{"id":2027,"date":"2012-11-05T20:51:08","date_gmt":"2012-11-05T18:51:08","guid":{"rendered":"http:\/\/www.nalaz.org\/wp\/?p=2027"},"modified":"2018-10-25T20:10:31","modified_gmt":"2018-10-25T20:10:31","slug":"hemoragijska-groznica-sa-bubreznim-sindromom-u-bosni-i-hercegovini","status":"publish","type":"post","link":"https:\/\/www.nalaz.org\/v2\/hemoragijska-groznica-sa-bubreznim-sindromom-u-bosni-i-hercegovini\/","title":{"rendered":"Hemoragijska groznica sa bubre\u017enim sindromom u Bosni i Hercegovini"},"content":{"rendered":"

Preko 60 godina Bosna i Hercegovina je poznata kao endemi\u010dna regija za hantavirus infekcije. Najmanje tri razli\u010dita Hantavirus (HTV) serotipa su endemi\u010dni u BiH. Dokazano je da HTV mogu uzrokovati asimptomatsku i blagu klini\u010dku sliku bolesti, ali i te\u0161ku bolest sa krvarenjima, prestankom rada bubrega i smrtnim ishodom. Epidemiolo\u0161ka istra\u017eivanja pokazuju da su rizikofaktori za nastanak HTV infekcije u BiH: \u017eivot na u endemskom podru\u010dju, poljoprivredni radovi, rad sa otpadom, spavanje na zemlji, vojne vje\u017ebe i ni\u017ei socio-ekonomski status.<\/em><\/p>\n

Istorijski pregled<\/strong><\/p>\n

\"mis\"<\/a>Preko 60 godina Bosna i Hercegovina je poznata kao endemi\u010dna regija za hantavirus infekcije. Prvi slu\u010daj hemoragijske groznice sa bubre\u017enim sindromom (HFRS) izvan Skandinavije, opisan je 1952. godine u vojnom kampu u planinskim \u0161umama Fojnice, 25 kilometara sjevero-zapadno od glavnog grada Sarajeva. Retrospektivno, sama \u010dinjenica da je pritonealna dijaliza bila neophodna upu\u0107ivala je na klini\u010dku manifestaciju, koja je neobi\u010dna za ve\u0107inu blagih oblika epidemijske nefropatije, koji su do tada bili poznati. Prva dokumentovana epidemija HFRS u Evropi zabilje\u017eena je 1961. godine, opet u vojnom kampu smje\u0161tenom u Fru\u0161koj Gori (Edevik, Srbija), na samo 75 km sjeveroisto\u010dno od prethodnog epidemi\u010dnog fokusa. Za vrijeme vojnih vje\u017ebi, ukupno 46 vojnika se razbolilo, od toga 33 je imalo blagi oblik, 13 je imalo te\u017eak oblik, a bio je i 1 smrtni ishod. Va\u017enu ulogu u ovom iznenadnom izbijanju bolesti su imali glodari koji su naselili kamp. Kontinuirano izbijanje HFRS u biv\u0161oj Jugoslaviji (1966., 1986. i 1989.), rezultiralo je u opisu preko 1.000 slu\u010dajeva, od kojih su ve\u0107ina bili iz sjeverne Bosne. U toku 1981.- 1984., u akciji izlovljavanja sitnih glodavaca u okolini Fojnici, Bosna, kao najbrojnija vrsta identifikovan je \u017eutogrli poljski mi\u0161i (Apodemus flavicollis). Laboratorijskim analizama dokazano je prisustvo hantavirusnog antigena u plu\u0107ima u 7,1% uhva\u0107enih \u017eivotinja. Crvena voluharica (Myodes glareolus), glavni doma\u0107in evropskog serotipa Pumala virusa (PPUV), pokazala se manje zastupljenom, ali inficiranom u procentu od 11%. Ne\u0161to kasnije, A. flavicolis je identificiran kao doma\u0107in Dobrava virusa (DOBV), uzro\u010dnika te\u0161kog oblika HVBS. Ve\u0107 u ranim 80-tim, HFRS pacijenti iz Bosne su imali najvi\u0161e titrove antitijela protiv prototipa Korejskog Hantaan, serotipa 76-118, i pokazali su najte\u017ee klini\u010dke simptome. Za vrijeme do tada najve\u0107e epidemije u 1989.god., kada je hospitalizirano 609 oboljelih sa klini\u010dkim znacima i simptomima karakteristi\u010dnim za HFRS, od njih 226 su bili serolo\u0161ki potvr\u0111eni kao Hantavirusna (HTV) infekcija, sa mortalitetom od 6,6% (15\/226). BiH je jo\u0161 jednom potvr\u0111ena kao centar izbijanja infekcije, sa 108 serolo\u0161ki potvr\u0111enih slu\u010dajeva (48%) i mortalitetom od 5,5% (6\/108). Analizom klini\u010dke slike i rezultata serolo\u0161kih analiza, postalo je jasno da na podru\u010dju biv\u0161e Jugoslavije cirkuli\u0161u barem dva razli\u010dita hantavirusa: jedan blisko srodan Hantaan virusu, no\u0161en sa A. flavicollis, uzro\u010dnik te\u0161kog klini\u010dkog oblika HFRS; a drugi srodan Puumala virusu, no\u0161en sa Myodes glareolus, koji izazivaju blage oblike klini\u010dke slike. Ista istra\u017eivanja su sprovedena i u Sloveniji. Kona\u010dno, Avsi\u0107 i saradnici su izolovali hantavirus blisko srodan, ali ne i identi\u010dan sa HTN iz A. flavicollis izlovljenog u Dobravi, selu u Sjevernoj Sloveniji, gdje su se javili te\u0161ki HVBS slu\u010dajevi.<\/p>\n

