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Kitterer D, Segerer S, Dippon J, Alscher MD, Braun N, Latus J. Smoking Is a Risk Factor for Severe Acute Kidney Injury in Hantavirus-Induced Nephropathia Epidemica. Nephron Clin Pract 2016; 134:89-94. [PMID: 27388481 DOI: 10.1159/000447783] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/21/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Hantaviruses are zoonotic pathogens causing emerging diseases worldwide. Patients typically present with fever, acute kidney injury (AKI) and thrombocytopenia. Puumala virus (PUUV) that causes nephropathia epidemica (NE) is common in Germany. Recently, a study from Finland revealed an association between nicotine consumption and the severity of AKI in NE. Differences between individuals in Finland and Germany might modulate the effect; therefore, the aim of our study was to prove that smoking is a risk factor for a severe course of NE in Germany. METHODS A cross-sectional prospective survey of 485 patients with hantavirus infections was performed. Clinical and laboratory data during the acute course of the disease were obtained from medical reports and files, while follow-up (including smoking status) data were collected prospectively. RESULTS Smoking information was available for 298 out of 485 patients (61%). Male was the predominant gender (67%), median age at the time of diagnosis was 50 (interquartile range, IQR 41-60) years and 34% of patients were current smokers during the phase of acute NE. Patients in the smoking group were significantly younger than in the non-smoking group (p < 0.0001). Peak serum creatinine levels were significantly higher in the smoking group than in the non-smoking patients (median 301 (IQR 186-469 μmol/l) vs. median 240 (IQR 137-469 μmol/l), p < 0.05). In addition, severe AKI (stages 2 and 3 using KDIGO criteria) was more common in current smokers (80%) than in the non-smokers (68%, p < 0.05). CONCLUSION Current smoking is a risk factor for severity of AKI in patients with acute PUUV infection in Germany. Therefore, information about smoking habits needs to be an integral part of the documentation in patients with suspected acute PUUV infection, and increased monitoring of kidney function should be done in NE patients who are current smokers.
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Affiliation(s)
- Daniel Kitterer
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch Hospital, Stuttgart, Germany
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Jiang H, Du H, Wang LM, Wang PZ, Bai XF. Hemorrhagic Fever with Renal Syndrome: Pathogenesis and Clinical Picture. Front Cell Infect Microbiol 2016; 6:1. [PMID: 26870699 PMCID: PMC4737898 DOI: 10.3389/fcimb.2016.00001] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/05/2016] [Indexed: 01/08/2023] Open
Abstract
Hantaan virus (HTNV) causes hemorrhagic fever with renal syndrome (HFRS), which is a zoonosis endemic in eastern Asia, especially in China. The reservoir host of HTNV is field mouse (Apodemus agraricus). The main manifestation of HFRS, including acute kidney injury, increases vascular permeability, and coagulation abnormalities. In this paper, we review the current knowledge of the pathogenesis of HFRS including virus factor, immunity factor and host genetic factors. Furthermore, the treatment and prevention will be discussed.
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Affiliation(s)
- Hong Jiang
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University Xi'an, China
| | - Hong Du
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University Xi'an, China
| | - Li M Wang
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University Xi'an, China
| | - Ping Z Wang
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University Xi'an, China
| | - Xue F Bai
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University Xi'an, China
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Latus J, Schwab M, Tacconelli E, Pieper FM, Wegener D, Dippon J, Müller S, Zakim D, Segerer S, Kitterer D, Priwitzer M, Mezger B, Walter-Frank B, Corea A, Wiedenmann A, Brockmann S, Pöhlmann C, Alscher MD, Braun N. Clinical course and long-term outcome of hantavirus-associated nephropathia epidemica, Germany. Emerg Infect Dis 2015; 21:76-83. [PMID: 25533268 PMCID: PMC4285283 DOI: 10.3201/eid2101.140861] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The consequences of associated hematuria may be long-lasting, and hantavirus IgG is detectable years after acute infection. Human infection with Puumala virus (PUUV), the most common hantavirus in Central Europe, causes nephropathia epidemica (NE), a disease characterized by acute kidney injury and thrombocytopenia. To determine the clinical phenotype of hantavirus-infected patients and their long-term outcome and humoral immunity to PUUV, we conducted a cross-sectional prospective survey of 456 patients in Germany with clinically and serologically confirmed hantavirus-associated NE during 2001–2012. Prominent clinical findings during acute NE were fever and back/limb pain, and 88% of the patients had acute kidney injury. At follow-up (7–35 mo), all patients had detectable hantavirus-specific IgG; 8.5% had persistent IgM; 25% had hematuria; 23% had hypertension (new diagnosis for 67%); and 7% had proteinuria. NE-associated hypertension and proteinuria do not appear to have long-term consequences, but NE-associated hematuria may. All patients in this study had hantavirus-specific IgG up to years after the infection.
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Sane J, Reimerink J, Harms M, Bakker J, Mughini-Gras L, Schimmer B, van Pelt W. Human hantavirus infections in the Netherlands. Emerg Infect Dis 2015; 20:2107-10. [PMID: 25417752 PMCID: PMC4257821 DOI: 10.3201/eid2012.131886] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
We report the recent epidemiology and estimated seroprevalence of human hantavirus infections in the Netherlands. Sixty-two cases were reported during December 2008-December 2013. The estimated seroprevalence in the screened municipalities in 2006-2007 was 1.7% (95% CI 1.3%-2.3%). Findings suggest that hantavirus infections are underdiagnosed in the Netherlands.
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Tervo L, Mäkelä S, Syrjänen J, Huttunen R, Rimpelä A, Huhtala H, Vapalahti O, Vaheri A, Mustonen J. Smoking is associated with aggravated kidney injury in Puumala hantavirus-induced haemorrhagic fever with renal syndrome. Nephrol Dial Transplant 2015; 30:1693-8. [PMID: 26150428 DOI: 10.1093/ndt/gfv273] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 06/05/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Previous studies indicate that smoking affects the outcome of some infections and is a risk factor for Puumala virus (PUUV) infection. The aim of this study was to assess the effect of smoking on the clinical severity of PUUV infection and the prevalence of smoking in patients with PUUV infection. METHODS A questionnaire on smoking habits was sent to 494 patients in 2012, who had been treated in Tampere University Hospital, Finland, for serologically confirmed PUUV infection during years 1982-2012. RESULTS Of all patients, 357 (72%) participated. Maximum plasma creatinine level measured during acute illness was significantly higher in current smokers than in non-smokers (median: 273 versus 184 µmol/L, P < 0.001). Current smokers had a higher maximum blood leucocyte count than non-smokers (median: 10.8 versus 8.9 × 10(9)/L, P < 0.001) and they were younger than non-smokers (38 versus 45 years, P < 0.001). There were no differences between current smokers and non-smokers in the other variables reflecting the severity of PUUV infection. Altogether 51% were current smokers at the time of onset of the illness, 57% of males and 36% of females. During these years in Finland, smoking among males in the same aged population has decreased from 33 to 22% and among females, smoking has varied between 14 and 20%. CONCLUSIONS Smoking is common in patients with PUUV infection. Current smokers suffer from more severe acute kidney injury (AKI) and they have higher leucocyte count than non-smokers in PUUV infection. Smoking cessation decreases the risk of severe AKI to the same level as observed in never-smokers.
