studies are required to further validate these findings.

Investigating the impact of climatic and environmental factors on HFRS prevalence in Anhui Province, China, using satellite and reanalysis data

Introduction

Hemorrhagic Fever with Renal Syndrome (HFRS) is the most commonly diagnosed zoonosis in Asia. Despite taking various preventive measures, HFRS remains prevalent across multiple regions in China. This study aims to investigate the impact of climatic and environmental factors on the prevalence of HFRS in Anhui Province, China, utilizing satellite and reanalysis data.

Methods

We collect monthly HFRS data from Anhui Province spanning 2005 to 2019 and integrated MODIS satellite datasets and ERA5 reanalysis data, including variables such as precipitation, temperature, humidity, solar radiation, aerosol optical depth (AOD), and Normalized Difference Vegetation Index (NDVI). Continuous wavelet transform, Spearman correlation analysis, and Poisson regression analysis are employed to assess the association between climatic and environmental factors and HFRS cases.

Results

Our findings reveal that HFRS cases predominantly occur during the spring and winter seasons, with the highest peak intensity observed in a 9-year cycle. Notably, the monthly average relative humidity exhibits a Spearman correlation coefficient of 0.404 at a 4-month lag, taking precedence over other contributing factors. Poisson regression analysis elucidates that NDVI at a 2-month lag, mean temperature (T) and solar radiation (SR) at a 4-month lag, precipitation (P), relative humidity (RH), and AOD at a 5-month lag exhibit the most robust explanatory power for HFRS occurrence. Moreover, the developed predictive model exhibiting commendable accuracy.

Discussion

This study provides key evidence for understanding how climatic and environmental factors influence the transmission of HFRS at the provincial scale. Insights from this research are critical for formulating effective preventive strategies and serving as a resource for HFRS prevention and control efforts.

Seroprevalence of hantavirus infection in non-epidemic settings over four decades: a systematic review and meta-analysis

INTRODUCTION

Hantavirus infection is a zoonotic disease from rodents to humans, necessitating seroprevalence assessment for disease burden clarification and control measure implementation. This study aimed to estimate global hantaviruses seroprevalence, examining variations by regions, populations or settings.

METHODS

A comprehensive database search identified studies on human hantaviruses seroprevalence using IgG detection until january 2024. A random-effects meta-analysis estimated pooled seroprevalence, with subgroup analyses for geographical region, population, setting or occupation.

RESULTS

Out of 3,382 abstracts reviewed, 110 studies were selected, comprising 81,815 observations and 3207 events. The global seroprevalence was calculated at 2.93% (2.34%-3.67%). In terms of geographical distribution, our analysis encompassed 61 studies from the Americas, where the seroprevalence was estimated at 2.43% (95% CI: 1.71%-3.46%), 33 studies from Europe indicating a seroprevalence of 2.98% (95% CI: 2.19%-4.06%), 10 studies from Asia revealing a seroprevalence of 6.84% (95% CI: 3.64%-12.50%), and 6 studies from Africa demonstrating a seroprevalence of 2.21% (95% CI: 1.82%-2.71%). Subgroup analysis underscored varying seroprevalence rates across different populations, settings, and occupations, highlighting the necessity for targeted interventions and preventive measures.

CONCLUSION

The analysis reveals a moderate global hantaviruses seroprevalence, emphasizing the viral family's complex transmission dynamics influenced by exposure and geographical factors. This highlights the need for targeted prevention and control strategies.

A bibliometric analysis of domestic and international research on hemorrhagic fever with renal syndrome over the past 2 decades

BACKGROUND

Bibliometrics and statistics were used to determine and analyze the research status of hemorrhagic fever with renal syndrome (HFRS) from 2004 to 2023, and objectively reflect the development and future trend of HFRS at home and abroad through comparison.

METHODS

To search the research literature on HFRS in China National Knowledge Network and Web of Science databases from January 2004 to December 2023, CiteSpace and VOSviewer were used to visually analyze the annual publication trends, authors, research institutions, countries, co-cited literature, keywords and other contents of the included literatures.

