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Pathology of Hemorrhagic Fever with Renal Syndrome (Korean Hemorrhagic Fever) caused by Hantavirus

Dr Sampurna Roy MD                      






Hemorrhagic fever with renal syndrome includes diseases such as Korean hemorrhagic fever, epidemic hemorrhagic fever, and nephropathia epidemica.

It is a group of clinically similar illnesses caused by hantaviruses from the family Bunyaviridae.

In Europe, hemorrhagic fever with renal failure syndrome is caused by 3 hantaviruses: Puumala virus (PUUV), carried by the bank vole (Myodes glareolus); Dobrava virus (DOBV), carried by the mouse (Apodemus flavicollis); and Saaremaa virus (SAAV), carried by the striped field mouse (Apodemus agrarius).

Hantavirus is usually acquired directly from rodents.

In these rodents, the virus is detected primarily in the lung and kidney, where it is able to persist in the presence of serum antibodies.

Large quantities of virus are excreted throughout life. 

Hemorrhagic fever with renal syndrome (Korean Hemorrhagic fever) occurs in rural communities where people may become infected through minor cuts and abrasions contaminated with rodent urine or feces, but evidence also suggests that aerosol infection may occur where virus contamination is heavy.

The illness was known to Russians in Vladivostok (1890), and similar diseases are found across the entire European land mass, from European and Asiatic Russia to Manchuria, Korea, and Japan.

The disease became known to American medicine when it struck United Nations troops serving in Korea in 1951, hence the misnomer "Korean".

Clinically five stages have been described :  Febrile ; shock ; oliguric ; polyuric, and convalescent.

Symptoms include fever, periorbital edema, flushed face and palatal and axillary petechiae.

Conjunctivitis, headache and lumbar pain may be present.


Principal laboratory findings are proteinuria, hemoconcentration, and thrombocytopenia.

Recovery is usual, but fatal cases do occur. In such cases, morphologic evidence of shock is present.

There is a mononuclear cell infiltrate in the sinusoids of liver and spleen, and throughout the body damage to the capillaries is manifested by dilatation, engorgement, diapedesis of erythrocytes, and rupture.

Viral antigen has been found in endothelial cells.

Patients are determined to have HFRS if they have serologic test results positive for hantavirus infection or evidence of hantavirus antigen in tissue by immunohistochemical staining and microscope examination.

Autopsied kidney of a Korean male presenting acute renal failure


Visit related sites: Viral hemorrhagic fevers ; Alphaviruses causing Encephalitis Crimean-Congo Hemorrhagic Fever ; Filovirus ; Flavivirus ;  Ebola Virus Infection ;  Marburg Virus Disease ;  Kyasanur Forest Disease ;  Lymphocytic choriomeningitis ; Omsk hemorrhagic fever ;  Tick-borne Encephalitis ;  Rift Valley Fever ;  St.Louis Encephalitis


Further reading:

Isolation of the etiologic agent of Korean Hemorrhagic fever.

Korean hemorrhagic fever among rural residents in Japan

Hemorrhagic fever with renal syndrome (HFRS, Korean hemorrhagic fever).Pediatr Nephrol. 2007 Jan;22(1):156-7. Epub 2006 Sep 16.

International Notes on Korean Hemorrhagic Fever.MMWR. February 19, 1988 / 37(6);87-90,95-6

Clinical and laboratory predictors of oliguric renal failure in haemorrhagic fever with renal syndrome caused by Hantaan virus.

Hemorrhagic fever with the renal syndrome: modern  aspects of epidemiology and prophylaxis.

Emerging viral zoonoses: hantavirus infections.




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


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