OBJECTIVE: Hantavirus infections are emerging infections that cause either Hantavirus pulmonary syndrome or haemorrhagic fever with renal syndrome (HFRS). A recent Swedish outbreak of nephropathia epidemica, a European HFRS, was analysed to study the patient flow and clinical picture and to investigate the value of an early diagnosis in general practice. Design. In a retrospective design, medical records of verified cases of Hantavirus infection were studied. SETTING: The study was conducted in the county of Norrbotten, Sweden. SUBJECTS: Data from Hantavirus patients diagnosed between 2006 and 2008 were analysed. MAIN OUTCOME MEASURES: Demographic data, level of care, treatment, clinical symptoms, and laboratory findings were obtained. RESULTS: In total, 456 cases were included (58% males and 42% females). The majority of patients first saw their general practitioner and were exclusively treated in general practice (83% and 56%, respectively). When diagnosed correctly at the first visit, antibiotics and hospitalization were significantly lowered compared with delayed diagnosis (14% vs. 53% and 30% vs. 54%, respectively; p < 0.0001). The clinical picture was diverse. Early thrombocytopenia was found in 65% of the patients, and haemorrhagic manifestations were documented in a few cases. Signs of renal involvement--haematuria, proteinuria, and raised levels of serum creatinine--were found in a majority of patients. CONCLUSIONS: Raised awareness in general practice regarding emerging infections and better diagnostic tools are desirable. This study of a Hantavirus outbreak shows that general practitioners are frontline doctors during outbreaks and through early and correct diagnosis they can reduce antibiotic treatment and hospitalization.
OBJECTIVE:Hantavirus infections are emerging infections that cause either Hantavirus pulmonary syndrome or haemorrhagic fever with renal syndrome (HFRS). A recent Swedish outbreak of nephropathia epidemica, a European HFRS, was analysed to study the patient flow and clinical picture and to investigate the value of an early diagnosis in general practice. Design. In a retrospective design, medical records of verified cases of Hantavirus infection were studied. SETTING: The study was conducted in the county of Norrbotten, Sweden. SUBJECTS: Data from Hantaviruspatients diagnosed between 2006 and 2008 were analysed. MAIN OUTCOME MEASURES: Demographic data, level of care, treatment, clinical symptoms, and laboratory findings were obtained. RESULTS: In total, 456 cases were included (58% males and 42% females). The majority of patients first saw their general practitioner and were exclusively treated in general practice (83% and 56%, respectively). When diagnosed correctly at the first visit, antibiotics and hospitalization were significantly lowered compared with delayed diagnosis (14% vs. 53% and 30% vs. 54%, respectively; p < 0.0001). The clinical picture was diverse. Early thrombocytopenia was found in 65% of the patients, and haemorrhagic manifestations were documented in a few cases. Signs of renal involvement--haematuria, proteinuria, and raised levels of serum creatinine--were found in a majority of patients. CONCLUSIONS: Raised awareness in general practice regarding emerging infections and better diagnostic tools are desirable. This study of a Hantavirus outbreak shows that general practitioners are frontline doctors during outbreaks and through early and correct diagnosis they can reduce antibiotic treatment and hospitalization.
Authors: M H Miettinen; S M Mäkelä; I O Ala-Houhala; H S A Huhtala; T Kööbi; A I Vaheri; A I Pasternack; I H Pörsti; J T Mustonen Journal: Kidney Int Date: 2006-06 Impact factor: 10.612
Authors: C Ahlm; A Thelin; F Elgh; P Juto; E L Stiernström; S Holmberg; A Tärnvik Journal: Scand J Work Environ Health Date: 1998-04 Impact factor: 5.024
Authors: Olli Vapalahti; Jukka Mustonen; Ake Lundkvist; Heikki Henttonen; Alexander Plyusnin; Antti Vaheri Journal: Lancet Infect Dis Date: 2003-10 Impact factor: 25.071