RESULTS

A total of 4460 Chinese literatures and 2372 foreign literatures were included. The number of HFRS published in the Web of Science database showed a trend of positive growth, while the number of HFRS published in China National Knowledge Network showed a trend of decline. Bai Xuefan and Wang Zhiqiang were the most published authors in China, and foreign scholars Vaheri, Antti, Ahlm, Clas. The main research institutions in the domestic literature were Zhejiang Provincial Center for Disease Control and Prevention, Liaoning Provincial Center for Disease Control and Prevention, while foreign research institutions concentrated on the University of Helsinki and Ministry of Health. The top 3 countries in the literature research of Web of Science are the USA, China, and Germany.

CONCLUSION

The analysis results of hot spots and trends suggested that we need to develop more reliable tools and methods in the monitoring and spatio-temporal analysis of HFRS epidemic data in the future, so as to provide references for the surveillance and early warning of zoonotic diseases in the field of public health research.

Isolation and characterization of genetic variants of Orthohantavirus hantanense from clinical cases of HFRS in Jiangxi Province, China

BACKGROUND

Hemorrhagic fever with renal syndrome (HFRS) is a severe public health problem in Jiangxi province, China. Previous studies reported genetic variants of Orthohantavirus hantanense (Hantaan virus, HTNV) in rodents in this area. However, the relationship between HTNV variants and human infection needs to be confirmed. This study aimed to identify the HTNV variants in patients and to understand the clinical characteristics of HFRS caused by these variants.

METHODS

Samples were collected from hospitalized suspected cases of HFRS during the acute phase. HFRS cases were confirmed using quantitative real-time RT-PCR. Peripheral blood mononuclear cells (PBMC) from patients with HFRS were inoculated into Vero-E6 cells for viral isolation. The genomic sequences of HTNV from patients were obtained by amplicon-based next-generation sequencing. A retrospective analysis was conducted on the clinical characteristics of the patients.

RESULTS

HTNV RNA was detected in 53 of 183 suspected HFRS patients. Thirteen HTNVs were isolated from 32 PBMCs of HFRS cases. Whole genome sequences of 14 HTNVs were obtained, including 13 isolates in cell culture from 13 patients, and one from plasma of the fatal case which was not isolated successfully in cell culture. Genetic analysis revealed that the HTNV sequence from the 14 patients showed significant variations in nucleotide and amino acid to the HTNV strains found in other areas. Fever (100%, 53/53), thrombocytopenia (100%, 53/53), increased serum aspartate aminotransferase (100%, 53/53), and increased lactate dehydrogenase (96.2%, 51/53) were the most common characteristics. Severe acute kidney injury was observed in 13.2% (7/53) of cases. Clinical symptoms, such as pain, petechiae, and gastrointestinal or respiratory symptoms were uncommon.

CONCLUSION

The HTNV genetic variants cause human infections in Jiangxi. The clinical symptoms of HFRS caused by the HTNV genetic variant during the acute phase are atypical. In addition to renal dysfunction, attention should be paid to the common liver injuries caused by these genetic variants.

Clinical and etiological characteristics of severe hemorrhagic fever caused by coinfection of hantaan orthohantavirus and severe fever with thrombocytopenia syndrome virus

