Background. Over last five years, 20 cases of Hemorrhagic Fever with Renal syndrome (HFRS) have been officially registered in Ukraine. We believe that the real incidence rates of HFRS are significantly higher. This underdiagnosis is partially due to the rarity of HFRS cases in Ukraine and the limited number of patients that are referred to specialists for laboratory examinations.

Case description. Patient D., 34 years old, became acutely ill with a fever of 39°C, back pain, nausea, and weakness. He was hospitalized with suspicion of leptospirosis. The biochemical panel revealed increasing levels of creatinine and urea, and the level of ALAT was slightly elevated.  Other biochemical data were normal. A complete blood cell count (CBC) revealed thrombocytopenia. Tests for viral hepatitis and leptospirosis were negative. HFRS was not suspected at this stage and symptomatic treatment was prescribed. The patient was discharged from the hospital on the 17th day of the disease. However, the patient's condition was not satisfactory, and the patient was hospitalized again on the 20th day of the disease. CBC, urine test, and coagulation test were unchanged. Only an elevated level of ALT(120.6 U/l) was identified.  An epidemiological review of the patient’s history revealed that he worked in a fish farm, feeding fish with dry food that was stored where rodents were possibly present. During the second hospitalization, the doctor again did not suspect HFRS. Only on the 25th day of the illness, during a multi-disciplinary meeting on the basis of the epidemiological history and after familiarization with the initial clinical signs and symptoms, was HFRS suspected. On the 25th day of the disease, Hantavirus IgM (IFA titer 1:640) and IgG (titer 1:10240) were detected in the blood of the patient. The patient received symptomatic therapy and was discharged on the 32nd day of disease.

Discussion. This case demonstrates a low vigilance of Ukrainian doctors to Hantavirus infection. To improve diagnosis and detect more cases of HFRS, it is necessary to introduce a mandatory examination of all patients with fever and kidney damage, as well as with suspicion of leptospirosis for Hantaviruses. 

Patients with leptospirosis had lower levels of adaptation markers at the start of the disease, which likely corresponds to a "stress reaction". As the disease progressed there was a trend of the values returning to normal ranges, likely corresponding to the "reaction of orientation". These findings suggest a potential use of hematological blood indices as predictors of disease severity for leptospirosis.

The GIS technologies allowed to obtain a spatial understanding of the Leptospira geographical distribution in Lviv Oblast. These differences may allow us to identify specific risk factors associated with these differences. More detailed studies on the epidemiology of Leptospirosis in the Lviv Oblast are needed. 

In Lviv Oblast, predominance of severe icteric forms is typical for hospitalized leptospirosis patients (77.08%) with various complications (74.17% of patients), the most common of them is acute renal failure (51.85%). L. icterohaemorrhagiae, which caused a quarter of all cases, was the main causative agent of leptospirosis in Lviv Oblast during the study period.

Introduction and aim. Earlier, by applying the water-immersion and restraint stress (WIRS) model, we reproduced primary attributes of stress and found that the severity of the damage to the gastric mucosa correlates with changes in ECG parameters, which indicate myocardial dystrophy. Further, it was found that such a connection is caused by the damaging effect on both targets of increasing the level of parathyroid hormone, as well as the production of aldosterone and catecholamines by enlarged adrenal glands. In addition, an increase in the level of corticosterone and sympathetic tone with a simultaneous decrease in vagal tone as well as serum calcitonin and testosterone cause damage to the gastric mucosa, but not to the myocardium. Such a constellation of neuro-endocrine reactions to stressors determines the severity of damage to the gastric mucosa and myocardium by 73%. The purpose of this study is to find out metabolic and immune accompaniments of electrocardiogram and gastric mucosa parameters in naїve and stressed rats. Material and methods. The experiment is at 18 male and 20 female Wistar rats. Over the 10 days, one animal remained intact and 3 other rats were exposed to WIRS. The next day after stressing, immune and metabolic parameters as well as ECG and gastric mucosa injuries was recorded. Results. Serum levels of Phosphates, Сatalase and α-LP Cholesterol as well as erythrocyte level of Potassium and Na,K-ATPase activity of the erythrocyte are positively correlated with ECG markers of myocardial damage, and negatively correlated with visual markers of damage to the gastric mucosa. Erythrocyte level of Sodium and serum levels of Potassium and Alkaline Phosphatase reflect the intactness of the gastric mucosa only. While serum level of Calcium reflects damage to the gastric mucosa. Taken together, the listed metabolic factors determine the morpho-functional state of the gastric mucosa and myocardium by 72% (R=0.851). Damage to the gastric mucosa and myocardium is more severe, the lower the bactericidal activity of blood neutrophils, and the greater the mass of the thymus. The spleen mass and the content of fibroblasts in the thymus are negatively correlated only with the severity of damage to the gastric mucosa, while the percentages of reticulocytes and lymphoblasts in the spleen are positively correlated with it. Finally, the higher the percentage of macrophages in the thymus, the deeper the damage to the myocardium. The canonical correlation between the listed immune parameters and markers of the two targets of stressors is very strong (R=0.809). Conclusion. Water-immersion and restraint stress causes changes in the neuro-endocrine-immune complex, which lead to changes in the metabolome and damage to the gastric mucosa and myocardium.