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Affiliation(s)
- Laura Tervo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland School of Medicine, University of Tampere, Tampere, Finland
| | - Jaana Syrjänen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland School of Medicine, University of Tampere, Tampere, Finland
| | - Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Arja Rimpelä
- Tampere School of Health Sciences, University of Tampere, Tampere, Finland Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Tampere School of Health Sciences, University of Tampere, Tampere, Finland
| | - Olli Vapalahti
- Department of Virology, Medical Faculty, University of Helsinki, Helsinki, Finland Department of Virology and Immunology, HUSLAB, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Antti Vaheri
- Department of Virology, Medical Faculty, University of Helsinki, Helsinki, Finland Department of Virology and Immunology, HUSLAB, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland School of Medicine, University of Tampere, Tampere, Finland
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Latus J, Kitterer D, Segerer S, Artunc F, Alscher MD, Braun N. Determination of procalcitonin levels in patients with nephropathia epidemica - a useful tool or an unnecessary diagnostic procedure? Kidney Blood Press Res 2015; 40:22-30. [PMID: 25662000 DOI: 10.1159/000368479] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Puumala virus causes nephropathia epidemica (NE), a milder form of hemorrhagic fever with renal syndrome that occurs in Central and Northern Europe. Several studies have sought to identify risk factors for severe NE. However, elevated procalcitonin (PCT) levels have not previously been investigated as a predictive marker for a severe course of NE. METHODS A cross-sectional prospective survey of 456 adults with serologically confirmed NE was performed. RESULTS PCT levels at the time of diagnosis were available for 43 out of 456 patients, and in 24 of these patients (56%) PCT levels were elevated ("PCT positive"). C-reactive protein (CRP) levels at admission to hospital and peak CRP levels during the acute course of the disease were higher in the PCT-positive compared with the PCT-negative group (p<0.05). Severe acute kidney injury (AKI) (RIFLE I and F) was present in similar numbers of PCT-positive and -negative patients (p=0.7), but antibiotics were more frequently used in the PCT-positive than the PCT-negative group (p<0.05). Within the PCT-positive group, PCT levels were similar among those receiving and not receiving antibiotics (p=0.13), and neither the duration of hospital stay nor CRP peak levels were lower in those treated with antibiotics (p=0.12 and p=0.13, respectively). CONCLUSIONS Elevated PCT levels are common in patients with acute NE. There was no association between PCT levels and severity of disease, including AKI or thrombocytopenia. It is important to distinguish Puumala virus infection from other causes of AKI with thrombocytopenia. However, PCT might not be useful in differentiating hantavirus infection from bacterial infection.
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Affiliation(s)
- Joerg Latus
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch Hospital, Stuttgart, Germany
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Abstract
In this chapter, we describe 73 zoonotic viruses that were isolated in Northern Eurasia and that belong to the different families of viruses with a single-stranded RNA (ssRNA) genome. The family includes viruses with a segmented negative-sense ssRNA genome (families Bunyaviridae and Orthomyxoviridae) and viruses with a positive-sense ssRNA genome (families Togaviridae and Flaviviridae). Among them are viruses associated with sporadic cases or outbreaks of human disease, such as hemorrhagic fever with renal syndrome (viruses of the genus Hantavirus), Crimean–Congo hemorrhagic fever (CCHFV, Nairovirus), California encephalitis (INKV, TAHV, and KHATV; Orthobunyavirus), sandfly fever (SFCV and SFNV, Phlebovirus), Tick-borne encephalitis (TBEV, Flavivirus), Omsk hemorrhagic fever (OHFV, Flavivirus), West Nile fever (WNV, Flavivirus), Sindbis fever (SINV, Alphavirus) Chikungunya fever (CHIKV, Alphavirus) and others. Other viruses described in the chapter can cause epizootics in wild or domestic animals: Geta virus (GETV, Alphavirus), Influenza A virus (Influenzavirus A), Bhanja virus (BHAV, Phlebovirus) and more. The chapter also discusses both ecological peculiarities that promote the circulation of these viruses in natural foci and factors influencing the occurrence of epidemic and epizootic outbreaks
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Laine O, Leppänen I, Koskela S, Antonen J, Mäkelä S, Sinisalo M, Vaheri A, Mustonen J. Severe Puumala virus infection in a patient with a lymphoproliferative disease treated with icatibant. Infect Dis (Lond) 2014; 47:107-11. [PMID: 25496418 DOI: 10.3109/00365548.2014.969304] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Early identification of patients at risk of a severe course of hantaviral disease and lack of effective medication represent a global challenge in the treatment of this emerging infection. We describe a 67-year-old female patient with a history of chronic lymphoproliferative disease involving the spleen and an extremely severe acute Puumala hantavirus infection. She was treated with the bradykinin receptor antagonist icatibant and recovered. She is the second patient with a spleen abnormality and severe Puumala infection treated with icatibant in our hospital. We suggest that patients with spleen abnormalities may be more susceptible to severe hantavirus disease. The activation of the kinin-kallikrein system and the formation of bradykinin in hantavirus-infected endothelial cells indicate that the role of bradykinin receptor antagonist icatibant in the treatment of hantavirus disease is worth studying.
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Affiliation(s)
- Outi Laine
- From the Department of Internal Medicine, Tampere University Hospital , Tampere , Finland
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Latus J, Schwab M, Tacconelli E, Pieper FM, Wegener D, Rettenmaier B, Schwab A, Hoffmann L, Dippon J, Müller S, Fritz P, Zakim D, Segerer S, Kitterer D, Kimmel M, Gußmann K, Priwitzer M, Mezger B, Walter-Frank B, Corea A, Wiedenmann A, Brockmann S, Pöhlmann C, Alscher MD, Braun N. Acute kidney injury and tools for risk-stratification in 456 patients with hantavirus-induced nephropathia epidemica. Nephrol Dial Transplant 2014; 30:245-51. [PMID: 25313168 DOI: 10.1093/ndt/gfu319] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Puumala virus (PUUV) is the most common species of hantavirus in Central Europe. Nephropathia epidemica (NE), caused by PUUV, is characterized by acute kidney injury (AKI) and thrombocytopenia. The major goals of this study were to provide a clear clinical phenotyping of AKI in patients with NE and to develop an easy prediction rule to identify patients, who are at lower risk to develop severe AKI. METHODS A cross-sectional prospective survey of 456 adult patients with serologically confirmed NE was performed. Data were collected from medical records and prospectively at follow-up visit. Severe AKI was defined by standard criteria according to the RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) classification. Fuller statistical models were developed and validated to estimate the probability for severe AKI. RESULTS During acute NE, 88% of the patients had AKI according to the RILFE criteria during acute NE. A risk index score for severe AKI was derived by using three independent risk factors in patients with normal kidney function at time of diagnosis: thrombocytopenia [two points; odds ratios (OR): 3.77; 95% confidence intervals (CI): 1.82, 8.03], elevated C-reactive protein levels (one point; OR: 3.02; 95% CI: 1.42, 6.58) and proteinuria (one point; OR: 3.92; 95% CI: 1.33, 13.35). On the basis of a point score of one or two, the probability of severe AKI was 0.18 and 0.28 with an area under the curve of 0.71. CONCLUSION This clinical prediction rule provides a novel and diagnostically accurate strategy for the potential prevention and improved management of kidney complications in patients with NE and, ultimately, for a possible decrease in unnecessary hospitalization in a high number of patients.