Severe fever with thrombocytopenia syndrome (SFTS) and hemorrhagic fever with renal syndrome (HFRS) usually have different infection routes, and coinfection is relatively rare. This study examines the clinical and etiological characteristics of coinfection by these two pathogens to provide important references for clinical diagnosis and treatment. Blood samples from 22 clinically diagnosed patients with HFRS were collected for molecular detection of HFRS and common tick and mouse borne diseases. Inoculate the blood of six severe and critically patients into cells to isolate and proliferate potential viruses, and retest the cell culture to determine the pathogen. In addition, complete data were collected from these 22 HFRS and concurrent SFTS patients, and white blood cells (WBCs), platelet (PLT), blood urea nitrogen (BUN), creatinine (Cr) and other data were compared and analyzed. A total of 31 febrile patients, including 22 HFRS patients and 9 SFTS patients, were collected from September 2021 to October 2022. Among these HFRS patients, 11 were severe or critical. Severe and critical HFRS patients were characterized by rodent exposure history, pharyngeal and conjunctival hyperemia, abnormal WBC and PLT counts, and elevated BUN and Cr values. Virus isolation and molecular detection on blood samples from 6 patients showed that three of the six severe patients were positive for hantaan virus (HTNV), and two of the three HTNV positives were also positive for SFTS bunyavirus (SFTSV). The two coinfected patients exhibited different clinical and laboratory characteristics compared to those infected by either virus alone. Coinfection of HTNV and SFTSV leads to severe and complex hemorrhagic fever. Laboratory characteristics, such as the indicators of WBC, PLT, BUN, and Cr, may differ between HFRS and SFTS. These findings have implications and provide references for the diagnosis and treatment of coinfected cases.

Spatial and temporal patterns of haemorrhagic fever with renal syndrome (HFRS) and the impact of environmental drivers in a border area of the Russian Far East

AIMS

Haemorrhagic fever with renal syndrome (HFRS) is a significant zoonotic disease transmitted by rodents. The distribution of HFRS in the European part of Russia has been studied quite well; however, much less is known about the endemic area in the Russian Far East. The mutual influence of the epidemic situation in the border regions and the possibility of cross-border transmission of infection remain poorly understood. This study aims to identify the spatiotemporal hot spots of the incidence and the impact of environmental drivers on the HFRS distribution in the Russian Far East.

METHODS AND RESULTS

A two-scale study design was performed. Kulldorf's spatial scan statistic was used to conduct spatiotemporal analysis at a regional scale from 2000 to 2020. In addition, an ecological niche model based on maximum entropy was applied to analyse the contribution of various factors and identify spatial favourability at the local scale. One spatiotemporal cluster that existed from 2002 to 2011 and located in the border area and one pure temporal cluster from 2004 to 2007 were revealed. The best suitability for orthohantavirus persistence was found along rivers, including those at the Chinese-Russian border, and was mainly explained by land cover, NDVI (as an indicator of vegetation density and greenness) and elevation.

CONCLUSIONS

Despite the stable incidence in recent years in, targeted prevention strategies are still needed due to the high potential for HRFS distribution in the southeast of the Russian Far East.

Designing a Conserved Immunogenic Peptide Construct from the Nucleocapsid Protein of Puumala orthohantavirus

Puumala orthohantavirus (PUUV) is an emerging zoonotic virus endemic to Europe and Russia that causes nephropathia epidemica, a mild form of hemorrhagic fever with renal syndrome (HFRS). There are limited options for treatment and diagnosis of orthohantavirus infection, making the search for potential immunogenic candidates crucial. In the present work, various bioinformatics tools were employed to design conserved immunogenic peptides containing multiple epitopes of PUUV nucleocapsid protein. Eleven conserved peptides (90% conservancy) of the PUUV nucleocapsid protein were identified. Three conserved peptides containing multiple T and B cell epitopes were selected using a consensus epitope prediction algorithm. Molecular docking using the HPEP dock server demonstrated strong binding interactions between the epitopes and HLA molecules (ten alleles for each class I and II HLA). Moreover, an analysis of population coverage using the IEDB database revealed that the identified peptides have over 90% average population coverage across six continents. Molecular docking and simulation analysis reveal a stable interaction with peptide constructs of chosen immunogenic peptides and Toll-like receptor-4. These computational analyses demonstrate selected peptides' immunogenic potential, which needs to be validated in different experimental systems.

