Hemorrhagic fever-renal syndrome

Hemorrhagic fever with renal syndrome (HFRS), also known as epidemic hemorrhagic fever, Korean hemorrhagic fever, or nephropathia epidemica (for milder forms), is an acute viral illness caused by hantaviruses belonging to the family Bunyaviridae. The disease is transmitted to humans primarily through inhalation of aerosolized excreta (urine, droppings, or saliva) from infected rodents. Several hantavirus species can cause HFRS, including Hantaan virus, Seoul virus, Dobrava-Belgrade virus, and Puumala virus, each associated with different rodent hosts and varying degrees of clinical severity. HFRS primarily affects the vascular system and the kidneys. The disease typically progresses through five clinical phases: febrile, hypotensive, oliguric, diuretic, and convalescent. Key symptoms include sudden onset of high fever, headache, back pain, abdominal pain, nausea, and blurred vision. Hemorrhagic manifestations such as petechiae, conjunctival injection, and in severe cases frank bleeding may occur. Renal involvement ranges from mild proteinuria to acute kidney injury with oliguria or anuria, which can be life-threatening. Thrombocytopenia and disseminated intravascular coagulation may complicate the course. There is no specific antiviral therapy universally approved for HFRS, though early administration of intravenous ribavirin has shown some benefit in reducing mortality and disease severity, particularly when given during the febrile phase. Treatment is primarily supportive, including careful fluid management, electrolyte correction, dialysis for severe renal failure, and management of hemorrhagic complications. The case fatality rate varies from less than 1% for Puumala virus infections (nephropathia epidemica) to up to 15% for Hantaan or Dobrava virus infections. An inactivated vaccine is available in some endemic countries (China, South Korea) but is not widely used globally. Prevention focuses on rodent control and avoidance of exposure to rodent excreta.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

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