The Minor Problem of Hemostatic Impairment in Nephropathia Epidemica, the Mild Scandinavian Form of Hemorrhagic Fever with Renal Syndrome

Nephropathia epidemica (NE) is the mild Scandinavian form of hemorrhagic fever with renal syndrome (HFRS). Its hemorrhagic manifestations are so mild that initially- as its name implies- it was not considered a hemorrhagic fever. It is, however, clinically, histologically, and epidemiologically similar to Korean hemorrhagic fever (KHF) except that hemorrhagic manifestations are fewer and mortality is lower. The etiologic agents of the two disorders, Puumala virus (NE) and Hantaan virus (KHF), are closely related. NE is the most benign of the hemorrhagic fevers. Hemostatic impairment is not a signifi-cant clinical problem in this disease and therefore has not been thoroughly studied, al-though abnormalities in hemostasis have been noted. Further investigations of this dis-ease might provide insights concerning the treatment of other, more severe, hemorrhagic fevers. The Latin name nephropathia epidemica (NE) was proposed in 1945 by the Swedish investigator Myhr-man [1], who had described this disease in 1934 [2] at the same time as his countryman Zetterholm [3]. It initially was considered to be a nephritic disease and not a hemorrhagic fever because of its minimal hemorrhagic manifestations. In 1953 Gajdusek sug-gested that NE could also be a hemorrhagic fever [4]. In 1971, a detailed study by Lahdevirta [5] showed that clinically, histologically, and epidemiologically NE was similar to Korean hemorrhagic fever (KHF), the severe from of hemorrhagic fever with renal syn-drome (HFRS). The principal differences between NE and KHF are the milder hemorrhagic manifesta-tions and the lower mortality «0.5070 vs. 5%-10%) in NE than in KHF