Partial hypopituitarism with ACTH deficiency as the main manifestation as a complication of hemorrhagic fever with renal syndrome

Hypopituitarism is a relatively rare complication of hemorrhagic fever with renal syndrome. However, almost all available reported cases were total anterior pituitary hypofunction, isolated growth-hormone deficiency, or isolated gonadotropin deficiency. Here, we firstly describe a patient with partial hypopituitarism with ACTH deficiency as the main manifestation as a complication of hemorrhagic fever with renal syndrome.

Patient with suspected co-infection of hemorrhagic fever with renal syndrome and malaria: a case report

Background

Hemorrhagic fever with renal syndrome (HFRS) is a natural epidemic disease that can be caused by the Hantaan virus (HTNV). Malaria is caused by plasmodium and can be transmitted by a mosquito bite. The similar manifestations shared by these disorders pose a challenge for clinicians in differential diagnosis, in particular, coupled with a false-positive serological test.

Case presentation

A 46-year-old man was admitted for fever and chills for over 10 days and was suspected of being co-infected with HFRS and malaria due to a history of travel to malaria-endemic areas and a positive HTNV-immunoglobulin M (IgM) test. Although leukocytosis, thrombocytopenia, renal injury, lymphocytosis, overexpression of interleukin-6, and procalcitonin were observed during the hospitalization, the hypotensive, oliguria, and polyuria phases of the HFRS course were not observed. Instead, typical symptoms of malaria were found, including a progressive decrease in erythrocytes and hemoglobin levels with signs of anemia. Furthermore, because the patient had no history of exposure to HFRS endemic areas, exposure to an HTNV-infected rodent, or a positive HTNV-IgG test, and false serological tests of IgM can be caused by various factors, the HFRS coinfection with malaria was ruled out.

Conclusion

Misdiagnosis can be easily induced by a false serological test, in particular the IgM test which can be influenced by various factors. A combination of health history, epidemiology, physical examination, precise application of specific examinations involving tests of conventional laboratory parameters as well as well-accepted methods such as the immunochromatographic (ICG) test, real-time reverse transcription-polymerase chain reaction (PCR), and Western blot (WB), and acquaintance with disorders with similar manifestations will contribute to the precise diagnosis in clinical treatment.

Asymmetric impact of climatic parameters on hemorrhagic fever with renal syndrome in Shandong using a nonlinear autoregressive distributed lag model

Hemorrhagic fever with renal syndrome (HFRS) poses a major threat in Shandong. This study aimed to investigate the long- and short-term asymmetric effects of meteorological factors on HFRS and establish an early forecasting system using autoregressive distributed lag (ARDL) and nonlinear ARDL (NARDL) models. Between 2004 and 2019, HFRS exhibited a declining trend (average annual percentage change = - 9.568%, 95% CI - 16.165 to - 2.451%) with a bimodal seasonality. A long-term asymmetric influence of aggregate precipitation (AP) (Wald long-run asymmetry [WLR] = - 2.697, P = 0.008) and aggregate sunshine hours (ASH) (WLR = 2.561, P = 0.011) on HFRS was observed. Additionally, a short-term asymmetric impact of AP (Wald short-run symmetry [WSR] = - 2.419, P = 0.017), ASH (WSR = 2.075, P = 0.04), mean wind velocity (MWV) (WSR = - 4.594, P < 0.001), and mean relative humidity (MRH) (WSR = - 2.515, P = 0.013) on HFRS was identified. Also, HFRS demonstrated notable variations in response to positive and negative changes in ∆MRH(-), ∆AP(+), ∆MWV(+), and ∆ASH(-) at 0-2 month delays over the short term. In terms of forecasting, the NARDL model demonstrated lower error rates compared to ARDL. Meteorological parameters have substantial long- and short-term asymmetric and/or symmetric impacts on HFRS. Merging NARDL model with meteorological factors can enhance early warning systems and support proactive measures to mitigate the disease's impact.

