A clinical case of Hemorrhagic Fever with Renal Syndrome in Lviv oblast. Difficulties of diagnostics

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.