2nd order laboratory parameters – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification.
- Serologic examination by IgM-/IgG-ELISA; can be determined:
- Hantaan virus antibodies (IgG; IgM).
- Dobrava-Belgrade virus (IgG; IgM)
- Puumala virus antibody (IgG; IgM)
- Antibody detection – Hantavirus antibody (IgM/IgG immunoblot, confirmation); covers hantavirus subtypes:
- Hantaan virus
- Dobrava-Belgrade virus
- Puumala virus
- Seoul virus
- Molecular epidemiological fine differentiation of the Puumalavirus strains; this molecular diagnostic (from serum or whole blood) is only possible in the first days of illness, as the virus is then eliminated from the blood again – this is used for more accurate mapping of the hantavirus outbreak areas.
- Small blood count [leukocytosis/increase in white blood cell count; thrombocytopenia/deficiency of platelets in blood]
- Inflammatory parameters – CRP (C-reactive protein).
- Urine sediment [microhematuria/presence of blood in urine detectable by microscope].
- Protein (protein) in the urine [proteinuria]
- Blood gas analysis (BGA)
- Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH) and gamma-glutamyl transferase (gamma-GT, GGT).
- Renal parameters – urea, creatinine, possibly cystatin C or creatinine clearance [increase in renal retention values already in the febrile phase (fever phase); maximum in the stage of oliguria/falling below the age-standard physiological urine volume to less than 200 ml per m2].
- Coagulation parameters – Quick, PTT
Namely, direct or indirect detection of hantaviruses must be reported if the evidence indicates acute infection (Act on the Prevention and Control of Infectious Diseases in Humans).
