MEDIX, God. 18 Br. 100  •  Pregledni članak  •  Infektologija HR ENG

Hemoragijska vrućica s bubrežnim sindromomHaemorrhagic fever with renal syndrome

Vladimir Krajinović, Lidija Cvetko Krajinović

Hemoragijska vrućica s bubrežnim sindromom (HVBS) je zoonoza koju uzrokuju hantavirusi. Infekcija ovim virusima dobiva se najčešće inhalacijom aerosola s česticama koje sadržavaju virus ili drugim kontaminiranim izlučevinama (mokraćom, stolicom, slinom) inficiranih glodavaca. Infekcija može životno ugroziti bolesnika zahvativši pluća i bubrege. Klinički tijek, međutim, može biti vrlo varijabilan, a neki zaraženi bolesnici su bez bilo kakvih simptoma. Bolesnici s teškim, klasičnim HVBS-om postupno progrediraju od vrućice s krvarenjima do hipotenzije i šoka, a zatim i do akutnog bubrežnog zatajenja. Bubrežne manifestacije razlikuju se ovisno o tipu hantavirusne infekcije, najteže su kod infekcije virusima Hantaan, Dobrava i Seoul, a blaže kod infekcije virusom Puumala koji je dominantan u Hrvatskoj. Čini se da glavnu ulogu u patogenezi teških hantavirusnih infekcija ima povećana propusnost krvnih žila. Dijagnoza se postavlja na osnovi epidemiološke anamneze o izloženosti glodavcima, kliničke slike, laboratorijskih nalaza koji upućuju na ovu bolest (trombocitopenija, povišena vrijednost serumskoga kreatinina i ureje, proteinurija, hematurija), a potvrđuje se serološkim i molekularnim dijagnostičkim metodama. Ne postoji specifična antivirusna terapija za hantavirusne infekcije, a jedino liječenje je simptomatsko. 

Ključne riječi:
akutno zatajenje bubrega; Hantavirus; hemoragijska vrućica s bubrežnim sindromom

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 18 Br. 100

Haemorrhagic fever with renal syndrome (HF RS) is a zoonosis caused by Hantaviruses. Hantavirus infection is acquired by inhalation of aerosol containing virus particles or by contact with urine, secretions or faeces of infected rodents. The infection may lead to life-threatening pulmonary and renal disease. The clinical course, however, can be very variable, and some of the infected patients are asymptomatic. Severe, classic form of HF RS may progress from fever with haemorrhage to hypotension and shock and, eventually, acute oliguric renal failure. Renal manifestations may vary depending on the type of hantavirus infection – the signs and symptoms are more severe with Hantaan and Dobrava virus infections and milder with Puumala virus infection, which is predominant in Croatia. Increased vascular permeability seems to play the main role in the pathogenesis of severe hantavirus infections. The diagnosis is based on a history of potential exposure to rodents, clinical presentation, laboratory findings suggestive of the diagnosis (thrombocytopenia, elevated serum urea and creatinine level, proteinuria and haematuria) and confirmed by serologic findings or molecular diagnostic methods. Since there are no specific antiviral therapies for hantavirus infection, the therapy is restricted to supportive care. 

Key words:
acute kidney failure; Hantavirus; hemorrhagic fever with renal syndrome