title: Clinical aspects of hantavirus infections in Bulgaria.
abstract: BACKGROUND
  Hantaviruses cause two distinct human diseases: hemorrhagic fever with renal syndrome (HFRS) in Asia and Europe and hantavirus pulmonary syndrome (HPS) in America. In Europe, mainly Puumala, Dobrava and Seoul viruses cause HFRS. A total of 23 cases of HFRS were detected in Bulgaria over a 2‑year period 2013-2014. The aim of the study was to present epidemiology, clinical manifestations and laboratory findings of these patients.
  
  
  METHODS
  Patients with HFRS were diagnosed using PCR, ELISA and immunoblotting tests.
  
  
  RESULTS
  Dobrava-Belgrade virus (DOBV) was revealed as etiological agent in 16 (69.6%) patients and Puumala virus (PUUV) in 7 (30.4%) patients. All 23 patients were men aged 22-66 years of which 6 (26.1%) patients originated from regions in northern and western Bulgaria previously thought to be non-endemic. Patients with HFRS, despite the infecting hantavirus, manifested acute renal failure, asthenia and less pronounced hemorrhagic syndrome. Patients with DOBV infection were much more likely to present with arthromyalgia, severe headache, severe to moderately severe asthenoadynamia, abdominal pain, vomiting, hypotension, nervous system disorders as well as kidney enlargement, leucopenia and higher levels of blood creatinine, requiring hemodialysis procedures more often and for a longer period of time than patients with PUUV infection.
  
  
  CONCLUSIONS
  The present report describes for the first time comparative analysis of epidemiological features, clinical manifestations and laboratory findings of DOBV and PUUV infections in Bulgaria.
authors.affiliation: National Center of Infectious and Parasitic Diseases, Blvd. Yanko Sakazov 26, 1504, Sofia, Bulgaria. iva_christova@yahoo.com.
authors.forename: I
authors.identifier: http://orcid.org/0000-0002-7878-3995
authors.initials: I
authors.lastname: Christova
authors.affiliation: Department of Infectious Diseases, Regional Hospital Pazardzhik, Pazardzhik, Bulgaria.
authors.forename: M
authors.initials: M
authors.lastname: Pishmisheva
authors.affiliation: National Center of Infectious and Parasitic Diseases, Blvd. Yanko Sakazov 26, 1504, Sofia, Bulgaria.
authors.forename: I
authors.initials: I
authors.lastname: Trifonova
authors.affiliation: Department of Epidemiology of Infectious Diseases, Medical University-Plovdiv, Plovidv, Bulgaria.
authors.forename: N
authors.initials: N
authors.lastname: Vatev
authors.affiliation: Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University-Plovdiv, Plovidv, Bulgaria.
authors.forename: M
authors.initials: M
authors.lastname: Stoycheva
authors.affiliation: University Hospital for Infectious and Parasitic Diseases, Sofia, Bulgaria.
authors.forename: M
authors.initials: M
authors.lastname: Tiholova
authors.affiliation: Department of Infectious Diseases, Regional Hospital Ruse, Ruse, Bulgaria.
authors.forename: D
authors.initials: D
authors.lastname: Igova
authors.affiliation: Department of Infectious Diseases, Regional Hospital Sliven, Sliven, Bulgaria.
authors.forename: M
authors.initials: M
authors.lastname: Baev
authors.affiliation: Department of Infectious Diseases, Regional Hospital Smolyan, Smolyan, Bulgaria.
authors.forename: R
authors.initials: R
authors.lastname: Karagyaurova
authors.affiliation: Department of Infectious Diseases, Regional Hospital Gotse Delchev, Gotse Delchev, Bulgaria.
authors.forename: U
authors.initials: U
authors.lastname: Prokopova
mesh_terms: D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D002031:Bulgaria; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D019353:Endemic Diseases; D062306:Geography, Medical; D018063:Hantaan virus; D006480:Hemorrhagic Fever with Renal Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D029262:Puumala virus; D006435:Renal Dialysis; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D003404:Creatinine
keywords: Dobrava-Belgrade virus; Hantavirus; Hemorrhagic fever with renal syndrome; Puumala virus; Renal failure