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Affiliation(s)
- Joerg Latus
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Matthias Schwab
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany Department of Clinical Pharmacology, University Hospital Tuebingen, Tuebingen, Germany
| | - Evelina Tacconelli
- Department of Internal Medicine I, Division of Infectious Diseases, University Hospital Tuebingen, Tuebingen, Germany
| | - Friedrich-Michael Pieper
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Daniel Wegener
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Bianka Rettenmaier
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Andrea Schwab
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Larissa Hoffmann
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Juergen Dippon
- Department of Mathematics, University of Stuttgart, Stuttgart, Germany
| | - Simon Müller
- Department of Mathematics, University of Stuttgart, Stuttgart, Germany
| | - Peter Fritz
- Institute of Digital Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - David Zakim
- Institute of Digital Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Stephan Segerer
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Kitterer
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Martin Kimmel
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | | | | | | | | | | | | | - Christoph Pöhlmann
- Department of Diagnostic and Laboratory Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - M Dominik Alscher
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Niko Braun
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
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Connolly-Andersen AM, Hammargren E, Whitaker H, Eliasson M, Holmgren L, Klingström J, Ahlm C. Increased risk of acute myocardial infarction and stroke during hemorrhagic fever with renal syndrome: a self-controlled case series study. Circulation 2014; 129:1295-302. [PMID: 24398017 DOI: 10.1161/circulationaha.113.001870] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We recently observed that cardiovascular causes of death are common in patients with hemorrhagic fever with renal syndrome (HFRS), which is caused by hantaviruses. However, it is not known whether HFRS is a risk factor for the acute cardiovascular events of acute myocardial infarction (AMI) and stroke. METHODS AND RESULTS Personal identification numbers from the Swedish HFRS patient database (1997-2012; n=6643) were cross-linked with the National Patient Register from 1987 to 2011. Using the self-controlled case series method, we calculated the incidence rate ratio of AMI/stroke in the 21 days after HFRS against 2 different control periods either excluding (analysis 1) or including (analysis 2) fatal AMI/stroke events. The incidence rate ratios for analyses 1 and 2 for all AMI events were 5.53 (95% confidence interval [CI], 2.6-11.8) and 6.02 (95% CI, 2.95-12.3) and for first AMI events were 3.53 (95% CI, 1.25-9.96) and 4.64 (95% CI, 1.83-11.77). The incidence rate ratios for analyses 1 and 2 for all stroke events were 12.93 (95% CI, 5.62-29.74) and 15.16 (95% CI, 7.21-31.87) and for first stroke events were 14.54 (95% CI, 5.87-36.04) and 17.09 (95% CI, 7.49-38.96). The majority of stroke events occurred in the first week after HFRS. Seasonal effects were not observed, and apart from 1 study, neither sex nor age interacted with the associations observed in this study. CONCLUSIONS There is a significantly increased risk for AMI and stroke in the immediate time period after HFRS. Therefore, HFRS patients should be carefully monitored during the acute phase of disease to ensure early recognition of symptoms of impending AMI or stroke.
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Affiliation(s)
- Anne-Marie Connolly-Andersen
- Department of Clinical Microbiology, Infectious Diseases (A.-M.C.-A., E.H., C.A.) and Department of Public Health and Clinical Medicine, Sunderby Research Unit (M.E., L.H.), Umeå University, Umeå, Sweden; Department of Mathematics and Statistics, The Open University, Milton Keynes, UK (H.W.); and Department of Medicine, Center for Infectious Medicine, Karolinska Institutet, Huddinge, Sweden (J.K.)
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Srikiatkhachorn A, Spiropoulou CF. Vascular events in viral hemorrhagic fevers: a comparative study of dengue and hantaviruses. Cell Tissue Res 2014; 355:621-33. [PMID: 24623445 PMCID: PMC3972431 DOI: 10.1007/s00441-014-1841-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/03/2014] [Indexed: 11/30/2022]
Abstract
Viral hemorrhagic diseases are a group of systemic viral infections with worldwide distribution and are significant causes of global mortality and morbidity. The hallmarks of viral hemorrhagic fevers are plasma leakage, thrombocytopenia, coagulopathy and hemorrhagic manifestations. The molecular mechanisms leading to plasma leakage in viral hemorrhagic fevers are not well understood. A common theme has emerged in which a complex interplay between pathogens, host immune response, and endothelial cells leads to the activation of endothelial cells and perturbation of barrier integrity. In this article, two clinically distinct viral hemorrhagic fevers caused by dengue viruses and hantaviruses are discussed to highlight their similarities and differences that may provide insights into the pathogenesis and therapeutic approach.
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Affiliation(s)
- Anon Srikiatkhachorn
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA,
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Chen ZH, Qin XC, Song R, Shen Y, Chen XP, Wang W, Zhao YX, Zhang JS, He JR, Li MH, Zhao XH, Liu DW, Fu XK, Tian D, Li XW, Xu J, Plyusnin A, Holmes EC, Zhang YZ. Co-circulation of multiple hemorrhagic fever diseases with distinct clinical characteristics in Dandong, China. PLoS One 2014; 9:e89896. [PMID: 24587107 PMCID: PMC3937409 DOI: 10.1371/journal.pone.0089896] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/29/2014] [Indexed: 12/14/2022] Open
Abstract
Hemorrhagic fevers (HF) caused by viruses and bacteria are a major public health problem in China and characterized by variable clinical manifestations, such that it is often difficult to achieve accurate diagnosis and treatment. The causes of HF in 85 patients admitted to Dandong hospital, China, between 2011–2012 were determined by serological and PCR tests. Of these, 34 patients were diagnosed with Huaiyangshan hemorrhagic fever (HYSHF), 34 with Hemorrhagic Fever with Renal Syndrome (HFRS), one with murine typhus, and one with scrub typhus. Etiologic agents could not be determined in the 15 remaining patients. Phylogenetic analyses of recovered bacterial and viral sequences revealed that the causative infectious agents were closely related to those described in other geographical regions. As these diseases have no distinctive clinical features in their early stage, only 13 patients were initially accurately diagnosed. The distinctive clinical features of HFRS and HYSHF developed during disease progression. Enlarged lymph nodes, cough, sputum, and diarrhea were more common in HYSHF patients, while more HFRS cases presented with headache, sore throat, oliguria, percussion pain kidney area, and petechiae. Additionally, HYSHF patients displayed significantly lower levels of white blood cells (WBC), higher levels of creations kinase (CK) and alanine aminotransferase (ALT), while HFRS patients presented with an elevation of blood urea nitrogen (BUN) and creatinine (CREA). These clinical features will assist in the accurate diagnosis of both HYSHF and HFRS. Overall, our data reveal the complexity of pathogens causing HFs in a single Chinese hospital, and highlight the need for accurate early diagnosis and a better understanding of their distinctive clinical features.
