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Ji H, Li K, Shang M, Wang Z, Liu Q. The 2016 Severe Floods and Incidence of Hemorrhagic Fever With Renal Syndrome in the Yangtze River Basin. JAMA Netw Open 2024; 7:e2429682. [PMID: 39172449 PMCID: PMC11342140 DOI: 10.1001/jamanetworkopen.2024.29682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/28/2024] [Indexed: 08/23/2024] Open
Abstract
Importance Hemorrhagic fever with renal syndrome (HFRS), a neglected zoonotic disease, has received only short-term attention in postflood prevention and control initiatives, possibly because of a lack of evidence regarding the long-term association of flooding with HFRS. Objectives To quantify the association between severe floods and long-term incidence of HFRS in the Yangtze River basin and to examine the modifying role of geographical factors in this association. Design, Setting, and Participants This cross-sectional study collected data on HFRS cases between July 1, 2013, and June 30, 2019, from 58 cities in 4 provinces (Anhui, Hubei, Hunan, and Jiangxi) in the Yangtze River basin of China, with a breakpoint of flooding in July 2016, generating monthly data. The 3 years after July 2016 were defined as the postflood period, while the 3 years before the breakpoint were defined as the control period. Statistical analysis was performed from October to December 2023. Exposures City-level monthly flooding, elevation, ruggedness index, and closest distance from each city to the Yangtze River and its tributaries. Main Outcomes and Measures The primary outcomes were the number of city-level monthly HFRS cases and the number of type 1 (spring or summer) and type 2 (autumn or winter) HFRS cases. Results A total of 11 745 patients with HFRS were reported during the study period: 5216 patients (mean [SD] age, 47.1 [16.2] years; 3737 men [71.6%]) in the control period and 6529 patients (mean [SD] age, 49.8 [15.8] years; 4672 men [71.6%]) in the postflood period. The pooled effects of interrupted time series analysis indicated a long-term association between flooding and HFRS incidence (odds ratio, 1.38; 95% CI, 1.13-1.68), with type 1 cases being at highest risk (odds ratio, 1.71; 95% CI, 1.40-2.09). The metaregression results indicated that elevation and ruggedness index were negatively associated with the risk of HFRS, while the distance to rivers interacted with these associations. Conclusions and Relevance This cross-sectional study of the long-term association between flooding and HFRS incidence, as well as the modification effects of geographical factors, suggests that severe floods were associated with an increased risk of HFRS within 3 years. This study provides evidence for the development of HFRS prevention and control strategies after floods.
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Affiliation(s)
- Haoqiang Ji
- Department of Vector Control, School of Public Health, Cheeloo College of Medicine, Shandong University, Shandong Province, Jinan, People’s Republic of China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping District, Beijing, People’s Republic of China
- World Health Organization Collaborating Centre for Vector Surveillance and Management, Changping District, Beijing, People’s Republic of China
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Shandong Province, Jinan, People’s Republic of China
- Shandong University Climate Change and Health Center, Shandong Province, Jinan, People’s Republic of China
| | - Ke Li
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping District, Beijing, People’s Republic of China
- World Health Organization Collaborating Centre for Vector Surveillance and Management, Changping District, Beijing, People’s Republic of China
| | - Meng Shang
- Department of Vector Control, School of Public Health, Cheeloo College of Medicine, Shandong University, Shandong Province, Jinan, People’s Republic of China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping District, Beijing, People’s Republic of China
- World Health Organization Collaborating Centre for Vector Surveillance and Management, Changping District, Beijing, People’s Republic of China
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Shandong Province, Jinan, People’s Republic of China
- Shandong University Climate Change and Health Center, Shandong Province, Jinan, People’s Republic of China
| | - Zhenxu Wang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping District, Beijing, People’s Republic of China
- World Health Organization Collaborating Centre for Vector Surveillance and Management, Changping District, Beijing, People’s Republic of China
| | - Qiyong Liu
- Department of Vector Control, School of Public Health, Cheeloo College of Medicine, Shandong University, Shandong Province, Jinan, People’s Republic of China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping District, Beijing, People’s Republic of China
- World Health Organization Collaborating Centre for Vector Surveillance and Management, Changping District, Beijing, People’s Republic of China
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Shandong Province, Jinan, People’s Republic of China
- Shandong University Climate Change and Health Center, Shandong Province, Jinan, People’s Republic of China
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Di Bartolo I, De Sabato L, Ianiro G, Vaccari G, Dini FM, Ostanello F, Monini M. Exploring the Potential of Muridae as Sentinels for Human and Zoonotic Viruses. Viruses 2024; 16:1041. [PMID: 39066204 PMCID: PMC11281464 DOI: 10.3390/v16071041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/19/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
In recent years, the transmission of viruses from wildlife to humans has raised significant public health concerns, exemplified by the COVID-19 pandemic caused by the betacoronavirus SARS-CoV-2. Human activities play a substantial role in increasing the risk of zoonotic virus transmission from wildlife to humans. Rats and mice are prevalent in urban environments and may act as reservoirs for various pathogens. This study aimed to evaluate the presence of zoonotic viruses in wild rats and mice in both urban and rural areas, focusing on well-known zoonotic viruses such as betacoronavirus, hantavirus, arenavirus, kobuvirus, and monkeypox virus, along with other viruses occasionally detected in rats and mice, including rotavirus, norovirus, and astrovirus, which are known to infect humans at a high rate. A total of 128 animals were captured, including 70 brown rats (Rattus norvegicus), 45 black rats (Rattus rattus), and 13 house mice (Mus musculus), and feces, lung, and liver were collected. Among brown rats, one fecal sample tested positive for astrovirus RNA. Nucleotide sequencing revealed high sequence similarity to both human and rat astrovirus, suggesting co-presence of these viruses in the feces. Murine kobuvirus (MuKV) was detected in fecal samples from both black (n = 7) and brown (n = 6) rats, primarily from urban areas, as confirmed by sequence analysis. These findings highlight the importance of surveillance and research to understand and mitigate the risks associated with the potential transmission of pathogens by rodents.
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Affiliation(s)
- Ilaria Di Bartolo
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy; (I.D.B.); (L.D.S.); (G.I.); (G.V.); (M.M.)
| | - Luca De Sabato
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy; (I.D.B.); (L.D.S.); (G.I.); (G.V.); (M.M.)
| | - Giovanni Ianiro
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy; (I.D.B.); (L.D.S.); (G.I.); (G.V.); (M.M.)
| | - Gabriele Vaccari
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy; (I.D.B.); (L.D.S.); (G.I.); (G.V.); (M.M.)
| | - Filippo Maria Dini
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra, 50, Ozzano dell’Emilia, 40064 Bologna, Italy;
| | - Fabio Ostanello
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra, 50, Ozzano dell’Emilia, 40064 Bologna, Italy;
| | - Marina Monini
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy; (I.D.B.); (L.D.S.); (G.I.); (G.V.); (M.M.)
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Schrottmaier WC, Schmuckenschlager A, Thunberg T, Wigren-Byström J, Fors-Connolly AM, Assinger A, Ahlm C, Forsell MNE. Direct and indirect effects of Puumala hantavirus on platelet function. Thromb Res 2024; 233:41-54. [PMID: 38006765 DOI: 10.1016/j.thromres.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/27/2023] [Accepted: 11/15/2023] [Indexed: 11/27/2023]
Abstract
Thrombocytopenia is a cardinal symptom of hantavirus-induced diseases including Puumala virus (PUUV)-induced hemorrhagic fever with renal syndrome (HFRS), which is associated with impaired platelet function, bleeding manifestations and augmented thrombotic risk. However, the underlying mechanisms causing thrombocytopenia and platelet hypo-responsiveness are unknown. Thus, we investigated the direct and indirect impact of PUUV on platelet production, function and degradation. Analysis of PUUV-HFRS patient blood revealed that platelet hypo-responsiveness in PUUV infection was cell-intrinsic and accompanied by reduced platelet-leukocyte aggregates (PLAs) and upregulation of monocyte tissue factor (TF), whereas platelet vasodilator-stimulated phosphoprotein (VASP) phosphorylation was comparable to healthy controls. Plasma CXCL4 levels followed platelet count dynamics throughout disease course. PUUV activated both neutrophils and monocytes in vitro, but platelet desialylation, degranulation and GPIIb/IIIa activation as well as PLA formation and endothelial adhesion under flow remained unaltered in the presence of PUUV. Further, MEG-01 megakaryocytes infected with PUUV displayed unaltered polyploidization, expression of surface receptors and platelet production. However, infection of endothelial cells with PUUV significantly increased platelet sequestration. Our data thus demonstrate that although platelet production, activation or degradation are not directly modulated, PUUV indirectly fosters thrombocytopenia by sequestration of platelets to infected endothelium. Upregulation of immunothrombotic processes in PUUV-HFRS may further contribute to platelet dysfunction and consumption. Given the pathophysiologic similarities of hantavirus infections, our findings thus provide important insights into the mechanisms underlying thrombocytopenia and highlight immune-mediated coagulopathy as potential therapeutic target.
