engleski

Dual infection with Puumala virus and E.coli

E. coli is one of the most common pathogens of urinary tract infections, while Puumala virus causes haemorrhagic fever with renal syndrome (HFRS), an endemic disease in Croatia. Both diseases in their initial phase can have similar symptoms such as fever, chills, shivers, lumbar pain as well as positive urinalysis. We report a case with dual infection with E. coli and Puumala virus. A 41-year-old female patient from Zagreb complained of dysuric problems several days prior hospitalization, with high fever, chills, shivers and headache. A highly sensitive E. coli (106/ml) was detected in urine culture. Acute pyelonephritis was diagnosed and antibiotic treatment initiated. Patient`s anamnestic data included iatrogenic hypothyreosis and glaucoma for which the patient received no medication two months prior hospitalization. The patient lived in a rural household in suburban area, and worked as a cleaner at a transfusiology department. Clinical examination revealed a severe exophthalmos with bilateral conjunctival injection and mild lumbar pain. Further laboratory findings showed elevated CRP (125, 5), thrombocytopenia and positive urine culture. On the sixth day of disease, the patient complained of blurred vision, and despite antibiotic therapy remained highly febrile. Ophthalmological examination revealed acute myopia. Infection with Puumala virus was serologically confirmed and HFRS diagnosed. Puumala virus most commonly causes milder to moderately severe forms of HFRS, and cases of acute myopia have already been described in patients with HFRS. The basis of this disorder is most probably the fluctuation in electrolyte and osmotic balance. This case shows that in endemic areas of HFRS, in patients with clinical presentation of acute pyelonephritis (even with bacteria found in urine), HFRS should be considered, especially when there is no clinical improvement after antibiotic therapy.

Puumala virus; E. coli

Rad je kao poster na hrvatskom jeziku pod naslovom 'Dvojna infekcija virusom Puumala i E. coli' prezentiran na skupu 1. hrvatski kongres o urogenitalnim i spolno prenosivim infekcijama s međunarodnim sudjelovanjem, održanom od 05.-07.06.2009., Opatija, Hrvatska ; objavljen u Knjizi sažetaka, str. 88-88.