title: Early diagnosis of hantavirus infection by family doctors can reduce inappropriate antibiotic use and hospitalization.
abstract: OBJECTIVE
  Hantavirus infections are emerging infections that cause either Hantavirus pulmonary syndrome or haemorrhagic fever with renal syndrome (HFRS). A recent Swedish outbreak of nephropathia epidemica, a European HFRS, was analysed to study the patient flow and clinical picture and to investigate the value of an early diagnosis in general practice. Design. In a retrospective design, medical records of verified cases of Hantavirus infection were studied.
  
  
  METHODS
  The study was conducted in the county of Norrbotten, Sweden.
  
  
  METHODS
  Data from Hantavirus patients diagnosed between 2006 and 2008 were analysed.
  
  
  METHODS
  Demographic data, level of care, treatment, clinical symptoms, and laboratory findings were obtained.
  
  
  RESULTS
  In total, 456 cases were included (58% males and 42% females). The majority of patients first saw their general practitioner and were exclusively treated in general practice (83% and 56%, respectively). When diagnosed correctly at the first visit, antibiotics and hospitalization were significantly lowered compared with delayed diagnosis (14% vs. 53% and 30% vs. 54%, respectively; p < 0.0001). The clinical picture was diverse. Early thrombocytopenia was found in 65% of the patients, and haemorrhagic manifestations were documented in a few cases. Signs of renal involvement--haematuria, proteinuria, and raised levels of serum creatinine--were found in a majority of patients.
  
  
  CONCLUSIONS
  Raised awareness in general practice regarding emerging infections and better diagnostic tools are desirable. This study of a Hantavirus outbreak shows that general practitioners are frontline doctors during outbreaks and through early and correct diagnosis they can reduce antibiotic treatment and hospitalization.
authors.affiliation: Primary Care Centre in Piteå, County of Norrbotten, Sweden. alette.brorstad@cederkliniken.se
authors.forename: Alette
authors.initials: A
authors.lastname: Brorstad
authors.forename: Kristina Bergstedt
authors.initials: KB
authors.lastname: Oscarsson
authors.forename: Clas
authors.initials: C
authors.lastname: Ahlm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage; D004196:Disease Outbreaks; D042241:Early Diagnosis; D005194:Family Practice; D005260:Female; D006480:Hemorrhagic Fever with Renal Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D015047:Zoonoses / Q000821:virology
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents