title: [Hemorrhagic fever with renal syndrome: imported or native disease in the Zadar region].
abstract: OBJECTIVE
  The aim of the study is to warn of the need of clinical hemorrhagic fever with renal syndrome (HFRS) recognition and determination, and of the risk of its spread from a new focus of this natural zoonosis near Zadar (north Dalmatia), i.e., in the northern part (Lika) of the Zadar County.
  
  
  METHODS
  Clinical and epidemiologic characteristics of HFRS were analyzed in four patients. Patient sera were analyzed for Puumala (PUU) and Hantaan (HTN) viruses by immunofluorescence test (IFT) and immunoenzyme test (ELISA).
  
  
  RESULTS
  Epidemiologic studies confirmed the source of infection to be out of the area in three patients, whereas in one patient it was near Zadar area. Mild symptoms pointed to the disease. Pathologic findings showed pathologic leukocyte values (leukocytosis), two- to four-fold alanine aminotransferase, aspartate aminotransferase and creatinine increase in serum, proteinuria and erythrocyturia. A significant PUU antibody titer was found by serum IF and ELISA.
  
  
  CONCLUSIONS
  The occurrence of HFRS in the Zadar area was confirmed by clinical description and laboratory evidence. The newly identified focus was in the vicinity of this area could imply a risk for the disease epidemic in the Zadar area.
authors.affiliation: Odjel za zarazne bolesti, Opća bolnica Zadar, Boze Pericića 5 23000 Zadar, Hrvatska. boris.dzelalija@zd.tel.hr
authors.forename: Boris
authors.initials: B
authors.lastname: Dzelalija
authors.forename: Alan
authors.initials: A
authors.lastname: Medić
authors.forename: Tatjana
authors.initials: T
authors.lastname: Avsic-Zupanc
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D017523:Croatia / Q000453:epidemiology; D004197:Disease Reservoirs; D019084:Fluorescent Antibody Technique, Indirect; D006476:Orthohantavirus / Q000276:immunology; D006480:Hemorrhagic Fever with Renal Syndrome / Q000453:epidemiology* / Q000635:transmission / Q000821:virology*; D006801:Humans; D008297:Male; D029262:Puumala virus / Q000276:immunology*
chemical_list: D000914:Antibodies, Viral