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Affiliation(s)
- Zhi-Hai Chen
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xin-Cheng Qin
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Rui Song
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yi Shen
- Department of Infectious Diseases, Dandong Infectious Hospital, Dandong, Liaoning Province, China
| | - Xiao-Ping Chen
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wen Wang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yong-Xiang Zhao
- Department of Infectious Diseases, Dandong Infectious Hospital, Dandong, Liaoning Province, China
| | - Jing-Shan Zhang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jin-Rong He
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ming-Hui Li
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xue-Hua Zhao
- Department of Infectious Diseases, Dandong Infectious Hospital, Dandong, Liaoning Province, China
| | - De-Wei Liu
- Department of Infectious Diseases, Dandong Infectious Hospital, Dandong, Liaoning Province, China
| | - Xiao-Kang Fu
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Di Tian
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xing-Wang Li
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Xu
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Alexander Plyusnin
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Virology, Haartman Institute, University of Helsinki, Finland
| | - Edward C. Holmes
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Yong-Zhen Zhang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Zoonoses, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
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Petersen J, Drake MJ, Bruce EA, Riblett AM, Didigu CA, Wilen CB, Malani N, Male F, Lee FH, Bushman FD, Cherry S, Doms RW, Bates P, Briley K. The major cellular sterol regulatory pathway is required for Andes virus infection. PLoS Pathog 2014; 10:e1003911. [PMID: 24516383 PMCID: PMC3916400 DOI: 10.1371/journal.ppat.1003911] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 12/18/2013] [Indexed: 12/21/2022] Open
Abstract
The Bunyaviridae comprise a large family of RNA viruses with worldwide distribution and includes the pathogenic New World hantavirus, Andes virus (ANDV). Host factors needed for hantavirus entry remain largely enigmatic and therapeutics are unavailable. To identify cellular requirements for ANDV infection, we performed two parallel genetic screens. Analysis of a large library of insertionally mutagenized human haploid cells and a siRNA genomic screen converged on components (SREBP-2, SCAP, S1P and S2P) of the sterol regulatory pathway as critically important for infection by ANDV. The significance of this pathway was confirmed using functionally deficient cells, TALEN-mediated gene disruption, RNA interference and pharmacologic inhibition. Disruption of sterol regulatory complex function impaired ANDV internalization without affecting virus binding. Pharmacologic manipulation of cholesterol levels demonstrated that ANDV entry is sensitive to changes in cellular cholesterol and raises the possibility that clinically approved regulators of sterol synthesis may prove useful for combating ANDV infection. As obligate, intracellular parasites viruses are dependent upon the host cell for numerous factors and processes. However, for many important viruses few of the required host factors have been identified. Hantaviruses are rodent-borne viruses that are associated with severe human disease. Transmission to humans occurs sporadically with a recent notable example in Yosemite National park. In the present study, we utilized two independent genetic strategies to discover cellular factors needed for replication of the highly pathogenic hantavirus Andes virus. We found that four genes, encoding components of a complex involved in regulation of cholesterol synthesis and uptake, were critical for Andes virus infection. Drugs that inhibit an enzyme in this complex or that reduce cellular cholesterol levels effectively blocked Andes virus infection, suggesting new ways for combating this pathogenic virus.
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Affiliation(s)
- Josiah Petersen
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Mary Jane Drake
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Emily A. Bruce
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Amber M. Riblett
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Chukwuka A. Didigu
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Craig B. Wilen
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Nirav Malani
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Frances Male
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Fang-Hua Lee
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Frederic D. Bushman
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sara Cherry
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Robert W. Doms
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Paul Bates
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail: (PB); (KB)
| | - Kenneth Briley
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail: (PB); (KB)
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64
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Krautkrämer E, Zeier M. Old World hantaviruses: aspects of pathogenesis and clinical course of acute renal failure. Virus Res 2014; 187:59-64. [PMID: 24412712 DOI: 10.1016/j.virusres.2013.12.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/09/2013] [Accepted: 12/24/2013] [Indexed: 12/31/2022]
Abstract
Hantavirus-associated diseases represent emerging infections that are ranked in the highest priority group of communicable diseases for surveillance and epidemiological research. In the last years, several novel hantavirus species were described and the number of host reservoir species harboring hantaviruses is also increasing. Reports of cases with severe or atypical clinical courses become also more frequent. These facts raise more and more questions concerning host reservoir specificity, pathogenicity and molecular mechanism of pathogenesis. Hantavirus disease is characterized by vascular leakage due to increased capillary permeability. The infection manifests often in the lung (hantaviral cardiopulmonary syndrome; HCPS) or in the kidney (hemorrhagic fever with renal syndrome, HFRS). The underlying mechanisms of both syndromes are probably similar despite the difference in organ tropism. Characterization of hantaviral replication cycle and of patient-specific determinants will help to identify factors responsible for the clinical symptoms and course.