Serum Concentrations of TIM-3, LAG-3, and PD-1 in Patients with Hemorrhagic Fever with Renal Syndrome

Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne disease widespread in Europe and Asia. HFRS is caused by negative-sensed single-stranded RNA orthohantaviruses transmitted to humans through inhaling aerosolized excreta of infected rodents. Symptoms of HFRS include acute kidney injury, thrombocytopenia, hemorrhages, and hypotension. The immune response raised against viral antigens plays an important role in the pathogenesis of HFRS. Inhibitory co-receptors are essential in regulating immune responses, mitigating immunopathogenesis, and reducing tissue damage. Our research showed an increased soluble form of inhibitory co-receptors TIM-3, LAG-3, and PD-1 in HFRS patients associated with disease severity. Our study aimed to investigate the impact of HFRS on the concentrations of soluble forms of inhibitory receptors TIM-3, LAG-3, and PD-1 in the patient's serum and the potential correlation with key clinical parameters. Our study aimed to investigate the impact of HFRS on the concentrations of soluble forms of inhibitory receptors TIM-3, LAG-3, and PD-1 in the patient's serum and their possible association with relevant clinical parameters. Using multiplex immunoassay, we found elevated levels of TIM-3, LAG-3, and PD-1 proteins in the serum of HFRS patients. Furthermore, increased levels were associated with creatinine, urea, lactate dehydrogenase concentrations, and platelet count. These findings suggest that these proteins play a role in regulating the immune response and disease progression.

Epidemiological and clinical characteristics of death from hemorrhagic fever with renal syndrome: a meta-analysis

Introduction

Hemorrhagic fever with renal syndrome (HFRS) is an acute infectious disease comprising five stages: fever, hypotension, oliguria, diuresis (polyuria), and convalescence. Increased vascular permeability, coagulopathy, and renal injury are typical clinical features of HFRS, which has a case fatality rate of 1-15%. Despite this, a comprehensive meta-analyses of the clinical characteristics of patients who died from HFRS is lacking.

Methods

Eleven Chinese- and English-language research databases were searched, including the China National Knowledge Infrastructure Database, Wanfang Database, SinoMed, VIP Database, PubMed, Embase, Scopus, Cochrane Library, Web of Science, Proquest, and Ovid, up to October 5, 2023. The search focused on clinical features of patients who died from HFRS. The extracted data were analyzed using STATA 14.0.

Results

A total of 37 articles on 140,295 patients with laboratory-confirmed HFRS were included. Categorizing patients into those who died and those who survived, it was found that patients who died were older and more likely to smoke, have hypertension, and have diabetes. Significant differences were also observed in the clinical manifestations of multiple organ dysfunction syndrome, shock, occurrence of overlapping disease courses, cerebral edema, cerebral hemorrhage, toxic encephalopathy, convulsions, arrhythmias, heart failure, dyspnea, acute respiratory distress syndrome, pulmonary infection, liver damage, gastrointestinal bleeding, acute kidney injury, and urine protein levels. Compared to patients who survived, those who died were more likely to demonstrate elevated leukocyte count; decreased platelet count; increased lactate dehydrogenase, alanine aminotransferase, and aspartate aminotransferase levels; prolonged activated partial thromboplastin time and prothrombin time; and low albumin and chloride levels and were more likely to use continuous renal therapy. Interestingly, patients who died received less dialysis and had shorter average length of hospital stay than those who survived.

Conclusion

Older patients and those with histories of smoking, hypertension, diabetes, central nervous system damage, heart damage, liver damage, kidney damage, or multiorgan dysfunction were at a high risk of death. The results can be used to assess patients' clinical presentations and assist with prognostication.Systematic review registration:https://www.crd.york.ac.uk/prospero/, (CRD42023454553).

Comparison of simulation and predictive efficacy for hemorrhagic fever with renal syndrome incidence in mainland China based on five time series models

Background

Hemorrhagic fever with renal syndrome (HFRS) is a zoonotic infectious disease commonly found in Asia and Europe, characterized by fever, hemorrhage, shock, and renal failure. China is the most severely affected region, necessitating an analysis of the temporal incidence patterns in the country.

