Consider a diagnosis of eagle fever in Skåne, too

An epidemic of nephropathy, or gout fever, was first reported in Sweden in 1933 when Gustav Mermann described three cases from Jämtland. [1]. Avian fever is a zoonotic disease caused by the Hantavirus (Pumala virus) that… Contains wood crater (Myodes glareolus) as a natural host (reservoir). The disease has long been considered to be restricted to northern Dalälven, but in recent decades it appears to have spread south [2].

The first case of mushroom fever was discovered in Skåne in 2018 and reported the following year in Läkartidningen. [3]. The patient, who did not live in an endemic area, first developed non-specific symptoms such as fever, muscle aches and respiratory problems. Later, oliguria and epistaxis developed. In vitro, moderate elevation of C-reactive protein, thrombocytopenia, and gradual elevation of creatinine were observed. The patient improved with symptomatic treatment, and after the polyuric phase the creatinine value was adjusted.

As a result, on the part of Skåne, completely new cases of the disease, we started a project where approximately 70 mares were collected in the forest using shock traps that were placed around the patient’s house and in the immediate surroundings. Prior to collection, an ethical permit was obtained from the Swedish Agricultural Agency and a hunting permit from the Swedish Environmental Protection Agency. The lungs of the animals were analyzed using PCR technology at the Zoonoses Disease Center (ZSC) in Uppsala. There, Puumalavirus was discovered with unique genetic sequences that differ from the Puumalavirus strains that occur in northern Sweden.

Our results indicate that Puumalavirus is present among forest mice in Skåne and that mushroom fever should be a differential diagnosis in southern Sweden. Eagle fever appears to be spreading in increasingly densely populated areas of the country, so the number of cases may increase. Given that mushroom fever can cause hemorrhagic manifestations and acute renal failure, an increase in the number of cases can have consequences not only for the individual but also for society, in the form of increased health care costs.

The spread of mushroom fever is in line with the global trend of increasing geographical spread of several zoonotic viral infectious diseases, such as TBE, Nile fever, dengue fever, and Crimean-Congo fever.

Global warming may be one of the factors that affected the spread of the disease [4]Another reduction in biodiversity [5]. Our Puumalavirus genetic sequences best match those previously studied in Finland and Russia. It will therefore be important in the future to study how the virus spread to Skåne, especially since its genetic sequence differs from previously known Swedish virus variants.

We want to draw the attention of colleagues in southern Sweden to consider vulture fever when treating patients with characteristic symptoms.

Medical Journal 43/2022

Lakartidningen.se 2022-10-31