\"Hemoragijska-groznica\"<\/a>U sigurno najve\u0107oj epidemiji HFRS, koja je pogodila BiH, tokom ratnog perioda 1995.god., oboljelo je vi\u0161e od 1.000 ljudi. Vi\u0161e od 500 bolesnika, prete\u017eno vojnika, hospitalizirano je u sjeveroisto\u010dnoj Bosni zbog akutne HFRS. Huki\u0107 i saradnici su serolo\u0161kim i virolo\u0161kim ispitivanjima dokazali da su uzro\u010dnici bolesti bili PUUV i DOBV. Nova, velika epidemija HFRS na Balkanskom poluostrvu buknula je ponovo 2002. god. BiH je bila zna\u010dajno pogo\u0111ena ovom epidemijom. Do 2012 godine, kontinuirano, svake godine bilje\u017eeni su pojedina\u010dni slu\u010dajevi obolijevanja od HFRS. Posljednja epidemija, na podru\u010dju Hrvatske, Slovenije i BiH, izbila je 2012.godine. Glavna karakteristika ove epidemije u BiH nije bila brojnost oboljelih, nego te\u017eina klini\u010dke slike i visok mortalitet.<\/p>\n

Istra\u017eivanja u Bosni i Hercegovini<\/strong><\/p>\n

Pored brojnih istra\u017eivanja, podru\u010dje BiH je ostalo neispitano u pogledu brojnosti i zastupljenosti razli\u010ditih vrsta glodara \u2013 prirodnih rezervoara hantavirusa, karakteristikama HTV, poznavanju u\u010destalosti PUU-infekcija i DOB-infekcija kod ljudi te osobitostima klini\u010dke slike bolesti. U cilju boljeg razumijevanja biologije i ekologije Hantavirusa, te bolesti koje uzrokuje, u posljednjih 17 godina, kontinuirano smo vr\u0161ili epizotiolo\u0161ki i epidemiolo\u0161ki nadzor.<\/p>\n

U razli\u010ditim ekosistemima BiH uhvatili smo 871 glodara (11 vrsta glodara).<\/p>\n

