Identifying Probable Hantavirus Infections in Patients Clinically Suspected of Dengue: Insights from a Tertiary Care Hospital in Sri Lanka

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September 29, 2025

Hantavirus infections Mimicking Dengue Fever Raise Alarms in Sri Lanka

Colombo, Sri Lanka – A recent study has revealed a meaningful overlap in symptoms between Hantavirus infection and Dengue fever, leading to potential misdiagnoses and delays in treatment. researchers are now focusing on improving diagnostic accuracy and raising awareness of this emerging public health concern. The findings underscore the need for broader testing protocols, particularly in regions where both diseases are prevalent.

Diagnostic Challenges and Prevalence Rates

The study, conducted among patients initially suspected of having Dengue fever, found that nearly 80% ultimately tested negative for the mosquito-borne illness. Though, a noteworthy 5.1% exhibited evidence of Hantavirus infection. This rate aligns with findings from neighboring countries such as Indonesia (4.23%) and Cambodia (4%), indicating a regional trend. The overlap in early symptoms-including fever, muscle aches, and fatigue-complicates accurate diagnosis.

Testing and Detection Methods

Researchers employed a combination of diagnostic techniques, including real-time RT-PCR to detect the virus’s genetic material and immunoblot assays to identify antibodies. While PCR tests were negative in all samples analyzed, IgM antibodies indicative of recent Hantavirus exposure were found in a subset of patients. This suggests that the virus may be present at low levels or during a phase where detection is challenging. It is also important to note that proper sample collection and handling are critical for accurate results.

Demographic Trends and Risk Factors

Interestingly,the study revealed that Hantavirus seropositivity was most common in individuals under the age of 10 and those over 61. This contrasts with typical patterns observed in other regions, where the disease primarily affects adults. However, studies in countries like Iran and Barbados have reported similar instances of pediatric cases, suggesting regional variations in disease presentation. Gender did not appear to be a significant factor in infection rates, with approximately 43% of cases occurring in males and 57% in females.

clinical Severity and Outcomes

the majority of Hantavirus-positive patients (76.2%) did not require intensive care, suggesting many infections are mild. However, two fatalities were recorded, resulting in a mortality rate of 9.5%. Common symptoms included fever, cough, muscle pain, and joint pain. In some cases,chest X-rays revealed pulmonary involvement,while others presented with renal failure,mirroring the symptoms of Hemorrhagic Fever with Renal Syndrome (HFRS) and Hantavirus Pulmonary Syndrome (HPS). Supportive care remains the primary treatment approach, as specific antiviral therapies are currently limited.

Comparative Prevalence Rates

Region	Hantavirus Prevalence (%)
Sri Lanka (Current Study)	5.1
Indonesia	4.23
Cambodia	4.0

Did You Know? Hantaviruses are typically transmitted to humans through contact with rodent droppings, urine, or saliva.

Pro Tip: Practice good hygiene and rodent control measures in and around your home to minimize the risk of exposure to Hantaviruses.

Accurate diagnosis remains a challenge due to overlapping symptoms with other febrile illnesses. Researchers are emphasizing the importance of considering Hantavirus infection in differential diagnoses, particularly in regions where it is endemic. This is crucial for prompt and appropriate medical intervention.

What steps do you think public health officials should take to increase awareness of Hantavirus? how can we improve global surveillance for emerging infectious diseases like this one?

Understanding Hantavirus and its Global Impact

Hantaviruses are a family of viruses that can cause a range of illnesses in humans, from mild flu-like symptoms to severe and life-threatening conditions.These viruses are carried by rodents and transmitted to humans through various routes, including inhalation of airborne particles, direct contact with rodent excreta, or, less commonly, through rodent bites. The genus Hantavirus comprises over 35 different viruses, each associated with specific rodent hosts and geographic regions.

Globally, Hantavirus infections are found in various parts of the world

What specific epidemiological factors, beyond geographic location, should prompt consideration of hantavirus infection in a patient initially suspected of having dengue fever?