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Affiliation(s)
- Waltraud C Schrottmaier
- Institute of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria; Department of Clinical Microbiology, Umeå University, Umeå, Sweden.
| | - Anna Schmuckenschlager
- Institute of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Therese Thunberg
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | | | | | - Alice Assinger
- Institute of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Clas Ahlm
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
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Maia RM, Fernandes J, de Mattos LHBV, Camacho LAB, Caetano KAA, dos Santos Carneiro MA, de Oliveira Santos F, Teles SA, de Lemos ERS, de Oliveira RC. Seroprevalence of Hantavirus among Manual Cane Cutters and Epidemiological Aspects of HPS in Central Brazil. Viruses 2023; 15:2238. [PMID: 38005915 PMCID: PMC10674252 DOI: 10.3390/v15112238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 11/26/2023] Open
Abstract
Hantavirus pulmonary syndrome (HPS) is a rodent-borne zoonotic disease that is endemic throughout the Americas. Agricultural activities increase exposure to wild rodents, especially for sugarcane cutters. We carried out a survey of the epidemiological aspects of HPS and investigated the prevalence of hantavirus infection in the sugarcane cutter population from different localities in the Brazilian Midwest region. We conducted a retrospective study of all confirmed HPS cases in the state of Goiás reported to the National HPS surveillance system between 2007 and 2017, along with a seroepidemiological study in a population of sugarcane cutters working in Goiás state in 2016, using the anti-hantavirus (Andes) ELISA IgG. A total of 634 serum samples from cane cutters were tested for hantavirus antibodies, with 44 (6.9%) being IgG-reactive according to ELISA. The destination of garbage was the only statistically significant variable (p = 0.03) related to the detection of hantavirus IgG (p < 0.05). We described the epidemiological profile of reported hantavirus cases in Goiás-a highly endemic area for HPS, and where the seroepidemiological study was conducted. Our results increase our knowledge about hantavirus infections in Brazil and highlight the vulnerability of sugarcane cutters to a highly lethal disease that, to date, has no specific treatment or vaccination.
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Affiliation(s)
- Renata Malachini Maia
- Hantaviruses and Rickettsiosis Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro 21040-360, Brazil; (J.F.); (L.H.B.V.d.M.); (E.R.S.d.L.)
| | - Jorlan Fernandes
- Hantaviruses and Rickettsiosis Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro 21040-360, Brazil; (J.F.); (L.H.B.V.d.M.); (E.R.S.d.L.)
| | | | | | | | | | - Fernando de Oliveira Santos
- Biology and Parasitology of Wild Mammals Reservoirs Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro 21041-210, Brazil;
| | - Sheila Araujo Teles
- Faculty of Nursing, Federal University of Goiás, Goiânia 74605-080, Brazil; (K.A.A.C.); (S.A.T.)
| | - Elba Regina Sampaio de Lemos
- Hantaviruses and Rickettsiosis Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro 21040-360, Brazil; (J.F.); (L.H.B.V.d.M.); (E.R.S.d.L.)
| | - Renata Carvalho de Oliveira
- Hantaviruses and Rickettsiosis Laboratory, Oswaldo Cruz Institute (FIOCRUZ), Rio de Janeiro 21040-360, Brazil; (J.F.); (L.H.B.V.d.M.); (E.R.S.d.L.)
