Haemorrhagic fever with renal syndrome: Hantaan virus infection.

Haemorrhagic fever with renal syndrome is a syndrome seen in diseases of varying severity which occur from the Far East across to Western Europe. The most common diseases in the Far East are Korean haemorrhagic fever and epidemic haemorrhagic fever, which are characterised by fever, muscular pains, haemorrhagic manifestations, and proteinuria; the complications of shock and renal failure may lead to death. The disease seen in Scandinavianephropathia epidemica-typifies the European disease and is much less severe, as haemorrhagic manifestations do not occur. The first description of this disease was in 1934, when Myhrman saw 30 cases in northern Scandinavia of "nephropathia epidemica."' Lahdevirta cites reports of 253 cases of the disease in Sweden, Norway, and Denmark up to 1968. An outbreak also occurred in Lapland in 1942 among Finnish and German troops.2 Nephropathia epidemica is characterised by an acute onset of fever with evidence of renal failure but no haemorrhagic manifestations. The usual outcome is full recovery. Lee cites references to a similar disease affecting troops stationed in Flanders during the first world war and soldiers in the American Civil War.3 Korean haemorrhagic fever is similar but has a distinct mortality. It was first described in the USSR between 1930 and 1934, where 915 cases resulted in five deaths. The disease was also reported from inner Mongolia in 1959.4 The syndrome attracted interest after the spring in 1951, when United Nations troops in Korea were affected.* 6 By the end of the Korean war a total of 3000 troops had been diagnosed as having Korean haemorrhagic fever. There were 80 deaths in the first 1000 cases, and the disease continues to be recognised in troops and civilian personnel in Korea, where there is a 5% mortality in those who are treated. Several thousands of cases have been reported from the Soviet Union, and in China there were 61 705 cases in 1982 alone, again with a case fatality of 5%.