\"Hemoragijska-groznica2\"<\/a>Antitijela za Hantaviruse na\u0111ena su serumima: Apodemus flavicollis, Clethrionomus glareolus, Chionomys nivalis, Dinaromys bogdanovi i Mycrotus arvalis. DOBV je izolovan iz Apodemus flavicollis, uhva\u0107enog u blizini Kladnja. Bosanski DOB virus, ozna\u010den je kao DOBV-Tuzla43. Analizom njegove RNA, utvr\u0111eno je da se radi o DOB, koji se u 7% genomski sekvenci razlikuje od orginalno izolovanog soja u Sloveniji. Iz Myodes glareolus je izolovan Bosanski PUUV, ali njegova genetska analiza jo\u0161 nije zavr\u0161ena.<\/p>\n

Kao uzro\u010dnici HFRS u BiH dokazani su: PUUV (49.84%), DOBV (23.15%) i neidentifikovani Hantavirus serotip (27.00%). Ovaj nalaz govori da su najmanje tri razli\u010dita HTV serotipa endemi\u010dni u BiH. Dokazano je da HTV mogu uzrokovati asimptomatsku i blagu klini\u010dku sliku bolesti, ali i te\u0161ku bolest sa krvarenjima, prestankom rada bubrega i smrtnim ishodom.<\/p>\n

Asimptomatske infekcije u zana\u010dajno ve\u0107em procentu uzrokuje PUUV (69.8%), u odnosu na DOBV (17.5%) i neidentificirani soje HTV (12.7%). Klini\u010dka evaluacija je pokazala da u toku akutne faze bolesti DOBV uzrokuje mnogo te\u017ea o\u0161te\u0107enja bubrega od PUUV. Nakon 10 godina nakon HFRS, funkcija bubrega se normalizuje, s tim da je glomerularna filtracija signifikantno ni\u017ea poslije DOB-infekcije, nego nakon PUUV infekcije.<\/p>\n

Epidemiolo\u0161ka istra\u017eivanja pokazuju da su rizikofaktori za nastanak HTV infekcije: \u017eivot na endemskom podru\u010dju, poljoprivredni radovi, rad sa otpadom, spavanje na zemlji, vojne vje\u017ebe i ni\u017ei socio-ekonomski status. Prema u\u010destalosti obolijevanja , u BiH su definisana endemska i ne-endemska podru\u010dja za Hantanvirusnu infekciju. Hantavirusna seroprevalence me\u0111u stanovni\u0161tvom u endemskim podru\u010djima je 7.4% , a 2.4% u ne-endemskim (P<\/p>\n

Reference<\/strong>:<\/p>\n

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25. Smajlovi\u0107 L, Davoren J, Heyman P, Cochez C, Haas C, Maake C, Huki\u0107 M. Development and optimization of a PCR assay for detection of Dobrava and Puumala hantaviruses in Bosnia and Herzegovina. J Virol Methods. 2012 Jun;182(1-2):37-42.<\/p>\n

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28. Huki\u0107 M, Tulumovi\u0107 D, \u010calki\u0107 L, Jahi\u0107 R. Aganovi\u0107 Mu\u0161inovi\u0107 I. Acute renal failure in hantavirus infections. The. 6th International Conference on Hemorrhagic Fever with Renal Syndrome (HFRS) Hantavirus Pulmonary Syndrome (HPS) and Hantaviruses. Conference program and Abstracts. The National Academy of Sciences, Republic of Korea, Seoul, 23-25 June 2004. 95.<\/p>\n

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35. Huki\u0107 M, Lundkvist A, Heilman P, Tihi\u0107 N, Delibegovi\u0107 Z, Nurki\u0107 M, Nurki\u0107 A, Rezakovi\u0107 D\u017e, Tulumovi\u0107 D, Me\u0161i\u0107 E, Seleskovi\u0107 H, \u0160ari\u0107 M, \u0160abovi\u0107 S, Jusufovi\u0107 E, \u010calki\u0107 L, Sinanovi\u0107 O, Slanjanki\u0107 K, Sarajli\u0107 D\u017e, Mott-Divkovi\u0107 S, Uzejrbegovi\u0107 M, Begi\u0107 L, Sarihod\u017ei\u0107 S, Puva\u010di\u0107 Z, \u010camd\u017ei\u0107 F, Karaka\u0161 S, \u010custovi\u0107 A, \u0106uri\u0107 M (2002) Hantaviruses in Bosnia and Herzegovina \u2013 microbiological and epidemiological aspects. ANUBiH, Book XCI, Department of Medicinae scientia, Book 30, Center for medical investigetion, Book 1: 175-182.<\/p>\n

