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Nephrol Dial Transplant (2001) 16: 1289-1290
© 2001 European Renal Association-European Dialysis and Transplant Association
Editorial Note
The history of viral haemorrhagic fever with renal disease (hantavirus)
Section Editor: Historical Notes
The group of disorders known as haemorrhagic fevers with renal failure first made a major impact throughout the medical world in 1951, when more than 3000 United Nations troops fighting in Korea suffered from what was thought by their Western-trained doctors to be a ‘new’ disease [1–3], with a mortality approaching 10%. Much later in 1978, the responsible hantavirus was identified, and its world-wide distribution and carriage by mice and voles were described [4]. In fact, this ‘new’ disease had been discovered and re-discovered in many times and in many places before.
Earle [5], following Langdon Brown [6] has suggested that it was evident during the American civil war in 1862 and 1863, and much discussion has centred on the nature of this ‘trench’ nephritis, which again plagued both German and Allied troops on the Western front in the First World War in 1915 and 1916 [6–9]. Interestingly, this type of disorder does not appear to have been reported in troops fighting in the Sino-Japanese war of 1905, which took place in the area discussed in the paper by Sirotin and Keiser. Extensive investigations which failed to reveal the nature of the thousands of cases of ‘trench’ nephritis were carried out [6–9], and Fischer-Hoch [10] has argued this condition was in fact haemorrhagic nephritis with renal involvement. Not all are in agreement however [9]: purpura was not a feature, and post-mortem histology by several observers in England and Germany showed a typical acute post-infectious nephritis [11].
In Korea, Manchuria and the far East of Russia the condition has been endemic, probably for centuries, although the first hints of it existence, according to Gavrilyuk [12] can be found in the records of the Vladivostock regional hospital in 1913–4. The paper by Sirotin and Keiser describes an excellent early account of patients from the annual epidemics of ‘nephroso-nephritis’ in the primor'ye region north of Vladivostock. A similar account of a milder form of the disease in Finland (which later came to be called Puumala fever) was published also in 1934 [13], followed by accounts of the same condition affecting Japanese troops in Manchuria during the second world war under the name of Song-go fever [14,15].
Why were none of these papers known in the West when the disaster in the Korean war happened? Probably because all were published in languages outside the mainstream of medicine at the time. German, French and above all English were the languages of medical discourse. Also, at that time ‘tropical medicine’ was seen very much as a separate discipline, with which most doctors did not concern themselves. However, Gajdusek quickly realised that the ‘new’ Korean disease and the Russian one were probably the same [16]. The globalization of medicine through travel and emigration was coming, and also the realization that lessons are there to be learned from apparently obscure diseases in remote areas.
References
- Gajdusek DC. Muroid virus nephropathies and muroid viruses of the Hantaan virus group. Scand J Infect Dis1982; 36 [Suppl]: 96–108
- Van Ypersele C. Hantavirus infection. In: Davison AM, Cameron JS, Grünfeld J-P, Kerr DNS, Ritz E, Winearls C, eds. Oxford Textbook of Clinical Nephrology, 2nd edn. Oxford University Press, Oxford: 1998; 1688–1692
- Harper DR, Meyer AS. Of mice, men and microbes: Hantavirus. Academic Press San Diego, CA: 1999
- Lee HW, Lee PW, Johnson KM. Identification of the etiologic agent of Korean hemorrhagic fever. J Infect Dis1978; 137: 298–308.[Web of Science][Medline]
- Earle DP. Analysis of the sequential physiologic derangements in epidemic hemorrhagic fever. Am J Med1954; 16: 690–709
- Langdon-Brown W. Trench nephritis. Lancet1916; i: 391–395
- Abercrombie RG. Observations on the acute phase of five hundred cases of war nephritis. J R Army Med Corps1916; 27: 131–157
- Bradford JR. Nephritis in the British troops in Flanders. Q J Med1916; 125–127.
- Maher JF. Trench nephritis: a retrospective perception. Am J Kidney Dis1986; 7: 355–362.[Web of Science][Medline]
- Fischer-Hoch S, McCormick JB. Haemorrhagic fever with renal syndrome. Abstr Hyg Commun Dis1985; 60: R1–R20.
- Dunn and MacNee, Br Med J 1917; ii: 745, Keith and Thomson, J Urol 1919; 3: 87, Herxheimer, Ziegler's Beitr 1917–8; 64: 454. Cited in Fishberg A, Hypertension and nephritis, 2nd edn. Lea & Febiger, Philadelphia: 1932; 374–375
- Gavrilyuk BK. [Hemorrhagic nephroso-nephritis in the primor'ye region]. Avtoref. Diss Sosh Uchen Step Dokt Med Nauk (Akad Med Nauk SSR, Ord Trud Krasn Znam Inst Eksp Med). Leningrad 1968, pp. 41 (cited in Fischer-Hoch [10])
- Zetterholm S. Akuta nefriter simulerande akuta bukfall. Läkartidningen1934; 31: 425–429
- Ishii S. Studies on Song-go fever. Jpn Army Med J1942 (cited in Fischer-Hoch [10])
- Kitano M. A study of epidemic hemorrhagic fever. Jpn Army Med J1944 (cited in Fischer-Hoch [10])
- Gajdusek DC. Acute Infectious Hemorrhagic Fevers and Mycotoxicoses in the Union of Soviet Socialist Republics. US Army Graduate School Medical Science Publication no 2. Walter Reed Army Medical Center, Washington: 1953
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