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Hemorrhagic fever with renal syndrome

Clinics in Dermatology
Publication Date
DOI: 10.1016/0738-081x(89)90031-x
  • Biology
  • Design
  • Medicine


Abstract The term “hemorrhagic fever” was first proposed by Japanese workers describing a new disease that had spread widely in areas between northeastern China and Siberia during the early 1930s. 1 Following this, a group of diseases characterized clinically by high fever and hemorrhagic manifestations, some with renal lesions and most with high mortality, were designated “viral hemorrhagic fever.” 2,3 A tentative classification according to the mode of transmission is shown in Table 9-1. Viral hemorrhagic fevers comprise 14 disease entities with different viral etiology. Some viruses are antigenically related, while others are entirely different. The classification of viral hemorrhagic fevers is shown in Table 9-2. Viral hemorrhagic fevers are zoonotic diseases. The viruses are mainly circulated and maintained in the animal hosts and the arthropod vectors. Human infections are usually from casual contacts with the virus-carrying animals (reservoir), or their bloodsucking ectoparasites. Other modes of transmission include contact with patient's blood, 3 air-borne, food-borne and mite-biting. 4 Vertical transmission may occur in vectors (ticks or laelaps) and animal carriers. Virus or viral antigens have been demonstrated in fetuses of human 5 and rodents. 6 The common clinical features include high fever, symptoms and signs of toxemia, hemorrhagic manifestations in various degrees, and shock (Table 9-3). Viral hemorrhagic fevers fall into two categories: those with renal involvement and those without. Hemorrhagic fever with renal syndrome (HFRS) is primarily caused by Hantanviruses and occasionally by Arenaviruses. Diagnosis of hemorrhagic fever depends on clinical features and epidemiologic characteristics. The causative agents can usually be isolated from blood, pharyngeal secretions, urine, cerebrospinal fluid, and tissues; by inoculation to newborn mice or hamsters; or certain cell cultures. Demonstration of antibody rise is useful for further confirmation. Early diagnosis can be made by demonstration of viral antigen in the serum or leukocytes 7 and/or demonstration of specific IgM antibodies. 8

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