nephropathia epidemica

Nephropathia Epidemica: A Zoonotic Disease

Nephropathia epidemica (NE) is a zoonosis, or an animal-borne disease, that affects humans. It is

Nephropathia epidemica, also known as Puumala virus disease, is a zoonotic illness caused by the Puumala type of hantavirus. The symptoms of this disease can vary in severity and may include:

• Fever: A sudden onset of fever is one of the initial symptoms of nephropathia epidemica [1].
• Headache: Intense headaches are a common symptom, often accompanied by back and abdominal pain [1].
• Nausea and vomiting: Many individuals experience nausea and vomiting as part of their clinical course [3].
• Flulike illness: Nephropathia epidemica can manifest as a self-limited flulike illness with proteinuria, azotemia, and petechiae [3].
• Proteinuria: Proteinuria is a common finding in patients with nephropathia epidemica, indicating kidney damage [3].
• Azotemia: Azotemia, or elevated levels of nitrogen waste products in the blood, can also occur in some cases [3].
• Petechiae: Petechiae, or small red spots on the skin, may be present in some individuals [3].
• Respiratory symptoms: Some patients may experience respiratory symptoms such as coughing and shortness of breath [11].
• Ophthalmologic symptoms: Ocular symptoms like conjunctivitis and blurred vision have been reported in a few cases [1].
• Neurologic symptoms: Rarely, nephropathia epidemica can cause neurologic symptoms such as headache, confusion, and seizures [11].

It's essential to note that the severity of these symptoms can vary widely among individuals, and some people may experience only mild or no symptoms at all.

Nephropathia epidemica, also known as Puumala virus infection, can be diagnosed through various diagnostic tests.

• Serologic tests: These are the mainstay of diagnosis for nephropathia epidemica. Serologic tests detect the presence of antibodies against the Puumala virus in a patient's blood. According to search result [9], serologic testing is used to diagnose nephropathia epidemica, and it was found that 40 out of 41 clinically accepted cases were serologically positive.
• Reverse transcriptase–polymerase chain reaction (RT-PCR): This molecular test can detect the genetic material of the Puumala virus in a patient's blood or urine. As per search result [8], laboratory diagnosis of hantavirus infection, including nephropathia epidemica, is established by serologic tests and RT-PCR.
• Indirect immunofluorescence assay (IFA): This test was the first clinical diagnostic test for nephropathia epidemica. It detects antibodies against the Puumala virus in a patient's blood using tissue sections of PUUV-infected bank voles.

It is worth noting that the diagnosis of nephropathia epidemica can be challenging, and a combination of clinical evaluation, serologic tests, and molecular testing may be necessary to confirm the diagnosis.

Nephropathia epidemica, also known as hemorrhagic fever with renal syndrome (HFRS) caused by the Puumala virus, is a serious disease that requires prompt medical attention.

Treatment Overview

The treatment for nephropathia epidemica is primarily supportive, focusing on managing symptoms and preventing complications. According to various studies [6][9], the following treatments may be necessary:

• Renal dialysis: This may be required in severe cases of kidney damage.
• Supportive therapy: This includes measures such as fluid management, electrolyte balance, and blood pressure control.

Specific Treatments

While there are no specific antiviral medications approved for treating nephropathia epidemica, some studies suggest that:

• Ribavirin: May be effective in reducing the severity of symptoms [10].
• Glucocorticoids: Are not recommended as treatment for this condition [8].

Other Considerations

It's essential to note that antihypertensive agents, vasoactive drugs, colloids, or diuretics may be needed to control hypertension, treat shock, or induce diuresis, respectively [4]. Additionally, mechanical ventilation and meticulous volume control may be required in severe cases of hantavirus pulmonary syndrome (HPS) [7].

References

[1-6] Various studies on hantavirus infections [8] Study involving 60 Chilean patients with HCPS [9] Article discussing the treatment of HFRS [10] Clinical study on ribavirin therapy for HFRS

Differential Diagnosis of Nephropathia Epidemica

Nephropathia epidemica (NE) is a zoonotic disease caused by the Puumala type of hantavirus. When diagnosing NE, it's essential to consider other conditions that may present with similar symptoms. Here are some differential diagnoses for NE:

• Viral infections: Adenovirus, cytomegalovirus, enterovirus, and influenza can all cause fever, thrombocytopenia, and renal failure, making them potential differential diagnoses for NE.
• Hemorrhagic Fever with Renal Syndrome (HFRS): HFRS is a severe form of hantavirus infection that can present with similar symptoms to NE. However, the severity and progression of HFRS are typically more pronounced than in NE.
• Acute disseminated encephalomyelitis: This condition can cause multiorgan failure, which may be mistaken for NE.
• Multiorgan failure: NE can also be considered in the differential diagnosis of multiorgan failure.

Key Considerations

When considering a differential diagnosis for NE, it's essential to note that:

• The incidence of NE varies cyclically, with peaks occurring every 3rd to 4th year, coinciding with peaks in vole populations.
• The disease typically presents with self-limiting renal failure, thrombocytopenia, fever, lower back and/or abdominal pain.

References

• [1] Nephropathia epidemica (NE) is a prevalent zoonosis throughout Europe and is caused by the Puumala type of hantavirus. The incidence of NE varies in a cyclic fashion, with peaks occurring every 3rd to 4th year, coinciding with peaks in vole populations.
• [11] The mild form of HFRS (nephropathia epidemica) is found in the Scandinavian countries of Finland, Sweden, Denmark, and Norway. The differential diagnoses include viral infections, hemorrhagic fever with renal failure syndrome, acute disseminated encephalomyelitis, and multiorgan failure.
• [13] The severity of Puumala hantavirus-induced nephropathia epidemica can be emphasized in the algorithm of differential diagnosis of pathologies associated with thrombocytopenia, anemia, hepatic cytolysis syndrome, and renal injury.