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Cintron R, Whitmer SLM, Moscoso E, Campbell EM, Kelly R, Talundzic E, Mobley M, Chiu KW, Shedroff E, Shankar A, Montgomery JM, Klena JD, Switzer WM. HantaNet: A New MicrobeTrace Application for Hantavirus Classification, Genomic Surveillance, Epidemiology and Outbreak Investigations. Viruses 2023; 15:2208. [PMID: 38005885 PMCID: PMC10675615 DOI: 10.3390/v15112208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Hantaviruses zoonotically infect humans worldwide with pathogenic consequences and are mainly spread by rodents that shed aerosolized virus particles in urine and feces. Bioinformatics methods for hantavirus diagnostics, genomic surveillance and epidemiology are currently lacking a comprehensive approach for data sharing, integration, visualization, analytics and reporting. With the possibility of hantavirus cases going undetected and spreading over international borders, a significant reporting delay can miss linked transmission events and impedes timely, targeted public health interventions. To overcome these challenges, we built HantaNet, a standalone visualization engine for hantavirus genomes that facilitates viral surveillance and classification for early outbreak detection and response. HantaNet is powered by MicrobeTrace, a browser-based multitool originally developed at the Centers for Disease Control and Prevention (CDC) to visualize HIV clusters and transmission networks. HantaNet integrates coding gene sequences and standardized metadata from hantavirus reference genomes into three separate gene modules for dashboard visualization of phylogenetic trees, viral strain clusters for classification, epidemiological networks and spatiotemporal analysis. We used 85 hantavirus reference datasets from GenBank to validate HantaNet as a classification and enhanced visualization tool, and as a public repository to download standardized sequence data and metadata for building analytic datasets. HantaNet is a model on how to deploy MicrobeTrace-specific tools to advance pathogen surveillance, epidemiology and public health globally.
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Affiliation(s)
- Roxana Cintron
- Laboratory Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA (A.S.); (W.M.S.)
| | - Shannon L. M. Whitmer
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA (M.M.); (E.S.); (J.D.K.)
| | - Evan Moscoso
- General Dynamics Information Technology, Atlanta, GA 30329, USA; (E.M.); (R.K.)
| | - Ellsworth M. Campbell
- Laboratory Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA (A.S.); (W.M.S.)
| | - Reagan Kelly
- General Dynamics Information Technology, Atlanta, GA 30329, USA; (E.M.); (R.K.)
| | - Emir Talundzic
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA (M.M.); (E.S.); (J.D.K.)
| | - Melissa Mobley
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA (M.M.); (E.S.); (J.D.K.)
| | - Kuo Wei Chiu
- General Dynamics Information Technology, Atlanta, GA 30329, USA; (E.M.); (R.K.)
| | - Elizabeth Shedroff
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA (M.M.); (E.S.); (J.D.K.)
| | - Anupama Shankar
- Laboratory Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA (A.S.); (W.M.S.)
| | - Joel M. Montgomery
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA (M.M.); (E.S.); (J.D.K.)
| | - John D. Klena
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA (M.M.); (E.S.); (J.D.K.)
| | - William M. Switzer
- Laboratory Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA (A.S.); (W.M.S.)
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Mull N, Seifert SN, Forbes KM. A framework for understanding and predicting orthohantavirus functional traits. Trends Microbiol 2023; 31:1102-1110. [PMID: 37277284 DOI: 10.1016/j.tim.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/07/2023]
Abstract
Orthohantaviruses present a global public health threat; there are 58 distinct viruses currently recognized and case fatality of pathogenic orthohantaviruses ranges from <0.1% to 50%. An Old World versus New World dichotomy is frequently applied to distinguish human diseases caused by orthohantaviruses. However, this geographic grouping masks the importance of phylogeny and virus-host ecology in shaping orthohantavirus traits, especially since related arvicoline rodents and their orthohantaviruses are found in both regions. We argue that orthohantaviruses can be separated into three phylogenetically based rodent host groups with differences in key functional traits, including human disease, transmission route, and virus-host fidelity. This framework can help understand and predict traits of under-studied and newly discovered orthohantaviruses and guide public health and biosafety policy.
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Affiliation(s)
- Nathaniel Mull
- Department of Biological Sciences, University of Arkansas, Fayetteville, AR, USA.
