HEMORRHAGIC-FEVER WITH RENAL SYNDROME IN KOREAN CHILDREN

Haemorrhagic fever with renal syndrome (HFRS) is an acute disease caus ed by Hantavirus and clinically characterised by abrupt onset of fever , various haemorrhagic manifestations and transient renal and hepatic dysfunction. We retrospectively reviewed 63 cases of HFRS in children from 13 different hospitals in Korea who presented over a 15-year peri od. The age of the patients ranged from 7 to 15 years, with a male to female ratio of 8 to 1. Fifty-four (86%) patients were 10 years or old er. On admission, 24 (38%) were in the febrile phase and 35 (56%) were in the oliguric phase. Fever (100%), abdominal pain (91%), headache ( 76%) and vomiting (73%) were the most common symptoms. Backache, subco njunctival haemorrhage and hypertension were also noted in about one-t hird of patients. Hypotension was documented in only 7 (11%) patients. Leucocytosis (>10,000/mm(3)) and thrombocytopenia (<150,000/mm(3)) we re noted in more than two-thirds of patients. Elevated blood urea nitr ogen and serum creatinine was observed in 94% by the 7th (median) day of illness. Elevated aspartate aminotransferase and/or alanine aminotr ansferase were found in more than two-thirds of patients. Renal biopsy was performed in 12 patients and revealed various stages of acute tub ular necrosis with occasional interstitial cell infiltration and oedem a. Only 2 showed evidence of interstitial haemorrhage. Eleven patients required 1-3 days of dialysis and the remaining patients required onl y conservative management. Three (5%) patients died of shock, respirat ory failure and pulmonary haemorrhage. All other patients recovered wi thout sequelae. Although childhood cases were much less common than ad ults, clinical and laboratory findings were in general similar between children and adults.