Methods

We employed Autoregressive Integrated Moving Average (ARIMA), Long Short-Term Memory (LSTM), Convolutional Neural Network (CNN), Nonlinear AutoRegressive with eXogenous inputs (NARX), and a hybrid CNN-LSTM model to model and forecast time series data spanning from January 2009 to November 2023 in the mainland China. By comparing the simulated performance of these models on training and testing sets, we determined the most suitable model.

Results

Overall, the CNN-LSTM model demonstrated optimal fitting performance (with Root Mean Square Error (RMSE), Mean Absolute Percentage Error (MAPE), and Mean Absolute Error (MAE) of 93.77/270.66, 7.59%/38.96%, and 64.37/189.73 for the training and testing sets, respectively, lower than those of individual CNN or LSTM models).

Conclusion

The hybrid CNN-LSTM model seamlessly integrates CNN's data feature extraction and LSTM's recurrent prediction capabilities, rendering it theoretically applicable for simulating diverse distributed time series data. We recommend that the CNN-LSTM model be considered as a valuable time series analysis tool for disease prediction by policy-makers.

A retrospective study of variations in the kinds of diseases discharged from the Department of Infectious Diseases of a large general hospital in Central China during 2013-2019

Objective

To analyze the changing trend of the absolute number and constituent ratio of various in-patient diseases in the Department of Infectious Diseases of a large general hospital in Central China during 2013-2019.

Methods

A retrospective study was conducted to analyze the diagnostic data of discharged patients for seven consecutive years, from 2013 to 2019. The first discharge diagnosis is used as the basis for the disease classification. The absolute number, constituent ratio, and changing trend of major diseases in hepatobiliary diseases and infectious diseases were analyzed.

Results

The changing trend of the diseases during 2013-2019 showed that the absolute number of cases of hepatobiliary disease did not change significantly (p = 0.615), while the constituent ratio decreased significantly, from 68.01% in 2013 to 55.29% in 2019 (p<0.001). The absolute number (constituent ratio) of cases of infectious diseases increased significantly from 585 (21.91%) in 2013 to 1,244 (36.86%) in 2019 (p = 0.015, p<0.001). The major part of the increase was non-communicable infectious diseases (NCIDs).

Conclusion

During 2013-2019, the proportion of cases of hepatobiliary disease gradually decreased. The absolute number and proportion of cases of infectious diseases, especially NCIDs, have increased rapidly.

Exploring the Genetic Diversity and Molecular Evolution of Seoul and Hantaan Orthohantaviruses

Seoul (SEOV) and Hantaan (HTNV) orthohantaviruses are significant zoonotic pathogens responsible for hemorrhagic fever with renal syndrome. Here, we investigated the molecular evolution of SEOV and HTNV through phylogenetic and bioinformatic analyses using complete genome sequences of their large (L), medium (M), and small (S) gene segments. Despite similar epizootic cycles and clinical symptoms, SEOV and HTNV exhibited distinct genetic and evolutionary dynamics. The phylogenetic trees of each segment consistently showed major genetic clades associated with the geographical distribution of both viruses. Remarkably, SEOV M and S segments exhibit higher evolutionary rates, rapidly increasing genetic diversity, and a more recent origin in contrast to HTNV. Reassortment events were infrequent, but both viruses appear to utilize the M gene segment in genetic exchanges. SEOV favors the L or M segment reassortment, while HTNV prefers the M or S segment exchange. Purifying selection dominates in all three gene segments of both viruses, yet SEOV experiences an elevated positive selection in its glycoprotein Gc ectodomain. Key amino acid differences, including a positive 'lysine fence' (through residues K77, K82, K231, K307, and K310) located at the tip of the Gn, alongside the physical stability around an RGD-like motif through M108-F334 interaction, may contribute to the unique antigenic properties of SEOV. With the increasing global dispersion and potential implications of SEOV for the global public health landscape, this study highlights the unique evolutionary dynamics and antigenic properties of SEOV and HTNV in informing vaccine design and public health preparedness.

