14th ICID - Poster Abstracts - International Society for Infectious ...

When citing these abstracts please use the following reference:
Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number.
Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1
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Final Abstract Number: 76.012
Session: Emerging Infectious Diseases
Date: Friday, March 12, 2010
Time: 12:30-13:30
Room: Poster & Exhibition Area/Ground Level
Type: Poster Presentation
Study of Hanta-viral hemorrhagic fever with renal syndrome (HFRS) in an endemic region of
Bulgaria
I. Baltadzhiev
Medical University, Plovdiv, Bulgaria
Background: HFRS started registration in Bulgaria since 1953. The major epidemics were first
described during 1957 and 1959 in Western Rhodopa region. In the 1953-1991 period 412
patients were registered and 67 of them with lethal exit.
The aim of the study was to describe the clinical and epidemiological characteristics of HFRS,
and to discuss the professional implications of the disease, as well as its control and prevention.
Methods: The authors analyze clinical, laboratory and epidemiological data about 21 cases of
HFRS for the period 1987-2009. The cases were etiologically proven in the National Reference
Arboviral laboratory. Hantaan (37.5%) and Puumala (12.5%) viruses were identified.
Results: All cases were registered in typical season - early spring, summer and late autumn.
Males (80.95%) present risk gender group for HFRS related to profession – military servants,
construction workers in the endemic mountain regions etc. Mountaineer personnel are exposed to
infection when working, digging, eating or sleeping in fields infested by infected rodents.
Patient age varies from 14 to 83 (38.52 ± 4.49) years and 57.14% of them were between 15-35
years old. Patients were febrile several days before admission, had dull and some of them
severe abdominal pain, decreased urine output, diarrhoea (53%) visual troubles (48%) and
arthromyalgiae. Bleeding was moderately expressed and rarely abundant (cavity organ
hemorrhages in 30%). Jaundice was mild and not frequent.
Blood tests showed metabolic acidosis, increased serum creatinine (784±72 mmol/l), blood urea
nitrogen (37±5 mmol/l), potassium (5.9±0.5 mmol/l), ALT (67±8.1 U/l), AST (89±7.4 U/l) and
decreased PLT (78±18x109/l), haemoglobin (7.4±2.2 mmol/l) and fibrinogen (1.98±0.34 mmol/l)
levels. Urinanalysis showed considerable proteinuria, leukocyturia and degenerated renal
epithelial cells with so-called fat corpuscles. Ultrasound: enlarged kidneys with acute
parenchymal lesions. One of our patients with 8-fold increased antibody titer to Hanta-virus
developed hemolytic anemia, decreased haptoglobin levels and exhibited transitional neurological
signs, mimicking thrombocytopenic-thrombotic syndrome. In the last years lethal exit is very rare.
Only one patient (4.76%), admitted in infectious shock state and abundant bleeding died four
hours after admission.
Conclusion: Deep changes in the social-economic standards of last decades affected the
spreading of HFRS and respective morbidity and mortality in this case.