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Affiliation(s)
- Ellen Krautkrämer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
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65
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Engler O, Klingström J, Aliyev E, Niederhauser C, Fontana S, Strasser M, Portmann J, Signer J, Bankoul S, Frey F, Hatz C, Stutz A, Tschaggelar A, Mütsch M. Seroprevalence of hantavirus infections in Switzerland in 2009: difficulties in determining prevalence in a country with low endemicity. Euro Surveill 2013; 18:20660. [DOI: 10.2807/1560-7917.es2013.18.50.20660] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- O Engler
- SPIEZ LABORATORY, Federal Office for Civil Protection, Spiez, Switzerland
| | - J Klingström
- Swedish Institute for Communicable Disease Control, Solna, Sweden
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - E Aliyev
- Institute of Social and Preventive Medicine (ISPM), Division of Communicable Diseases, World Health Organization (WHO) Collaborating Centre for Travellers’ Health, University of Zurich, Zurich, Switzerland
| | - C Niederhauser
- Blood Transfusion Service, Swiss Red Cross Berne, Berne, Switzerland
| | - S Fontana
- Blood Transfusion Service, Swiss Red Cross Berne, Berne, Switzerland
| | - M Strasser
- SPIEZ LABORATORY, Federal Office for Civil Protection, Spiez, Switzerland
| | - J Portmann
- SPIEZ LABORATORY, Federal Office for Civil Protection, Spiez, Switzerland
| | - J Signer
- SPIEZ LABORATORY, Federal Office for Civil Protection, Spiez, Switzerland
| | - S Bankoul
- CBRN Defence of the Swiss Armed Forces, Medical Services Directorate, Ittigen, Switzerland
| | - F Frey
- Military Medical Service, Swiss Armed Forces, Ittigen, Switzerland
| | - C Hatz
- Institute of Social and Preventive Medicine (ISPM), Division of Communicable Diseases, World Health Organization (WHO) Collaborating Centre for Travellers’ Health, University of Zurich, Zurich, Switzerland
| | - A Stutz
- Institute of Social and Preventive Medicine (ISPM), Division of Communicable Diseases, World Health Organization (WHO) Collaborating Centre for Travellers’ Health, University of Zurich, Zurich, Switzerland
| | - A Tschaggelar
- Blood Transfusion Service, Swiss Red Cross Berne, Berne, Switzerland
| | - M Mütsch
- Institute of Social and Preventive Medicine (ISPM), Division of Communicable Diseases, World Health Organization (WHO) Collaborating Centre for Travellers’ Health, University of Zurich, Zurich, Switzerland
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66
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Ongoing spillover of Hantaan and Gou hantaviruses from rodents is associated with hemorrhagic fever with renal syndrome (HFRS) in China. PLoS Negl Trop Dis 2013; 7:e2484. [PMID: 24147168 PMCID: PMC3798614 DOI: 10.1371/journal.pntd.0002484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/06/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Longquan City, Zhejiang province, China, has been seriously affected by hemorrhagic fever with renal syndrome (HFRS) since the first cases were registered in 1974. To understand the epidemiology and emergence of HFRS in Longquan, which may be indicative of large parts of rural China, we studied long-term incidence patterns and performed a molecular epidemiological investigation of the causative hantaviruses in human and rodent populations. METHOD/PRINCIPAL FINDINGS During 1974-2011, 1866 cases of HFRS were recorded in Longquan, including 20 deaths. In 2011, the incidence of HFRS remained high, with 19.61 cases/100,000 population, despite the onset of vaccination in 1997. During 1974-1998, HFRS cases in Longquan occurred mainly in winter, while in the past decade the peak of HFRS has shifted to the spring. Notably, the concurrent prevalence of rodent-borne hantaviruses in the region was also high. Phylogenetic analyses of viral sequences recovered from rodents in Longquan revealed the presence of novel genetic variants of Gou virus (GOUV) in Rattus sp. rats and Hantaan virus (HTNV) in the stripe field mice, respectively. Strikingly, viral sequences sampled from infected humans were very closely related to those from rodents. CONCLUSIONS/SIGNIFICANCE HFRS represents an important public health problem in Longquan even after years of preventive measures. Our data suggest that continual spillover of the novel genetic variant of GOUV and the new genetic lineage of HTNV are responsible for the high prevalence of HFRS in humans. In addition, this is the first report of GOUV associated with human HFRS cases, and our data suggest that GOUV is now the major cause of HFRS in this region.
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67
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Mustonen J, Mäkelä S, Outinen T, Laine O, Jylhävä J, Arstila PT, Hurme M, Vaheri A. The pathogenesis of nephropathia epidemica: new knowledge and unanswered questions. Antiviral Res 2013; 100:589-604. [PMID: 24126075 DOI: 10.1016/j.antiviral.2013.10.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/27/2013] [Accepted: 10/04/2013] [Indexed: 01/20/2023]
Abstract
Puumala virus (PUUV) causes an acute hemorrhagic fever with renal syndrome (HFRS), a zoonosis also called nephropathia epidemica (NE). The reservoir host of PUUV is the bank vole (Myodes glareolus). Herein we review the main clinical manifestations of NE, acute kidney injury, increased vascular permeability, coagulation abnormalities as well as pulmonary, cardiac, central nervous system and ocular manifestations of the disease. Several biomarkers of disease severity have recently been discovered: interleukin-6, pentraxin-3, C-reactive protein, indoleamine 2,3-dioxygenase, cell-free DNA, soluble urokinase-type plasminogen activator, GATA-3 and Mac-2 binding protein. The role of cytokines, vascular endothelial growth hormone, complement, bradykinin, cellular immune response and other mechanisms in the pathogenesis of NE as well as host genetic factors will be discussed. Finally therapeutic aspects and directions for further research will be handled.
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Affiliation(s)
- Jukka Mustonen
- School of Medicine, University of Tampere, Tampere, Finland; Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
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68
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Krautkrämer E, Grouls S, Urban E, Schnitzler P, Zeier M. No gender-related differences in the severity of nephropathia epidemica, Germany. BMC Infect Dis 2013; 13:457. [PMID: 24090247 PMCID: PMC3850742 DOI: 10.1186/1471-2334-13-457] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 09/26/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The number of cases of hantavirus disease caused by Puumala virus is increasing enormously in Germany within the last years. Men are overrepresented in hantavirus disease and differences in course and symptoms in relation to gender were reported from several countries. This study was conducted to define possible gender-specific risk factors and aspects of severity in hantavirus infections occurring in Germany. METHODS Characteristics, clinical parameters and symptoms were recorded in a retrospective analysis of 108 patients with serologically confirmed hantavirus infection treated in our department. This cohort corresponds in regard to age, time of infection and gender ratio to the characteristics of the overall cases reported in Germany. RESULTS The frequency of characteristic symptoms of hantavirus disease did not differ between males and females. The median of nadir and peak levels of clinical parameters did not exhibit relevant differences that would point to a more severe course in males or females. The clinical course and duration of hospitalization were similar for both sexes. No relevant differences in renal and pulmonary findings were observed. Males with hantavirus disease exhibited more cardiac findings than females.To compare the unequal gender distribution of the rodent-borne Puumala hantavirus disease with the gender ratio of other infectious diseases, we analyzed the gender ratio for notifiable infections according to their mode of transmission. Our data revealed a general overrepresentation of men in infections carried by arthropods and rodents. CONCLUSIONS In contrast to reports from other countries, no crucial differences in the symptoms, course or severity of hantavirus disease between infected men and female were observed in our cohort. However behavioural differences may account for the fact that men are more often affected by certain infectious diseases than females.
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Affiliation(s)
- Ellen Krautkrämer
- Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, 69120 Heidelberg, Germany.
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69
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Turčinov D, Puljiz I, Markotić A, Kuzman I, Begovac J. Clinical and laboratory findings in patients with oliguric and non-oliguric Hantavirus haemorrhagic fever with renal syndrome: an analysis of 128 patients. Clin Microbiol Infect 2013; 19:674-9. [DOI: 10.1111/j.1469-0691.2012.03994.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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70
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Pettersson L, Thunberg T, Rocklöv J, Klingström J, Evander M, Ahlm C. Viral load and humoral immune response in association with disease severity in Puumala hantavirus-infected patients--implications for treatment. Clin Microbiol Infect 2013; 20:235-41. [PMID: 23742660 PMCID: PMC4286007 DOI: 10.1111/1469-0691.12259] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/10/2013] [Accepted: 04/25/2013] [Indexed: 01/11/2023]
Abstract
Hantaviruses are the causative agents of haemorrhagic fever with renal syndrome (HFRS) in Eurasia and of hantavirus cardiopulmonary syndrome (HCPS) in the Americas. The case fatality rate varies between different hantaviruses and can be up to 40%. At present, there is no specific treatment available. The hantavirus pathogenesis is not well understood, but most likely, both virus-mediated and host-mediated mechanisms are involved. The aim of the present study was to investigate the association among Puumala hantavirus (PUUV) viral RNA load, humoral immune response and disease severity in patients with HFRS. We performed a study of 105 PUUV-infected patients that were followed during the acute phase of disease and for up to 1–3 months later. Fifteen of the 105 patients (14%) were classified as having moderate/severe disease. A low PUUV-specific IgG response (p <0.05) and also a higher white blood cell count (p <0.001) were significantly associated with more severe disease. The PUUV RNA was detected in a majority of patient plasma samples up to 9 days after disease onset; however, PUUV RNA load or longevity of viraemia were not significantly associated with disease severity. We conclude that a low specific IgG response was associated with disease severity in patients with HFRS, whereas PUUV RNA load did not seem to affect the severity of HFRS. Our results raise the possibility of passive immunotherapy as a useful treatment for hantavirus-infected patients.
