I Christova1, M Pishmisheva2, I Trifonova3, N Vatev4, M Stoycheva5, M Tiholova6, D Igova7, M Baev8, R Karagyaurova9, U Prokopova10. 1. National Center of Infectious and Parasitic Diseases, Blvd. Yanko Sakazov 26, 1504, Sofia, Bulgaria. iva_christova@yahoo.com. 2. Department of Infectious Diseases, Regional Hospital Pazardzhik, Pazardzhik, Bulgaria. 3. National Center of Infectious and Parasitic Diseases, Blvd. Yanko Sakazov 26, 1504, Sofia, Bulgaria. 4. Department of Epidemiology of Infectious Diseases, Medical University-Plovdiv, Plovidv, Bulgaria. 5. Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University-Plovdiv, Plovidv, Bulgaria. 6. University Hospital for Infectious and Parasitic Diseases, Sofia, Bulgaria. 7. Department of Infectious Diseases, Regional Hospital Ruse, Ruse, Bulgaria. 8. Department of Infectious Diseases, Regional Hospital Sliven, Sliven, Bulgaria. 9. Department of Infectious Diseases, Regional Hospital Smolyan, Smolyan, Bulgaria. 10. Department of Infectious Diseases, Regional Hospital Gotse Delchev, Gotse Delchev, Bulgaria.
Abstract
BACKGROUND: Hantaviruses cause two distinct human diseases: hemorrhagic fever with renal syndrome (HFRS) in Asia and Europe and hantavirus pulmonary syndrome (HPS) in America. In Europe, mainly Puumala, Dobrava and Seoul viruses cause HFRS. A total of 23 cases of HFRS were detected in Bulgaria over a 2‑year period 2013-2014. The aim of the study was to present epidemiology, clinical manifestations and laboratory findings of these patients. METHODS: Patients with HFRS were diagnosed using PCR, ELISA and immunoblotting tests. RESULTS: Dobrava-Belgrade virus (DOBV) was revealed as etiological agent in 16 (69.6%) patients and Puumala virus (PUUV) in 7 (30.4%) patients. All 23 patients were men aged 22-66 years of which 6 (26.1%) patients originated from regions in northern and western Bulgaria previously thought to be non-endemic. Patients with HFRS, despite the infecting hantavirus, manifested acute renal failure, asthenia and less pronounced hemorrhagic syndrome. Patients with DOBV infection were much more likely to present with arthromyalgia, severe headache, severe to moderately severe asthenoadynamia, abdominal pain, vomiting, hypotension, nervous system disorders as well as kidney enlargement, leucopenia and higher levels of blood creatinine, requiring hemodialysis procedures more often and for a longer period of time than patients with PUUV infection. CONCLUSIONS: The present report describes for the first time comparative analysis of epidemiological features, clinical manifestations and laboratory findings of DOBV and PUUV infections in Bulgaria.
BACKGROUND: Hantaviruses cause two distinct human diseases: hemorrhagic fever with renal syndrome (HFRS) in Asia and Europe and hantavirus pulmonary syndrome (HPS) in America. In Europe, mainly Puumala, Dobrava and Seoul viruses cause HFRS. A total of 23 cases of HFRS were detected in Bulgaria over a 2‑year period 2013-2014. The aim of the study was to present epidemiology, clinical manifestations and laboratory findings of these patients. METHODS:Patients with HFRS were diagnosed using PCR, ELISA and immunoblotting tests. RESULTS:Dobrava-Belgrade virus (DOBV) was revealed as etiological agent in 16 (69.6%) patients and Puumala virus (PUUV) in 7 (30.4%) patients. All 23 patients were men aged 22-66 years of which 6 (26.1%) patients originated from regions in northern and western Bulgaria previously thought to be non-endemic. Patients with HFRS, despite the infecting hantavirus, manifested acute renal failure, asthenia and less pronounced hemorrhagic syndrome. Patients with DOBVinfection were much more likely to present with arthromyalgia, severe headache, severe to moderately severe asthenoadynamia, abdominal pain, vomiting, hypotension, nervous system disorders as well as kidney enlargement, leucopenia and higher levels of blood creatinine, requiring hemodialysis procedures more often and for a longer period of time than patients with PUUV infection. CONCLUSIONS: The present report describes for the first time comparative analysis of epidemiological features, clinical manifestations and laboratory findings of DOBV and PUUV infections in Bulgaria.
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