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Exposure to Hantavirus is a Risk Factor Associated with Kidney Diseases in Sri Lanka: A Cross Sectional Study

Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
Department of Microbiology and Immunology, Faculty of Medicine, Hokkaido University, Sapporo 060-8638, Japan
Graduate School of Infectious Diseases, Hokkaido University, Sapporo 060-8638, Japan
Nephrology and Transplantation Unit, Teaching Hospital Kandy, Kandy 20000, Sri Lanka
Renal Clinic, District Hospital, Girandurukotte 90750, Sri Lanka
Author to whom correspondence should be addressed.
Viruses 2019, 11(8), 700;
Received: 31 May 2019 / Revised: 16 July 2019 / Accepted: 30 July 2019 / Published: 31 July 2019
(This article belongs to the Special Issue Hantaviruses)
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Chronic kidney disease of unknown etiology (CKDu) imposes a substantial burden on public health in Sri Lankan agricultural communities. High seroprevalences of hantavirus have been reported in CKDu patients in several locations of Sri Lanka. We carried out a cross-sectional study followed by an unmatched case-control comparison in two geographically distinct areas of Sri Lanka, Girandurukotte (CKDu endemic) and Kandy (CKDu non-endemic) to determine whether exposure to hantaviruses is a potential risk factor in patients with kidney disease. An indirect immunofluorescent antibody assay using two antigens, Thailand orthohantavirus-infected and recombinant N protein-expressing Vero E6 cells, were used for serodiagnosis. Participants’ demographic and other socio-economic data were collected through a structured questionnaire. Fifty kidney disease patients and 270 controls from Kandy and 104 kidney disease patients and 242 controls from Girandurukotte were examined. Seropositivities were 50% and 17.4% in kidney patients and controls, respectively, in Girandurukotte, and they were 18% and 7% in Kandy. The odds of exposure to hantaviruses were higher for kidney disease patients than for controls in both Girandurukotte (OR:3.66, 95% CI:2.01 to 6.64) and Kandy (OR:2.64, 95% CI:1.07 to 6.54) in binary logistic regression models. According to statistical analysis, individuals exposed to hantaviruses had a higher risk of developing renal impairment. Therefore, hantavirus infection might be an important risk factor for development of kidney disease in Sri Lanka. View Full-Text
Keywords: Thailand orthohantavirus; tropical nephropathy; rodent Thailand orthohantavirus; tropical nephropathy; rodent

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Sarathkumara, Y.D.; Gamage, C.D.; Lokupathirage, S.; Muthusinghe, D.S.; Nanayakkara, N.; Gunarathne, L.; Shimizu, K.; Tsuda, Y.; Arikawa, J.; Yoshimatsu, K. Exposure to Hantavirus is a Risk Factor Associated with Kidney Diseases in Sri Lanka: A Cross Sectional Study. Viruses 2019, 11, 700.

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