Clinical and virological characteristics of hantavirus infections in a 2014 Croatian outbreak

  • Tatjana Vilibic-Cavlek Croatian National Institute of Public Health, Zagreb, Croatia
  • Alena Furic General Hospital Ogulin, Ogulin, Croatia
  • Ljubo Barbic University of Zagreb, Zagreb, Croatia
  • Irena Tabain Croatian National Institute of Public Health, Zagreb, Croatia
  • Vladimir Stevanovic Faculty of Veterinary Medicine University of Zagreb, Zagreb, Croatia
  • Gordana Mlinaric-Galinovic Croatian National Institute of Public Health, Zagreb, Croatia
Keywords: hantaviruses, epidemiology, cross-reactivity, Croatia

Abstract

Introduction: Croatia is endemic for hemorrhagic fever with renal syndrome (HFRS), with both Puumala (PUUV) and Dobrava virus (DOBV) documented. Several large outbreaks were recorded in 1995, 2002, and 2012. We analyzed demographic, clinical, laboratory, and virological characteristics of HFRS cases detected in three geographically close natural foci (Ogulin, Slunj, and the Plitvice Lakes surroundings) during the 2014 outbreak.

Methodology: From January to December 2014, 122 patients with suspected HFRS were tested for hantavirus IgM/IgG antibodies using an indirect immunofluorescence assay (IFA). Cross-reactive samples were further tested using a western blot (WB). For hospitalized patients from Ogulin area, clinical and laboratory data were analyzed.

Results: Acute infection was documented in 57 (46.7%) patients, of whom 75.4% were hospitalized. Ten (8.2%) patients were found to be IgG seropositive. Patients were 15–69 years of age and predominantly male (74.5%). The outbreak started in winter months, with most cases recorded from May to July (80.7%). The most frequently reported symptoms were fever (96.3%), chills/shivering (62.9%), and lumbar pain (48.1%). Mild clinical form was found in 66.7% patients, moderate in 18.5%, and severe in 14.8% patients (all but one infected with PUUV). One patient died. Using IFA, 48.8% patients showed monotypic antibody response, while in 51.2%, cross-reactive antibodies were found. PUUV was confirmed in 94.7% and DOBV in 5.3% HFRS cases by WB.

Conclusions: Central mountainous Croatian regions are still highly endemic areas for HFRS. A higher percentage of severe PUUV infections could be at least partly associated with a patient’s immune status.

Author Biographies

Tatjana Vilibic-Cavlek, Croatian National Institute of Public Health, Zagreb, Croatia
Department of Virology, and School of Medicine University of Zagreb
Alena Furic, General Hospital Ogulin, Ogulin, Croatia
Department of Internal Medicine
Ljubo Barbic, University of Zagreb, Zagreb, Croatia
Department of Microbiology and Infectious Diseases with Clinic
Irena Tabain, Croatian National Institute of Public Health, Zagreb, Croatia
Department of Virology
Vladimir Stevanovic, Faculty of Veterinary Medicine University of Zagreb, Zagreb, Croatia
Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine
Gordana Mlinaric-Galinovic, Croatian National Institute of Public Health, Zagreb, Croatia
Department of Virology, and School of Medicine University of Zagreb
Published
2017-01-30
How to Cite
1.
Vilibic-Cavlek T, Furic A, Barbic L, Tabain I, Stevanovic V, Mlinaric-Galinovic G (2017) Clinical and virological characteristics of hantavirus infections in a 2014 Croatian outbreak. J Infect Dev Ctries 11:73-80. doi: 10.3855/jidc.7987
Section
Original Articles