Respiratory manifestations of hemorrhagic fever with renal syndrome - Retrospective study of 129 cases in Champagne-Ardenne and Lorraine

OBJECTIVES: The contradiction between airborne transmission of Puumala viru s and the low rate of airway manifestations reported in hemorrhagic fever w ith renal syndrome (HFRS) caused by this virus led us to conduct this study to check whether the incidence of respiratory manifestations may have been underestimated. PATIENTS AND METHODS: We retrospectively reviewed 129 consecutive cases of HFRS diagnosed between 1983 and 1995 in the eastern France. RESULTS: Clinical manifestations of airway involvement and chest X-ray abno rmalities were observed in 30% and 50% of the patients respectively. Analys ing the radiological anomalies by serum creatinine level showed that in two -thirds of the cases (33% of all the HFRS cases) they were concomitant with acute renal failure and probably related to pulmonary edema, and that in o ne-third (17% of the HFRS cases) they were compatible with pneumonia. These cases of pneumonia could correspond to specific manifestations of the hant avirus Puumala at the site of penetration. CONCLUSION: Although minimally expressive, respiratory manifestations were found to be more frequent than expected in hemorrhagic fever with renal syn drome. Incidence may have been formerly underestimated.