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KMID : 0376219950310010151
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Chonnam Medical Journal
1995 Volume.31 No. 1 p.151 ~ p.164
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Clinical observation of hemorrhagic fever with renal syndrome in chonnam area
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Lee Je-Jung
Yeum Chung-Ho
Chung You-Jeong
Lee Seong-Cheol
Kim Soo-Wan
Kim Nam-Ho
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Abstract
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Fifty-two cases of hemorrhagic fever with renal syndrome who were diagnosed by serologic test from January 1988 to December 1994 at Chonnam University Hospital were retrospectively reviewed for the evaluation of epidemiological and clinical findings. The results were as follows; 1. The peak incidence was in 1994(23.1%), annually increasing tendency, and on November (44.2%). 2. In distribution by age and sex, 14 cases(27%) were fifties, 13 cases(25%) in fourties, and 12 cases(23%) in thirties, and male to female ratio was 1.6:1. 3. The most prevalent epidemic area was Young Kwang Goon in 8 cases and most susceptible occupation was farmer in 37 cases(71%). 4. The mortality rate was 11.5%. 5. Clinical symptoms were characterized by fever998%), chill(85%), nausea967%), vomiting(65%), myalgia(63%), abdominal pain and diarrhea(50%), and cough (50%). 6. On physical examination. conjunctival injection(71%), abdominal tenderness (56%), soft palate injection(40%), generalized edema & facial edema(16%), costovertebral angle tenderness(29%), facial flushing (25%), and petechia & purpura(23%) were found. 7. Laboratory findings on admission. 1) Hemoconcentration was seen in 17%, leukocytosis in 89%, thrombocytopenia in 85% of cases. 2) Proteinuria was seen in 85%, hematuria in 79% of cases.
3) Bloody chemistry findings were characterized by increased BUN and serum creatinine(96%), increased AST(87%), hypoalbuminemia(71%), hyponatremia (69%), hypocalcemia(63%0, increased ALT956%), and increased LDH(27%).
4) The serologic diagnosis was confirmed with Hantadia kit by high density particle(HDP) agglutination and disclosed the cross reaction between Hantanvirus and Tsutsugamushi or Leptospira in 6% and 4% of cases. 8. Clinica stages of the patients on admission were as follows; febrile stage in 6 cases(12%), hypotensive stage & cases914%), oliguric stage 32 cases(62%) cases(62%), diuretic stage 3 cases(6%), and transformed from hypotensive stage to oliguric
stage in 3 cases(6%). The mean duration of each stage was as follows; febrile stage 5.1 days, hypotensive stage 1.7 days, oliguric stage 4.9 days, and diuretic stage 10.9 days. 9. The frequency of complications was as follows; transient hypertension in 27 cases(52%), anemia 19 cases(37%), pleural effusion 12 cases923%), epistaxis, hematemesis & melena, UTI 7 cases(14%), ascites 6 cases(12%), pulmonary edema & hemorrhage, and pneumonia 5 cases(10%). Others were ARDS, hypopituitarism, DI, Guillain-Barre syndrome, and cellulitis and the findings of gastrofiberoscopy in all 7 cases were hemorrhagic gastritis. 10. We performed conservative treatment in 29 cases(40%), hemodialysis in 21 cases(40%), and peritoneal dialysis and CAVHD in 1 case. The mortality rate was 11%(3 cases) in conservative treatment, 10%(2 cases) in hemodialysis, and 100%(1 case) in CAVHD. 11. The main causes of death were the combination of ARDS, primary shock, sepsis and cerebrovascular accident(CVA) in 2 cases. Others were pulmonary edema, pulmonary emorrhage, disseminated intravascular coagulation(DIC), hyperkalemia, and anoxic brain syndrome.
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