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Affiliation(s)
- L Pettersson
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden
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71
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Connolly-Andersen AM, Ahlm K, Ahlm C, Klingström J. Puumala virus infections associated with cardiovascular causes of death. Emerg Infect Dis 2013; 19:126-8. [PMID: 23260342 PMCID: PMC3557968 DOI: 10.3201/eid1901.111587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We studied the causes of death of patients in Sweden with diagnoses of hemorrhagic fever with renal syndrome (HFRS) during 1997–2009. Cardiovascular disorders were a common cause of death during acute-phase HFRS and were the cause of death for >50% of those who died during the first year after HFRS.
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72
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Sex differences in prophylaxis and therapeutic treatments for viral diseases. Handb Exp Pharmacol 2013:499-522. [PMID: 23027464 DOI: 10.1007/978-3-642-30726-3_22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The intensity and prevalence of viral infections are typically higher in males than in females. In contrast, disease outcome can be worse for females. Males and females also differ in their responses to prophylaxis and therapeutic treatments for viral diseases. In response to vaccines against herpes viruses, hepatitis viruses, influenza viruses, and others, females consistently mount higher humoral immune responses and experience more frequent and severe adverse reactions than males. Males and females also differ in the absorption, metabolism, and clearance of antiviral drugs. The pharmacological effects, including toxicity and adverse reactions, of antiviral drugs are typically greater in females than males. The efficacy of antiviral drugs at reducing viral load also differs between the sexes, with antiviral treatments being better at clearing HIV and hepatitis C virus in females, but showing greater reduction of herpes simplex virus and influenza A virus loads in males. Biological variables, including hormone and genes, as well as gender-specific factors related to access and compliance to drug regimens must be considered when evaluating male-female differences in responses to treatments for viral diseases. Clinicians, epidemiologists, and basic biomedical scientists should design experiments that include both males and females, develop a priori hypotheses that the sexes will differ in their responses to and the outcome of vaccines and antiviral treatments, and statistically analyze outcome data by sex. Knowledge that the sexes differ in response to prophylaxis and therapeutic treatments for viral diseases should influence the recommended course of treatment differently for males and females.
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73
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Antonen J, Leppänen I, Tenhunen J, Arvola P, Mäkelä S, Vaheri A, Mustonen J. A severe case of Puumala hantavirus infection successfully treated with bradykinin receptor antagonist icatibant. ACTA ACUST UNITED AC 2013; 45:494-6. [PMID: 23294035 DOI: 10.3109/00365548.2012.755268] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A patient with severe capillary leakage syndrome caused by a Puumala hantavirus infection was treated with a single dose of icatibant, a bradykinin receptor antagonist, with a dramatic positive response. We suggest that this drug should be tested in a larger number of patients with severe hantavirus infection.
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Affiliation(s)
- Jaakko Antonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
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74
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Krautkrämer E, Zeier M, Plyusnin A. Hantavirus infection: an emerging infectious disease causing acute renal failure. Kidney Int 2012; 83:23-7. [PMID: 23151954 DOI: 10.1038/ki.2012.360] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The function of the kidney with its highly differentiated and specialized cell types is affected by infection with several viruses. Viral infections of the kidney have a negative impact not only on patients undergoing renal transplantation and immunosuppression. Besides the increasing number of patients suffering from HIV-associated nephropathy, another group of viruses infects immunocompetent patients and induces renal failure. Hantaviruses belong nowadays to the emerging zoonoses that increase in number and geographic distribution. The viruses are distributed worldwide in endemic areas and distribution seems to expand. Together with the increase in the number of cases in the last few years, the understanding of epidemiology and pathology has deepened and some concepts had to be changed. Symptoms and mortality vary between species. The classification refers to geographical distribution: New World hantaviruses causing hantavirus cardiopulmonary syndrome (HCPS) and Old World hantaviruses causing hemorrhagic fever with renal syndrome (HFRS). Indeed, in most HFRS cases, the kidney is mainly affected and HCPS is characterized by cardiopulmonary involvement. But the picture of strict organ tropism is changing and reports of pulmonary findings and nonrenal manifestations in infections with Old World hantaviruses are increasing. However, the overall symptoms-vascular alterations and leakage-that are responsible for organ failure are characteristic for all diseases caused by hantaviruses.
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Affiliation(s)
- Ellen Krautkrämer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
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75
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Vaheri A, Henttonen H, Voutilainen L, Mustonen J, Sironen T, Vapalahti O. Hantavirus infections in Europe and their impact on public health. Rev Med Virol 2012; 23:35-49. [PMID: 22761056 DOI: 10.1002/rmv.1722] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/04/2012] [Accepted: 05/08/2012] [Indexed: 11/09/2022]
Abstract
Hantaviruses (genus Hantavirus, family Bunyaviridae) are enveloped tri-segmented negative-stranded RNA viruses each carried by a specific rodent or insectivore host species. Several different hantaviruses known to infect humans circulate in Europe. The most common is Puumala (PUUV) carried by the bank vole; another two important, genetically closely related ones are Dobrava-Belgrade (DOBV) and Saaremaa viruses (SAAV) carried by Apodemus mice (species names follow the International Committee on Taxonomy of Viruses nomenclature). Of the two hantaviral diseases, hemorrhagic fever with renal syndrome (HFRS) and hantaviral cardiopulmonary syndrome, the European viruses cause only HFRS: DOBV with often severe symptoms and a high case fatality rate, and PUUV and SAAV more often mild disease. More than 10,000 HFRS cases are diagnosed annually in Europe and in increasing numbers. Whether this is because of increasing recognition by the medical community or due to environmental factors such as climate change, or both, is not known. Nevertheless, in large areas of Europe, the population has a considerable seroprevalence but only relatively few HFRS cases are reported. Moreover, no epidemiological data are available from many countries. We know now that cardiac, pulmonary, ocular and hormonal disorders are, besides renal changes, common during the acute stage of PUUV and DOBV infection. About 5% of hospitalized PUUV and 16%-48% of DOBV patients require dialysis and some prolonged intensive-care treatment. Although PUUV-HFRS has a low case fatality rate, complications and long-term hormonal, renal, and cardiovascular consequences commonly occur. No vaccine or specific therapy is in general use in Europe. We conclude that hantaviruses have a significant impact on public health in Europe.
