HANTAVIRUS EPIDEMIC IN BELGIUM BETWEEN TH E SAMBRE AND MEUSE RIVERS 1992-1993 - CLINICAL AND BIOLOGICAL DATA

A multihospital study allowed us to follow a total of 62 serologically proven cases of Nephropathia epidemica (NE) in the Belgian region bet ween Sambre and Meuse during the 1992-1993 period. The clinical pictur e consisted of sudden high fever (100% of the cases), headache (71%), abdominal or lumbar pains (80%) and, as a less frequent but very speci fic sign, acute myopia (24%). Non-specific respiratory symptoms such a s a non-productive cough and an abnormal lung auscultation were found in 1 case out of 4. Frequent laboratory anomalies were thrombocytopeni a (69%), left-shift leucocytosis (77%), abnormal LDH (69%) and an infl ammatory syndrome (86%) with levels of C-reactive protein (CRP) elevat ed up to a mean of 102 mg/L, often accompanied by a marked fall of tot al serum cholesterol and a rise of triglycerides. Impaired kidney func tion is the rule (84%), nevertheless serum creatinine levels remain in ferior to 150 mu mol/L (1,7 mg%) in 25% of the patients. As for neurol ogical signs, 1 case of encephalitis and 1 syndrome of Guillain-Barre were observed. Relative bradycardia (< 90 bpm) was noted in 50% of the cases with fever, whereas Doppler-echocardiography detected pericardi tis in 1 case, and transient impairment of the left ventricle function in 3 cases. Frequent elevation of liver enzymes (46%) confirms the ob servation that from now on, Hantavirus infections should be considered in the differential diagnosis of viral hepatitis. One severe case was observed with shock, diffuse intravascular coagulation and adult resp iratory distress syndrome (ARDS), followed by 5 other patients present ing with marked degrees of hypoxemia and hypocapnia. We conclude that not only the causative Hantaviral serotype, but also the degree of ''s ystemic inflammatory response syndrome'' (SIRS) seems to determine the clinical picture in Hantavirus infections.