Diagnostic Challenge of Hemorrhagic Fever with Renal Syndrome on Admission before its Serological Confirmation

Kim, Ho Jung; Han, Sang Woong

Abstract

PURPOSE
The purpose of this study was to look for possible changes from typical clinical features of 5 sequential clinical phases described in 1950s. METHODS: The clinical features and laboratory data of hemorrhagic fever with renal syndrome (HFRS) with acute renal failure (ARF) and its subdivided 2 groups of correct and incorrect impression of HFRS on admission before the serological confirmation were reevaluated in 35 patients admitted at a single tertiary center from 1995 to 2000. RESULTS: We experienced the high failure rate (74%, 26/35) to recognize HFRS as the cause of ARF on admission. On admission, fever was present in all patients (100 %), and thirty three (94%) had either single or combined gastrointestinal symptoms. However, no one had clinical shock and only 4 patients (11%) had hypotension. Also, oliguria was noted only in 5 patients (14%) during the first 24 hrs on admission. When compared between 2 groups of correct (n=9) and incorrect impression of HFRS (n=26), febrile (100% vs 100%) and gastrointestinal symptoms (89% vs 96%) were present high both but hematologic (67% vs 23%) and hemodynamic signs (67% vs 4%) were much less present in the latter. The patients of incorrect impression on admission were admitted more than half (14/26, 54%) under non-renal care, and were exposed to antibiotics (46%) and even steroids (15%), respectively. In addition, these patients with incorrect impression on admission showed the unwanted outcomes of longer hospitalization than those with correct impression of HFRS (mean+/-SD, 21+/-3 vs. 12+/-4 days, p<0.01). CONCLUSION: Its well awareness of the changing clinical features in endemic area of HFRS would avoid overlooking Hantaviruses as a causal agent of ARF on the initial admission stage of HFRS leading to unnecessary treatments and longer hospitalization.