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Affiliation(s)
- Antti Vaheri
- Department of Virology, Haartman Institute, and Research Programs Unit, Infection Biology, University of Helsinki, Helsinki, Finland.
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76
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Goeijenbier M, Wagenaar J, Goris M, Martina B, Henttonen H, Vaheri A, Reusken C, Hartskeerl R, Osterhaus A, Van Gorp E. Rodent-borne hemorrhagic fevers: under-recognized, widely spread and preventable – epidemiology, diagnostics and treatment. Crit Rev Microbiol 2012; 39:26-42. [DOI: 10.3109/1040841x.2012.686481] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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77
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Sargianou M, Watson DC, Chra P, Papa A, Starakis I, Gogos C, Panos G. Hantavirus infections for the clinician: From case presentation to diagnosis and treatment. Crit Rev Microbiol 2012; 38:317-29. [DOI: 10.3109/1040841x.2012.673553] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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78
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Klein SL, Marks MA, Li W, Glass GE, Fang LQ, Ma JQ, Cao WC. Sex differences in the incidence and case fatality rates from hemorrhagic fever with renal syndrome in China, 2004-2008. Clin Infect Dis 2011; 52:1414-21. [PMID: 21628481 DOI: 10.1093/cid/cir232] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Differences between male and female individuals in response to infectious diseases are an overlooked global health problem. METHODS The relationship between sex and disease outcome was examined in populations of patients with hemorrhagic fever with renal syndrome (HFRS) in mainland China, where most cases of hantavirus exposure occur. HFRS in China is diagnosed on the basis of symptoms and is confirmed with serological testing. The geographical distribution, incidence, and case fatality rates (CFRs) of HFRS in China were estimated and compared by patient sex and age. In a subset of patients with HFRS, clinical manifestations of HFRS were assessed using latent class analysis and compared by sex. RESULTS There were 80,671 HFRS cases reported during the period 2004-2008, with a majority of HFRS cases (39.2%) occurring among individuals 20-39 years of age. The incidence of HFRS was higher among male patients than among female patients for all individuals >10 years of age. There were 945 deaths (CFR, 1.17%) due to HFRS in China during the period 2004-2008. CFRs were higher among women than among men between the ages of 20-39 and ≥ 50 years of age. There were no sex differences in the geographical distribution of HFRS cases or deaths. Although the prevalence of each clinical marker did not differ by sex, 2 profiles of clinical markers were identified that were related to both severity of disease and sex. CONCLUSIONS These data illustrate a paradox in which the incidence of disease is greater for males, but the severity of disease outcome is worse for females. Several behavioral, societal, and biological factors are hypothesized to be involved.
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Affiliation(s)
- Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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79
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Phan TG, Kapusinszky B, Wang C, Rose RK, Lipton HL, Delwart EL. The fecal viral flora of wild rodents. PLoS Pathog 2011; 7:e1002218. [PMID: 21909269 PMCID: PMC3164639 DOI: 10.1371/journal.ppat.1002218] [Citation(s) in RCA: 281] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 06/28/2011] [Indexed: 12/30/2022] Open
Abstract
The frequent interactions of rodents with humans make them a common source of zoonotic infections. To obtain an initial unbiased measure of the viral diversity in the enteric tract of wild rodents we sequenced partially purified, randomly amplified viral RNA and DNA in the feces of 105 wild rodents (mouse, vole, and rat) collected in California and Virginia. We identified in decreasing frequency sequences related to the mammalian viruses families Circoviridae, Picobirnaviridae, Picornaviridae, Astroviridae, Parvoviridae, Papillomaviridae, Adenoviridae, and Coronaviridae. Seventeen small circular DNA genomes containing one or two replicase genes distantly related to the Circoviridae representing several potentially new viral families were characterized. In the Picornaviridae family two new candidate genera as well as a close genetic relative of the human pathogen Aichi virus were characterized. Fragments of the first mouse sapelovirus and picobirnaviruses were identified and the first murine astrovirus genome was characterized. A mouse papillomavirus genome and fragments of a novel adenovirus and adenovirus-associated virus were also sequenced. The next largest fraction of the rodent fecal virome was related to insect viruses of the Densoviridae, Iridoviridae, Polydnaviridae, Dicistroviriade, Bromoviridae, and Virgaviridae families followed by plant virus-related sequences in the Nanoviridae, Geminiviridae, Phycodnaviridae, Secoviridae, Partitiviridae, Tymoviridae, Alphaflexiviridae, and Tombusviridae families reflecting the largely insect and plant rodent diet. Phylogenetic analyses of full and partial viral genomes therefore revealed many previously unreported viral species, genera, and families. The close genetic similarities noted between some rodent and human viruses might reflect past zoonoses. This study increases our understanding of the viral diversity in wild rodents and highlights the large number of still uncharacterized viruses in mammals. Rodents are the natural reservoir of numerous zoonotic viruses causing serious diseases in humans. We used an unbiased metagenomic approach to characterize the viral diversity in rodent feces. In addition to diet-derived insect and plant viruses mammalian viral sequences were abundant and diverse. Most notably, multiple new circular viral DNA families, two new picornaviridae genera, and the first murine astrovirus and picobirnaviruses were characterized. A mouse kobuvirus was a close relative to the Aichi virus human pathogen. This study significantly increases the known genetic diversity of eukaryotic viruses in rodents and provides an initial description of their enteric viromes.
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Affiliation(s)
- Tung G. Phan
- Blood Systems Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California, United States of America
| | - Beatrix Kapusinszky
- Blood Systems Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California, United States of America
- Department of Viral Diagnostics, National Center for Epidemiology, Budapest, Hungary
| | - Chunlin Wang
- Division of Infectious Diseases, Stanford University Medical Center, Stanford, California, United States of America
| | - Robert K. Rose
- Department of Biological Sciences, Old Dominion University, Norfolk, Virginia, United States of America
| | - Howard L. Lipton
- Department of Neurology and Microbiology-Immunology, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Eric L. Delwart
- Blood Systems Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California, United States of America
- * E-mail:
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80
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Sundberg E, Hultdin J, Nilsson S, Ahlm C. Evidence of disseminated intravascular coagulation in a hemorrhagic fever with renal syndrome-scoring models and severe illness. PLoS One 2011; 6:e21134. [PMID: 21731657 PMCID: PMC3121717 DOI: 10.1371/journal.pone.0021134] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 05/20/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Viral hemorrhagic fevers (VHF) are considered to be a serious threat to public health worldwide with up to 100 million cases annually. The general hypothesis is that disseminated intravascular coagulation (DIC) is an important part of the pathogenesis. The study objectives were to study the variability of DIC in consecutive patients with acute hemorrhagic fever with renal syndrome (HFRS), and to evaluate if different established DIC-scores can be used as a prognostic marker for a more severe illness. METHOD AND FINDINGS In a prospective study 2006-2008, data from 106 patients with confirmed HFRS were analyzed and scored for the presence of DIC according to six different templates based on criteria from the International Society on Thrombosis and Haemostasis (ISTH). The DIC-scoring templates with a fibrinogen/CRP-ratio were most predictive, with predictions for moderate/severe illness (p<0.01) and bleeding of moderate/major importance (p<0.05). With these templates, 18.9-28.3% of the patients were diagnosed with DIC. CONCLUSIONS DIC was found in about one fourth of the patients and correlated with a more severe disease. This supports that DIC is an important part of the pathogenesis in HFRS. ISTH-scores including fibrinogen/CRP-ratio outperform models without. The high negative predictive value could be a valuable tool for the clinician. We also believe that our findings could be relevant for other VHFs.