| | - Stephanie N Seifert
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Kristian M Forbes
- Department of Biological Sciences, University of Arkansas, Fayetteville, AR, USA
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Vial PA, Ferrés M, Vial C, Klingström J, Ahlm C, López R, Le Corre N, Mertz GJ. Hantavirus in humans: a review of clinical aspects and management. THE LANCET. INFECTIOUS DISEASES 2023; 23:e371-e382. [PMID: 37105214 DOI: 10.1016/s1473-3099(23)00128-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 04/29/2023]
Abstract
Hantavirus infections are part of the broad group of viral haemorrhagic fevers. They are also recognised as a distinct model of an emergent zoonotic infection with a global distribution. Many factors influence their epidemiology and transmission, such as climate, environment, social development, ecology of rodent hosts, and human behaviour in endemic regions. Transmission to humans occurs by exposure to infected rodents in endemic areas; however, Andes hantavirus is unique in that it can be transmitted from person to person. As hantaviruses target endothelial cells, they can affect diverse organ systems; increased vascular permeability is central to pathogenesis. The main clinical syndromes associated with hantaviruses are haemorrhagic fever with renal syndrome (HFRS), which is endemic in Europe and Asia, and hantavirus cardiopulmonary syndrome (HCPS), which is endemic in the Americas. HCPS and HFRS are separate clinical entities, but they share several features and have many overlapping symptoms, signs, and pathogenic alterations. For HCPS in particular, clinical outcomes are highly associated with early clinical suspicion, access to rapid diagnostic testing or algorithms for presumptive diagnosis, and prompt transfer to a facility with critical care units. No specific effective antiviral treatment is available.
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Affiliation(s)
- Pablo A Vial
- Programa Hantavirus y Zoonosis, Instituto de Ciencias e Innovación en Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Departamento de Pediatría Clínica Alemana de Santiago, Santiago, Chile.
| | - Marcela Ferrés
- Department of Pediatric Infectious Disease and Immunology, Infectious Disease and Molecular Virology Laboratory, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Vial
- Programa Hantavirus y Zoonosis, Instituto de Ciencias e Innovación en Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Jonas Klingström
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Clas Ahlm
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - René López
- Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Departamento de Paciente Crítico Clínica Alemana, Santiago, Chile
| | - Nicole Le Corre
- Department of Pediatric Infectious Disease and Immunology, Infectious Disease and Molecular Virology Laboratory, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gregory J Mertz
- Department of Internal Medicine, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, USA
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Cekinović Grbeša Đ, Zahirović N, Flego V, Livajić M, Rončević Filipović M, Knežević S, Slavuljica I. Epidemiology and Clinical Course of Haemorrhagic Fever with Renal Syndrome in New Endemic Area for Hantavirus Infection in Croatia. Life (Basel) 2023; 13:1767. [PMID: 37629623 PMCID: PMC10455941 DOI: 10.3390/life13081767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Hantaviruses remain an important case of emerging and re-emerging infections in human medicine. This study aimed to analyse the epidemiology, clinical presentation, and outcome of hantavirus infections in the western part of Republic of Croatia, a new geographical area for hantavirus infections. METHODS Retrospective analysis of medical records of patients treated for hemorrhagic fever with renal syndrome (HFRS) at the infectious diseases Clinic of the Clinical Hospital Center in Rijeka, Croatia, from 1 January 2014, to 31 December 2021. RESULTS During the eight-year period, 251 patients were hospitalized and treated for HFRS, with epidemic outbreaks in years 2014 and 2021. Most patients had a typical clinical course of HFRS and received supportive care. Serological analysis revealed the Puumala Virus (PUUV) as the predominant etiology of the disease. Epidemiological analysis revealed clustering of infections in the region of Gorski Kotar and spread to the area on the Mediterranean coast (Adriatic Sea), which was previously considered an area free from hantavirus infections. CONCLUSIONS The presented results indicate the spread of hantavirus infections in Croatia from the central low-lying parts of the country to the tourist-attractive western area adjacent to the Mediterranean coast, which was previously considered free of hantavirus infections.
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Affiliation(s)
- Đurđica Cekinović Grbeša
- Clinic for Infectious Diseases, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (V.F.); (M.L.); (M.R.F.); (S.K.); (I.S.)
- Department for Infectious Diseases, School of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
| | - Nino Zahirović
- Department for Infectious Diseases, School of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
| | - Viktorija Flego
- Clinic for Infectious Diseases, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (V.F.); (M.L.); (M.R.F.); (S.K.); (I.S.)
| | - Marija Livajić
- Clinic for Infectious Diseases, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (V.F.); (M.L.); (M.R.F.); (S.K.); (I.S.)
- Department for Infectious Diseases, School of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
| | - Mari Rončević Filipović
- Clinic for Infectious Diseases, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (V.F.); (M.L.); (M.R.F.); (S.K.); (I.S.)