36. Huki\u0107 M, Muzaferovi\u0107 \u0160, Tulumovi\u0107 D, \u010calki\u0107 L, \u0160abovi\u0107 S, Karaka\u0161 S, Sabitovi\u0107 D, Pavi\u0107 G, Osman\u010devi\u0107 E (2003) Puumala and Dobrava viruses in North-Estern Bosnia. Acta Med. Croatica; 57: 373-380.<\/p>\n

37. Tulumovi\u0107 D, Me\u0161i\u0107 E, Huki\u0107 M, Trna\u010devi\u0107 S (2004) Ultrasound evaluation of abdominal organs in hemorrhagic fever with renal syndrome. Final Programme and abstract Book XVI European Congress of ultrasound in medicine and biology, Zagreb, Croatia 5.-8. june 2004. Lije\u010dni\u010dki vijesnik. A. 118.<\/p>\n

38. Huki\u0107 M, Osman\u010devi\u0107 E, Tulumovi\u0107 D, Muzaferovi\u0107 \u0160. Influent of climatic Factors on the outbreak of epidemic of hemorrhagic fever with renal syndrome. The first Symphosium of Zoonoses with international participation. Final Program and Book of Abstracts, Sarajevo 22-23 April, 2005.<\/p>\n

39. Huki\u0107 M. Hantavirus-infections and diversity of rodent\u2019s species in Bosnia and Herzegovina. In: Abstract of the Congress of Emerging and Reemerging infectious diseases in central and eastrn Europe, Sofija, Bulgaria, September 21-24, 2009. U.S. Department of Health and Human Services, National Institutes of Health, Nacional Institute of Allergy and Infectious Diseases, U.S. Department of State, Biosecurity Engagement Program, Bedhesta 2009.<\/p>\n

40. Huki\u0107 M. The influence of the war in Bosnia and Herzegovina on the hemorrhagic fever with renal syndrome outbreaks.In: Abstract of the VIII nternational Conference on HFRS HPS & Hantaviruses, Athens, Greece 20-22 May 2010.<\/p>\n

Bosnia and Herzegovina (B&H) has been recognized as a highly endemic region for Hantavirus infections for over 60 years. The following causative agents of HFRS were confirmed: PUUV, DOBV and unidentified Hantavirus serotypes responsible for 49.84%, 23.15% and 27.00% of hospitalized cases, respectively. These findings suggest that at least three distinct serotypes are endemic throughout Bosnia and Herzegovina.<\/em><\/p>\n

\"mis\"<\/a>Bosnia and Herzegovina (B&H) has been recognized as a highly endemic region for Hantavirus infections for over 60 years. In 1952, the first probable hemorrhagic fever with renal syndrome case (HFRS) was described in the region. The victim was a soldier and infection was acquired near Fojnica, Bosnia and Herzegovina. Several HFRS outbreaks in B&H have been reported up to the present time. The first documented HFRS outbreak was reported in 1967, followed by three major outbreaks in the former Yugoslavia in 1986, 1987 and 1989. The majority of cases reported in these epidemics were located in B&H. From 1989 to 1991, 55 additional cases were detected in B&H with a mortality rate of 7.3%. During the war in B&H (1995), more than 500 patients, most of them soldiers exposed to the fields in northeast Bosnia, were hospitalized with acute Hantavirus disease due either to Puumala (PUUV) or Dobrava (DOBV) as first documented by IgG and IgM ELISA and later confirmed by focus reduction neutralization test. To our knowledge, this was the first report of an epidemic caused by two different hantaviruses each carried by a different rodent species, which were apparently synchronistic and sympatric in a limited but highly endemic area. The HFRS outbreak occurred again in 2002. The last outbreak of HFRS was in 2012. The most prominent characteristic of this epidemic was high rate of mortality 11% (3\/27).<\/p>\n

