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Background: The acute renal failure remains a diagnostic challenge for the clinician., Case Reports: Between 1991 and 1996, acute renal failure caused by hantavirus infection was diagnosed in 4 previously healthy male patients. Main symptoms consisted of fever, headache, arthralgia, lumbar and abdominal pain as well as a decline in diuresis. The ultrasonography showed a slight splenomegaly in 2 patients. The clinical chemistry showed elevated serum creatinine from 2.2 mg/dl to 6.7 mg/dl and thrombocytopenia from 4000 to 150,000/microliter. The examination of the urine showed slight proteinuria and microhematuria. The kidney biopsy of 1 patient showed a reversible damage of the tubuli. The pathologic findings normalized within 3 weeks in 3 patients without need for dialysis. One patient developed a severe clinical course with acute renal failure and pulmonary edema requiring dialysis. In all patients, the renal function improved.

Background: Infections with hantaviruses, mainly Clethrionomys-derived Puumala viruses, are known causes of acute renal failure [hemorrhagic fever with renal syndrome (HFRS)] in western Europe. Laboratory diagnosis is primarily based on serology. At the time of clinical symptoms, viral RNA can hardly be detected in the blood or urine, indicating that polymerase chain reaction (PCR) is of little diagnostic value for these infections. Biopsy material is usually formaldehyde-fixed and, thus, regarded as poor quality for PCR applications. The aim of this study was to establish a technique to retrieve such material for laboratory diagnostic., Methods: Formaldehyde-fixed, paraffin-embedded kidney biopsies of 14 patients with renal failure either clinically suspected for HFRS (7 cases) or caused by unknown (2 cases) or known other causes (drugs, sarcoidosis; 5 cases) were histologically investigated. An established S segment-specific PCR assay was applied to RNA isolated from the biopsies, and amplification products were verified by direct sequence determination., Results: Investigations revealed a typical histopathological appearance for hantavirus infections in all seven suspected HFRS cases and one case of unknown cause. With five of the suspected HFRS cases, hantavirus-specific RNA was detected. Sequence comparison revealed a close relationship to corresponding nucleoproteins of known Puumala viruses., Conclusion: The established technique provides a simple and powerful tool that expands the diagnostic possibilities, especially for otherwise unidentified or retrospective cases. It further allows insight into the molecular epidemiology of HFRS-causing agents.

History and Clinical Findings: A 49-year-old patient, a hobby hunter, fell ill acutely with joint and limb pain, abdominal pain, nausea and subfebrile temperatures. At hospitalization, the patient was in bad general condition, showing ascites and lid edema, and acute renal failure was diagnosed., Investigations: Laboratory tests revealed marked thrombocytopenia (15,000/ml), leucocytosis, elevated levels of creatinine, blood urea nitrogen and liver enzymes, respectively. Blood gas analysis showed metabolic acidosis. Chest X-ray showed an interstitial fluid accumulation, abdominal ultrasound disclosed ascites and enlarged kidneys as in acute renal failure. Immunologic tests verified the diagnosis of an acute hantavirus infection, by use of specific molecular biology techniques a previously unknown virus strain was identified., Treatment and Course: Hantavirus infections in western Europe usually show a benign course. However, in the present case, acute progressive pulmonary failure developed despite effective dialysis so that mechanical ventilation was necessary for several weeks. Dialysis had to be carried out for 17 days. As a complication a severe ulcero-destructive tracheobronchitis developed, caused by Aspergillus fumigatus. After several weeks, both renal and pulmonary function had returned to normal., Conclusion: Hantavirus infections may lead to severe and complicated courses also in western Europe. By use of new immunologic and molecular biology techniques a specific diagnosis is possible.

Collecting during two periods, from September 4, 1979, to September 12, 1980, and from August 17 to September 10, 1981, a total of 45,705 mosquitoes was caught for virus isolation studies in 6 different regions in Germany and the Netherlands (Lower Rhine area, Upper Rhine area near Germersheim, Upper Main area near Baunach, Amper Moos), in Austria (eastern shore of Lake Neusiedl), and in Italy (Isonzo river delta). 25 mosquito species were identified belonging to the genera Aedes, Culex, Culiseta, Mansonia, and Uranotaenia. The relative mosquito species composition was determined for the different collecting sites. By intracerebral inoculation of 2 to 4 days old suckling mice with extracts of each mosquito pool 6 virus strains were isolated which were identified as Tahyna (TAH) virus strains using the indirect immunofluorescence technique in cell culture and the baby mouse neutralization test. The origin of these strains were the following regions: one TAH virus strain was isolated from Aedes caspius mosquitoes (1 of 158 pools) collected from 17. 8 to 30. 8. 81 at the eastern shore of Lake Neusiedl. 5 additional isolates were obtained from 6,066 mosquitoes (62 pools) collected on 9. and 10. 9. 81 in the Upper Rhine area near Germersheim (Isle Grün). Two of these virus strains were isolated from Aedes vexans and three from unidentified mosquitoes. This is the first TAH virus isolation from mosquitoes in the Upper Rhine area, which had been regarded by Ackermann and coworkers (1970) and Spieckermann and Ackermann (1974) as a potential natural TAH virus focus on the basis of serological studies in humans and sentinel rabbits during 1969. The isolation of TAH virus in the Lake Neusiedl area essentially confirms the results obtained by Aspöck and Kunz (1967) for this region. The possible influence of some ecological factors on the geographical distribution of TAH virus is discussed.