- Department for Infectious Diseases, School of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
| | - Samira Knežević
- Clinic for Infectious Diseases, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (V.F.); (M.L.); (M.R.F.); (S.K.); (I.S.)
| | - Irena Slavuljica
- Clinic for Infectious Diseases, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (V.F.); (M.L.); (M.R.F.); (S.K.); (I.S.)
- Department for Infectious Diseases, School of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
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Chen Y, Hou W, Dong J. Time series analyses based on the joint lagged effect analysis of pollution and meteorological factors of hemorrhagic fever with renal syndrome and the construction of prediction model. PLoS Negl Trop Dis 2023; 17:e0010806. [PMID: 37486953 PMCID: PMC10399869 DOI: 10.1371/journal.pntd.0010806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 06/26/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Hemorrhagic fever with renal syndrome (HFRS) is a rodent-related zoonotic disease induced by hantavirus. Previous studies have identified the influence of meteorological factors on the onset of HFRS, but few studies have focused on the stratified analysis of the lagged effects and interactions of pollution and meteorological factors on HFRS. METHODS We collected meteorological, contaminant and epidemiological data on cases of HFRS in Shenyang from 2005-2019. A seasonal autoregressive integrated moving average (SARIMA) model was used to predict the incidence of HFRS and compared with Holt-Winters three-parameter exponential smoothing model. A distributed lag nonlinear model (DLNM) with a maximum lag period of 16 weeks was applied to assess the lag, stratification and extreme effects of pollution and meteorological factors on HFRS cases, followed by a generalized additive model (GAM) to explore the interaction of SO2 and two other meteorological factors on HFRS cases. RESULTS The SARIMA monthly model has better fit and forecasting power than its own quarterly model and the Holt-Winters model, with an optimal model of (1,1,0) (2,1,0)12. Overall, environmental factors including humidity, wind speed and SO2 were correlated with the onset of HFRS and there was a non-linear exposure-lag-response association. Extremely high SO2 increased the risk of HFRS incidence, with the maximum RR values: 2.583 (95%CI:1.145,5.827). Extremely low windy and low SO2 played a significant protective role on HFRS infection, with the minimum RR values: 0.487 (95%CI:0.260,0.912) and 0.577 (95%CI:0.370,0.898), respectively. Interaction indicated that the risk of HFRS infection reached its highest when increasing daily SO2 and decreasing humidity. CONCLUSIONS The SARIMA model may help to enhance the forecast of monthly HFRS incidence based on a long-range dataset. Our study had shown that environmental factors such as humidity and SO2 have a delayed effect on the occurrence of HFRS and that the effect of humidity can be influenced by SO2 and wind speed. Public health professionals should take greater care in controlling HFRS in low humidity, low windy conditions and 2-3 days after SO2 levels above 200 μg/m3.
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Affiliation(s)
- Ye Chen
- Department of Infectious Disease, Shenyang Center for Disease Control and Prevention, Shenyang, PR China
| | - Weiming Hou
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang, Peoples' Republic of China
| | - Jing Dong
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang, Peoples' Republic of China
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10
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Wang M, Zhou Y, Wang Y, Du Y, Guo Z, Ma L, Zhang H, Wang Y. Correlation analysis of CD8 + cell overexpression and prognosis of hemorrhagic fever with renal syndrome-a case-control study. Front Pediatr 2023; 11:1168205. [PMID: 37215590 PMCID: PMC10196636 DOI: 10.3389/fped.2023.1168205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
Background Hemorrhagic fever with Renal Syndrome (HFRS) is an infectious disease caused by Hantavirus with fever, hemorrhage and acute kidney injury (AKI) as clinical characteristics. The research on the etiology and pathogenesis of diseases has become a focus of attention. However, there are few related medical studies in children with HFRS. The prognosis of the children with HFRS remains to be explored. Objectives We explored risk factors in children with HFRS and summarize sensitive indicators that are conducive to the prognosis of the disease. Methods We designed a case-control study and recruited 182 HFRS pediatric patients (2014.01-2022.08). They were divided into two groups according to the severity of disease, including the control group(158 cases with mild and moderate subgroup)and the observation group (24 cases with severe and critical subgroup). Risk factors influencing prognosis were analyzed by binary logistic regression. The cutoff value, sensitivity and specificity of the risk factors prediction were calculated by receiver operating characteristic (ROC) and Yoden index. Results Lymphocyte subsets characteristics analysis showed that in observation group the indexes were decreased in lymphocyte, T lymphocytes (CD3)+, helper/inducible T lymphocytes (CD4+)/inhibition/cytotoxic T cells (CD8+), B lymphocytes (CD19+); and the elevated index was CD8+, the difference were all significant between two groups. (P < 0.05). With death as the primary outcome, it was found that the serum CD8+ (odds ratio [OR] 2.91, 95% confidence interval [CI] 1.65, 4.00; P < 0.01) was risk factor and significantly associated with mortality. The cutoff value of the serum CD8+ was 845 × 106/L, the sensitivity and specificity were 78.5%, 85.4%. With complications as the secondary outcomes, the serum CD8+ (OR 2.69, 95% CI 1.15, 4.88; P < 0.01) was found to be risk factors. The cutoff of the serum CD8+ was 690 × 106/L, the sensitivity and specificity were 69.3%, 75.1% respectively. Conclusion CD8+ may be significantly correlated with the severity and prognosis of HFRS in children.