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Affiliation(s)
- Erik Sundberg
- Department of Clinical Microbiology/Infectious Diseases, Umeå University, Umeå, Sweden.
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Marsac D, García S, Fournet A, Aguirre A, Pino K, Ferres M, Kalergis AM, Lopez-Lastra M, Veas F. Infection of human monocyte-derived dendritic cells by ANDES Hantavirus enhances pro-inflammatory state, the secretion of active MMP-9 and indirectly enhances endothelial permeability. Virol J 2011; 8:223. [PMID: 21569520 PMCID: PMC3104372 DOI: 10.1186/1743-422x-8-223] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/13/2011] [Indexed: 01/29/2023] Open
Abstract
Background Andes virus (ANDV), a rodent-borne Hantavirus, is the major etiological agent of Hantavirus cardiopulmonary syndrome (HCPS) in South America, which is mainly characterized by a vascular leakage with high rate of fatal outcomes for infected patients. Currently, neither specific therapy nor vaccines are available against this pathogen. ANDV infects both dendritic and epithelial cells, but in despite that the severity of the disease directly correlates with the viral RNA load, considerable evidence suggests that immune mechanisms rather than direct viral cytopathology are responsible for plasma leakage in HCPS. Here, we assessed the possible effect of soluble factors, induced in viral-activated DCs, on endothelial permeability. Activated immune cells, including DC, secrete gelatinolytic matrix metalloproteases (gMMP-2 and -9) that modulate the vascular permeability for their trafficking. Methods A clinical ANDES isolate was used to infect DC derived from primary PBMC. Maturation and pro-inflammatory phenotypes of ANDES-infected DC were assessed by studying the expression of receptors, cytokines and active gMMP-9, as well as some of their functional status. The ANDES-infected DC supernatants were assessed for their capacity to enhance a monolayer endothelial permeability using primary human vascular endothelial cells (HUVEC). Results Here, we show that in vitro primary DCs infected by a clinical isolate of ANDV shed virus RNA and proteins, suggesting a competent viral replication in these cells. Moreover, this infection induces an enhanced expression of soluble pro-inflammatory factors, including TNF-α and the active gMMP-9, as well as a decreased expression of anti-inflammatory cytokines, such as IL-10 and TGF-β. These viral activated cells are less sensitive to apoptosis. Moreover, supernatants from ANDV-infected DCs were able to indirectly enhance the permeability of a monolayer of primary HUVEC. Conclusions Primary human DCs, that are primarily targeted by hantaviruses can productively be infected by ANDV and subsequently induce direct effects favoring a proinflammatory phenotype of infected DCs. Finally, based on our observations, we hypothesize that soluble factors secreted in ANDV-infected DC supernatants, importantly contribute to the endothelial permeability enhancement that characterize the HCPS.
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Affiliation(s)
- Delphine Marsac
- UMR-MD3-University Montpellier 1, Comparative Molecular Immuno-Physiopathology Lab, Faculté de Pharmacie, 34093 Montpellier, France
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Buys KK, Jung KH, Smee DF, Furuta Y, Gowen BB. Maporal virus as a surrogate for pathogenic New World hantaviruses and its inhibition by favipiravir. Antivir Chem Chemother 2011; 21:193-200. [PMID: 21566265 DOI: 10.3851/imp1729] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pathogenic hantaviruses geographically distributed in the Old World cause haemorrhagic fever with renal syndrome (HFRS), whereas New World hantaviruses are the aetiological agents of hantavirus cardiopulmonary syndrome (HCPS). Ribavirin, a drug associated with toxicities, is presently indicated for treatment of HFRS, whereas treatment of the more frequently lethal HCPS is limited to supportive care. Because of the need for safe and effective antivirals to treat severe hantaviral infections, we evaluated favipiravir (T-705) against Dobrava and Maporal viruses as representative Old World and New World hantaviruses, respectively. Dobrava virus causes HFRS in Europe. Maporal virus (MPRLV), recently isolated from western Venezuela, is phylogenetically similar to Andes virus, the principal cause of HCPS in Argentina. METHODS Hantavirus replication in the presence of various inhibitors was measured by focus-forming unit assays and quantitative reverse transcriptase PCR. Phylogenetic relationships were assessed by the neighbour-joining and bootstrap consensus methods. RESULTS Here, we show that infection of Vero E6 cells with MPRLV is dependent on β3 integrins, similar to that reported for pathogenic hantaviruses. Furthermore, by analysis of molecular determinants associated with the G1 glycoprotein cytoplasmic tail, we show the close genetic proximity of MPRLV to other HCPS-causing hantaviruses in these regions predictive of pathogenicity. We also demonstrate anti-hantavirus activity by favipiravir with inhibitory concentrations ranging from 65 to 93 μM and selectivity indices>50. CONCLUSIONS Our data suggest that MPRLV may serve as a safer alternative to modelling infection caused by the highly lethal Andes virus and that hantaviruses are sensitive to the effects of favipiravir in cell culture.
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Affiliation(s)
- Kristin K Buys
- Institute for Antiviral Research and Department of Animal, Dairy, and Veterinary Sciences, Utah State University, Logan, UT, USA
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Klingström J, Ahlm C. Hantavirus protein interactions regulate cellular functions and signaling responses. Expert Rev Anti Infect Ther 2011; 9:33-47. [PMID: 21171876 DOI: 10.1586/eri.10.157] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Rodent-borne pathogenic hantaviruses cause two severe and often lethal zoonotic diseases: hemorrhagic fever with renal syndrome (HFRS) in Eurasia and hantavirus cardiopulmonary syndrome (HCPS) in the Americas. Currently, no US FDA-approved therapeutics or vaccines are available for HFRS/HCPS. Infections with hantaviruses are not lytic, and it is currently not known exactly why infections in humans cause disease. A better understanding of how hantaviruses interfere with normal cell functions and activation of innate and adaptive immune responses might provide clues to future development of specific treatment and/or vaccines against hantavirus infection. In this article, the current knowledge regarding immune responses observed in patients, hantavirus interference with cellular proteins and signaling pathways, and possible approaches in the development of therapeutics are discussed.
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Affiliation(s)
- Jonas Klingström
- Centre for Microbiological Preparedness, Swedish Institute for Infectious Disease Control, Solna, Sweden.
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