Abstract
Background
Hantavirus infections are endemic worldwide, and its incidence in Europe has been steadily increasing. In Western Europe, hantavirus infections are typically caused by Puumala hantavirus and cause nephropathia epidemica (NE), a mild form of haemorrhagic fever with renal syndrome. Up to now, there is only little data about the course of acute NE in children, but it has been suggested that hantavirus infections take a lighter course in children when compared to adults. We performed a retrospective analysis of adults and children diagnosed with acute NE in two counties in South-Western Germany to investigate if there are differences in the course of the disease.
Methods
We reviewed the medical records of 295 adults and 22 children with acute NE regarding clinical presentation, laboratory findings, complications and outcome.
Results
Acute kidney injury (AKI) and thrombocytopenia occurred at similar frequencies and severity in both groups. Sudden onset of fever and back/loin pain were two of the three most common symptoms in both adults and children. However, adults presented more frequently with arthralgia and visual disturbances, whereas abdominal pain and nausea/vomiting could be detected more often in children. No significant differences were found in the incidence of complications (haemodialysis, long-term outcome of kidney function, length of hospital stay).
Conclusions
The clinical course of acute NE was similar in adults and children with high frequency of AKI as well as thrombocytopenia, but with full recovery of all patients.
Similar content being viewed by others
References
Watson DC, Sargianou M, Papa A, Chra P, Starakis I, Panos G (2014) Epidemiology of hantavirus infections in humans: a comprehensive, global overview. Crit Rev Microbiol 40:261–272. https://doi.org/10.3109/1040841X.2013.783555
Peters CJ, Simpson GL, Levy H (1999) Spectrum of hantavirus infection: hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome. Annu Rev Med 50:531–545. https://doi.org/10.1146/annurev.med.50.1.531
Vapalahti O, Mustonen J, Lundkvist A, Henttonen H, Plyusnin A, Vaheri A (2003) Hantavirus infections in Europe. Lancet Infect Dis 3:653–661
Vaheri A, Henttonen H, Voutilainen L, Mustonen J, Sironen T, Vapalahti O (2013) Hantavirus infections in Europe and their impact on public health. Rev Med Virol 23:35–49. https://doi.org/10.1002/rmv.1722
Ettinger J, Hofmann J, Enders M, Tewald F, Oehme RM, Rosenfeld UM, Ali HS, Schlegel M, Essbauer S, Osterberg A, Jacob J, Reil D, Klempa B, Ulrich RG, Kruger DH (2012) Multiple synchronous outbreaks of Puumala virus, Germany, 2010. Emerg Infect Dis 18:1461–1464. https://doi.org/10.3201/eid1809.111447
Kruger DH, Ulrich RG, Hofmann J (2013) Hantaviruses as zoonotic pathogens in Germany. Dtsch Arztebl Int 110:461–467. https://doi.org/10.3238/arztebl.2013.0461
Latus J, Schwab M, Tacconelli E, Pieper FM, Wegener D, Dippon J, Muller S, Zakim D, Segerer S, Kitterer D, Priwitzer M, Mezger B, Walter-Frank B, Corea A, Wiedenmann A, Brockmann S, Pohlmann C, Alscher MD, Braun N (2015) Clinical course and long-term outcome of hantavirus-associated nephropathia epidemica, Germany. Emerg Infect Dis 21:76–83. https://doi.org/10.3201/eid2101.140861
Outinen TK, Makela S, Clement J, Paakkala A, Porsti I, Mustonen J (2015) Community acquired severe acute kidney injury caused by hantavirus-induced hemorrhagic fever with renal syndrome has a favorable outcome. Nephron 130:182–190. https://doi.org/10.1159/000433563
Mustonen J, Brummer-Korvenkontio M, Hedman K, Pasternack A, Pietila K, Vaheri A (1994) Nephropathia epidemica in Finland: a retrospective study of 126 cases. Scand J Infect Dis 26:7–13
Braun N, Haap M, Overkamp D, Kimmel M, Alscher MD, Lehnert H, Haas CS (2010) Characterization and outcome following Puumala virus infection: a retrospective analysis of 75 cases. Nephrol Dial Transplant 25:2997–3003. https://doi.org/10.1093/ndt/gfq118
Mustonen J, Huttunen NP, Brummer-Korvenkontio M, Vaheri A (1994) Clinical picture of nephropathia epidemica in children. Acta Paediatr 83:526–529
Ahlm C, Settergren B, Gothefors L, Juto P (1994) Nephropathia epidemica (hemorrhagic fever with renal syndrome) in children: clinical characteristics. Pediatr Infect Dis J 13:45–49
Lautala P, Uhari M (1991) Epidemic nephropathy in children. Am J Dis Child 145:1181–1183
Huttunen NP, Makela S, Pokka T, Mustonen J, Uhari M (2011) Systematic literature review of symptoms, signs and severity of serologically confirmed nephropathia epidemica in paediatric and adult patients. Scand J Infect Dis 43:405–410. https://doi.org/10.3109/00365548.2011.559666
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, Network AKI (2007) Acute kidney injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31. https://doi.org/10.1186/cc5713
Outinen TK, Laine OK, Makela S, Porsti I, Huhtala H, Vaheri A, Mustonen J (2016) Thrombocytopenia associates with the severity of inflammation and variables reflecting capillary leakage in Puumala hantavirus infection, an analysis of 546 Finnish patients. Infect Dis (Lond) 48:682–687. https://doi.org/10.1080/23744235.2016.1192719
Acham-Roschitz B, Aberle SW, Pirker N, Kaulfersch W, Boehm M, Roedl S, Zenz W, Ring E, Mache CJ (2010) Nephropathia epidemica (puumala virus infection) in Austrian children. Pediatr Infect Dis J 29:874–876. https://doi.org/10.1097/INF.0b013e3181dfbbe5
Makary P, Kanerva M, Ollgren J, Virtanen MJ, Vapalahti O, Lyytikainen O (2010) Disease burden of Puumala virus infections, 1995-2008. Epidemiol Infect 138:1484–1492. https://doi.org/10.1017/S0950268810000087
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
The study was approved by the ethic committee of the University of Tübingen.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Echterdiek, F., Kitterer, D., Alscher, M.D. et al. Clinical course of hantavirus-induced nephropathia epidemica in children compared to adults in Germany—analysis of 317 patients. Pediatr Nephrol 34, 1247–1252 (2019). https://doi.org/10.1007/s00467-019-04215-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-019-04215-9