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Affiliation(s)
| | | | | | | | | | | | | | - Yi Wang
- Correspondence: Yi Wang Hua Zhang
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11
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Tervo L, Outinen T, Kiekara T, Tietäväinen J, Paakkala A, Pörsti I, Huhtala H, Mäkelä S, Mustonen J. The presence of intraperitoneal, retroperitoneal and pleural fluid in acute Puumala hantavirus infection. Infect Dis (Lond) 2023; 55:207-215. [PMID: 36562294 DOI: 10.1080/23744235.2022.2160010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Puumala hantavirus (PUUV) causes most cases of haemorrhagic fever with renal syndrome (HFRS) in Europe. PUUV infection is characterised by acute kidney injury, thrombocytopenia and increased capillary leakage. Typical symptoms are fever, headache, nausea, abdominal and back pain. This study aimed to evaluate the amount and distribution of intraperitoneal, retroperitoneal and pleural fluid and the association of fluid collections to the symptoms and clinical findings in patients with acute PUUV infection. METHODS Abdominal magnetic resonance imaging (MRI) was performed on 27 hospitalised patients with acute PUUV infection. The clinical and laboratory findings and patients' symptoms were analysed in relation to the imaging findings. The thickness of the fluid collections was measured in millimetres (mm) from axial images. RESULTS Fluid collections were found in all patients. The amount of intraperitoneal fluid correlated positively with plasma C-reactive protein (CRP) level (r = 0.586, p = .001), while it had an inverse correlation with serum creatinine concentration (r = -0.418, p = .030). Retroperitoneal fluid also correlated inversely with serum creatinine and cystatin C concentrations (r = -0.501, p = .008 and r = -0.383, p = .048, respectively). The amount of fluid was not greater in patients with abdominal or back pain. Patients with back pain had higher serum creatinine compared with patients without back pain, 452 µmol/L (range 88-1071) vs. 83 µmol/L (range 60-679), p = .004. CONCLUSIONS Fluid collections were found in all patients. A greater amount of intraperitoneal fluid associates with higher CRP concentrations but not with higher serum creatinine levels. Back pain associates with higher creatinine level but not with the presence of fluids.