Epidemiological characteristics and prediction model construction of hemorrhagic fever with renal syndrome in Quzhou City, China, 2005-2022

Background

Hemorrhagic fever with renal syndrome (HFRS) is one of the 10 major infectious diseases that jeopardize human health and is distributed in more than 30 countries around the world. China is the country with the highest number of reported HFRS cases worldwide, accounting for 90% of global cases. The incidence level of HFRS in Quzhou is at the forefront of Zhejiang Province, and there is no specific treatment for it yet. Therefore, it is crucial to grasp the epidemiological characteristics of HFRS in Quzhou and establish a prediction model for HFRS to lay the foundation for early warning of HFRS.

Methods

Descriptive epidemiological methods were used to analyze the epidemic characteristics of HFRS, the incidence map was drawn by ArcGIS software, the Seasonal AutoRegressive Integrated Moving Average (SARIMA) and Prophet model were established by R software. Then, root mean square error (RMSE) and mean absolute error (MAE) were used to evaluate the fitting and prediction performances of the model.

Results

A total of 843 HFRS cases were reported in Quzhou City from 2005 to 2022, with the highest annual incidence rate in 2007 (3.93/100,000) and the lowest in 2022 (1.05/100,000) (P trend<0.001). The incidence is distributed in a seasonal double-peak distribution, with the first peak from October to January and the second peak from May to July. The incidence rate in males (2.87/100,000) was significantly higher than in females (1.32/100,000). Farmers had the highest number of cases, accounting for 79.95% of the total number of cases. The incidence is high in the northwest of Quzhou City, with cases concentrated on cultivated land and artificial land. The RMSE and MAE values of the Prophet model are smaller than those of the SARIMA (1,0,1) (2,1,0)12 model.

Conclusion

From 2005 to 2022, the incidence of HFRS in Quzhou City showed an overall downward trend, but the epidemic in high-incidence areas was still serious. In the future, the dynamics of HFRS outbreaks and host animal surveillance should be continuously strengthened in combination with the Prophet model. During the peak season, HFRS vaccination and health education are promoted with farmers as the key groups.

[Factors of the hemostasis system as biomarkers of severe course of acute viral infections]

The authors give literature review of hemostasis and immune system factors intraction as main biomarkers of a severe cause of viral infectious diseases. Pro-inflamatory cytokines as the main markers of inflammation, can serve both as biomarkers of the clinical severity of the infectious process and reflect the state of the hemostatic and fibrinolytic systems, since components of these systems are present in various structures of the central nervous system and affect the development of neurons and synaptic plasticity. An inverse correlation has been proven between the concentration of D-dimer and the oxygenation index, and the development of DIC is not associated with the presence of respiratory failure in patients with influenza type A, while the ferritin concentration directly reflects the severity of the disease. One of the markers of endothelial damage may be soluble thrombomodulin, which, however, is rarely used in routine clinical practice. Cytoflavin is a highly effective pathogenetic drug that affects various parts of the hemostasis system, has anti-ischemic, antioxidant, antihypoxic, immunocorrective effect, which is indicated for any generalized infectious disease since its debut.

FDG PET/CT in Hantavirus Hemorrhagic Fever With Renal Syndrome

ABSTRACT

A 58-year-old man with fever, myalgia, and dysuria was admitted to the hospital. Because of prolonged fever, FDG PET/CT was performed. Surprisingly, bilateral kidneys were rapidly enlarged for 5 days with the renal parenchyma showing intense hypermetabolism. FDG PET/CT demonstrated physiology of Hantavirus invading kidneys and causing nephritis. This case illustrates that FDG PET/CT could be the choice of image modality for diagnosis and treatment evaluation of patients suspected of hemorrhagic fever with renal syndrome. To the best of our knowledge, this is the first report of FDG PET/CT image for a patient with hemorrhagic fever with renal syndrome.