To know the reservoir animal species and characteristics of Hantaviruses as well as HFRS in Bosnia and Herzegovina, we have been continuing epizotiological and epidemiological surveys.<\/p>\n

\"\"<\/a>In different ecosystems of B&H we caught 871 rodents (11 different species of rodents). Five of them (Apodemus flavicollis, Clethrionomus glareolus, Chionomys nivalis, Dinaromys bogdanovi and Mycrotus arvalis) had antibodies to Hantaviruses. DOBV was isolated from Apodemus flavicollis. The Bosnian DOBV virus, designated DOBV-Tuzla43 is more closely related to the original DOBV isolated from Apodemus flavicollis in Slovenia (3.8% nucleotide difference) than to the Greek or Albanian DOB viruses (5.9 and 8.4% nucleotide differences, respectively). Bosnian PUUV was isolated from Clethrionomus glareolus; however, our RT-PCR analyses are not completed yet.<\/p>\n

The following causative agents of HFRS were confirmed: PUUV, DOBV and unidentified Hantavirus serotypes responsible for 49.84%, 23.15% and 27.00% of hospitalized cases, respectively. These findings suggest that at least three distinct serotypes are endemic throughout Bosnia and Herzegovina. PUUV was significantly predominant in asymptomatic hantavirus antibody-positive subjects (69.8%) compared to HFRS patients. DOBV was present in 17.5% of asymptomatic subjects and, interestingly, the preferential hantavirus serotype could not be determined in 12.7% of the asymptomatic antibody-positive subjects. Thorough clinical evaluation and follow up of affected patients has shown that during the acute phase, DOBV causes more severe renal impairment than PUUV infection. The 10 years follow up of these patients showed renal function within normal limits although after DOBV infection, glomerular filtration rate was significantly lower than after PUUV infection.<\/p>\n

Epidemiological investigations have linked viral exposure to activities such as heavy farm work, threshing, sleeping on the ground, military exercises, and lower socioeconomic status. Hantavirus seroprevalence was 7.4% in the endemic region of B&H and 2.4% in the non-endemic region of B&H (P<\/p>\n

Reference<\/strong>:<\/p>\n

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8. Tulumovi\u0107 D, Huki\u0107 M, Me\u0161i\u0107 E, \u0160abovi\u0107 S, Tulumovi\u0107 A.Ultrasonografski nalaz na abdominalnim organima u akutnoj fazi hemoragijske vru\u010dice sa bubre\u017enim sindromom. Acta Med Croatica. 2003; 57. 427-431<\/p>\n

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<\/div><\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"

Preko 60 godina Bosna i Hercegovina je poznata kao endemi\u010dna regija za hantavirus infekcije. Najmanje tri razli\u010dita Hantavirus (HTV) serotipa su endemi\u010dni u BiH. Dokazano je da HTV mogu uzrokovati asimptomatsku i blagu klini\u010dku sliku bolesti, ali i te\u0161ku bolest sa krvarenjima, prestankom rada bubrega i smrtnim ishodom. Epidemiolo\u0161ka istra\u017eivanja pokazuju da su rizikofaktori za […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[38,7],"class_list":["post-2027","post","type-post","status-publish","format-standard","hentry","category-novosti","tag-hantavirus","tag-nalaz"],"yoast_head":"\nHemoragijska groznica sa bubre\u017enim sindromom u Bosni i Hercegovini<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"http:\/\/www.nalaz.org\/v2\/hemoragijska-groznica-sa-bubreznim-sindromom-u-bosni-i-hercegovini\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Hemoragijska groznica sa bubre\u017enim sindromom u Bosni i Hercegovini\" \/>\n<meta property=\"og:description\" content=\"Preko 60 godina Bosna i Hercegovina je poznata kao endemi\u010dna regija za hantavirus infekcije. Najmanje tri razli\u010dita Hantavirus (HTV) serotipa su endemi\u010dni u BiH. Dokazano je da HTV mogu uzrokovati asimptomatsku i blagu klini\u010dku sliku bolesti, ali i te\u0161ku bolest sa krvarenjima, prestankom rada bubrega i smrtnim ishodom. 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