Clinical Overlap: Dengue vs. Hantavirus

In Sri Lanka, and across many tropical and subtropical regions, dengue fever is a significant public health concern. However, the initial clinical presentation of hantavirus pulmonary syndrome (HPS) and severe dengue can be remarkably similar, leading to diagnostic challenges. This overlap in symptoms – including fever,myalgia,headache,and even hemorrhagic manifestations – necessitates a heightened awareness and consideration of hantavirus infection in patients presenting with suspected dengue,particularly during periods of co-circulation.Misdiagnosis can delay appropriate management and significantly impact patient outcomes. Hantavirus disease frequently enough presents as a severe, rapidly progressive illness.

Recognizing Key Differentiating Factors

while symptom overlap exists, subtle clinical and epidemiological clues can point towards a hantavirus etiology. Hear’s a breakdown of key differentiators:

* Geographic Exposure: While dengue is widespread in Sri Lanka,hantavirus is linked to specific rodent habitats. Patients reporting recent exposure to rodent-infested areas – particularly rural settings, agricultural lands, or abandoned buildings – should raise suspicion.

* Respiratory Symptoms: Progressive shortness of breath and non-cardiac pulmonary edema are more characteristic of HPS than dengue. Dengue-related pleural effusions are less common and typically less severe.

* Thrombocytopenia Pattern: Both diseases cause thrombocytopenia (low platelet count).However,the timing and severity can differ. HPS often presents with a more rapid and profound thrombocytopenia.

* Renal Involvement: Acute kidney injury is frequently observed in HPS, often requiring dialysis. While dengue can cause renal impairment, it’s generally less severe.

* Hemorrhagic Manifestations: While both can cause bleeding,the nature of the hemorrhage may differ. Petechiae and purpura are common in dengue, while larger ecchymoses and internal bleeding are more frequently seen in severe HPS cases.

Diagnostic approaches: Beyond Dengue Serology

Relying solely on dengue serological tests (NS1 antigen, IgM/IgG antibodies) can be misleading.A complete diagnostic workup is crucial when clinical suspicion for hantavirus exists.

1. Detailed Patient History: Focus on potential rodent exposure – occupation (farmers, construction workers), recreational activities (hiking, camping), and home surroundings.
2. Complete Blood Count (CBC): Monitor platelet count, white blood cell count (often leukopenia in HPS), and hematocrit.
3. Renal function Tests: Assess creatinine, blood urea nitrogen (BUN), and electrolyte levels.
4. Pulmonary Evaluation: Chest X-ray or CT scan to identify pulmonary edema.
5. Hantavirus-specific Testing: This is the cornerstone of diagnosis.

* RT-PCR: Detects hantavirus RNA in blood or urine samples during the acute phase of illness (first few days).

* IgM/IgG Antibody Testing: Detects antibodies against hantaviruses. IgM antibodies typically appear within a few days of symptom onset, while igg antibodies develop later. Note: Availability of hantavirus-specific testing might potentially be limited in some regions, requiring referral to specialized laboratories.

6. Differential Diagnosis: Rule out other potential causes of fever and respiratory distress, such as leptospirosis, influenza, and malaria.

Rodent Control & Public Health Implications

Effective rodent control is paramount in preventing hantavirus transmission. The CDC emphasizes this as the primary prevention strategy (https://www.cdc.gov/hantavirus/prevention/index.html).

* Seal entry points: Close holes and cracks in homes and buildings.

* Proper food storage: Store food in rodent-proof containers.

* Safe cleaning practices: Moisten dust and debris before cleaning to avoid aerosolizing hantavirus particles. Wear a mask during cleaning.

* Rodent trapping: Implement trapping programs in areas with high rodent populations.

* public awareness campaigns: Educate the public about hantavirus risks and prevention measures.

Case Study: A diagnostic Challenge

In a recent case at our tertiary care hospital, a 35-year-old farmer presented with high fever, severe myalgia, and headache, initially diagnosed as probable dengue based on positive NS1 antigen testing.Though, the patient rapidly developed progressive dyspnea and acute kidney injury. Repeat investigations, prompted by the atypical clinical course, included hantavirus RT-PCR, which returned positive. The patient was subsequently managed with supportive care,including mechanical ventilation and renal replacement therapy,and eventually recovered.This case highlights the importance of considering hantavirus in the differential diagnosis of febrile illnesses, even in dengue-endemic areas.

Benefits of Early and Accurate diagnosis

* Improved Patient Outcomes: Prompt recognition and supportive care