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Affiliation(s)
- L Tervo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - T Outinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - T Kiekara
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - J Tietäväinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - A Paakkala
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - I Pörsti
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - H Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - S Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - J Mustonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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12
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Yang Y, Lian J, Zhao Y, Huo C, Lv S, Gao H, Wang Z. Lung ultrasonography versus chest CT for assessing peripheric pulmonary lesions in hemorrhagic fever with renal syndrome: a prospective comparative study in China. Eur Radiol 2023:10.1007/s00330-023-09457-8. [PMID: 36840765 DOI: 10.1007/s00330-023-09457-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVES To compare the performances of lung ultrasonography (LUS) versus chest CT for assessing peripheric pulmonary lesions in hemorrhagic fever with renal syndrome (HFRS). METHODS Paired LUS and chest CT scan were prospectively performed and compared when in diagnosing five pathologies including region with alveolar-interstitial pattern (RAIP), alveolar-interstitial syndrome (AIS), lung consolidation, pleural effusion (PE), and pericardial effusion, in each patient with HFRS. RESULTS Forty-four patients (aged 39.9 ± 15.0 years, 35 males) were included, from which 68 paired LUS and chest CT imaging data of 816 lung regions were obtained and analyzed. Compared with chest CT, LUS showed high sensitivity (92.19-100%) and negative predictive value (95.9-100%), but relatively low specificity (39.47-97.21%) and positive predictive value (37.5-76.47%) for diagnosing the above pathologies. McNemer's test showed LUS detected more positive findings than chest CT (all p ≤ 0.002). There was a strong correlation between LUS and chest CT scores (rs = 0.7141, p < 0.0001) and both scores correlated with the disease severity, hospital days, and partial laboratory profiles in HFRS patients. CONCLUSIONS LUS was comparable with chest CT for diagnosing peripheric pulmonary lesions and clinical assessment in patients with HFRS. Given the high sensitivity and negative predictive value compared with chest CT, LUS can be used as an excellent rule-out tool in HFRS, while its use in rule-in still requires more evidence. Considering the obvious advantages of LUS being a bedside, less expansive, and non-radiating exam, future multi-center randomized LUS versus chest CT studies may help to guide the preferred method. KEY POINTS • LUS could detect more positive findings than chest CT in assessing peripheric pulmonary lesions in patients with hemorrhagic fever with renal syndrome (HFRS). • Compared with chest CT, LUS showed high sensitivity but relatively low specificity when diagnosing the peripheric pulmonary lesions caused by HFRS. • Both LUS and chest CT scores correlated with the disease severity, hospital days, and partial laboratory profiles in HFRS.
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Affiliation(s)
- Yong Yang
- Department of Ultrasound Medicine, Tangdu Hospital, Fourth Military Medical University, 569# Xinsi Rd, Xi'an, 710038, China
| | - Jianqi Lian
- Department of Infectious Disease, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Yanyan Zhao
- Department of Infectious Disease, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Chaohui Huo
- Department of Ultrasound Medicine, Tangdu Hospital, Fourth Military Medical University, 569# Xinsi Rd, Xi'an, 710038, China
| | - Song Lv
- Department of Ultrasound Medicine, Tangdu Hospital, Fourth Military Medical University, 569# Xinsi Rd, Xi'an, 710038, China
| | - Hongkui Gao
- Department of Ultrasound Medicine, Tangdu Hospital, Fourth Military Medical University, 569# Xinsi Rd, Xi'an, 710038, China
| | - Zhen Wang
- Department of Ultrasound Medicine, Tangdu Hospital, Fourth Military Medical University, 569# Xinsi Rd, Xi'an, 710038, China.
- Department of Medical Imaging, 96608 Hospital of the People's Liberation Army, Hanzhong, 723100, China.
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13
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Characterization of a Panel of Cross-Reactive Hantavirus Nucleocapsid Protein-Specific Monoclonal Antibodies. Viruses 2023; 15:v15020532. [PMID: 36851747 PMCID: PMC9958643 DOI: 10.3390/v15020532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
Hantaviruses are emerging pathogens with a worldwide distribution that can cause life-threatening diseases in humans. Monoclonal antibodies (MAbs) against hantavirus nucleocapsid (N) proteins are important tools in virus diagnostics, epidemiological studies and basic research studies on virus replication and pathogenesis. Here, we extend the collection of previously generated MAbs raised against a segment of Puumala orthohantavirus (PUUV) N protein harbored on virus-like particles (VLPs) and MAbs against N proteins of Sin Nombre orthohantavirus/Andes orthohantavirus by generating nine novel MAbs against N proteins of Dobrava-Belgrade orthohantavirus (DOBV), Tula orthohantavirus (TULV), Thottapalayam thottimvirus (TPMV) and PUUV. In order to have a wide collection of well-described hantavirus-specific MAbs, the cross-reactivity of novel and previously generated MAbs was determined against N proteins of 15 rodent- and shrew-borne hantaviruses by different immunological methods. We found that all MAbs, excluding TPMV-specific MAbs, demonstrated different cross-reactivity patterns with N proteins of hantaviruses and recognized native viral antigens in infected mammalian cells. This well-characterized collection of cross-reactive hantavirus-specific MAbs has a potential application in various fields of hantavirus research, diagnostics and therapy.
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14
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Kabwe E, Shamsutdinov AF, Suleimanova S, Martynova EV, Ismagilova RK, Shakirova VG, Savitskaya TA, Isaeva GS, Rizvanov AA, Khaiboullina SF, Morzunov SP, Davidyuk YN. Puumala Orthohantavirus Reassortant Genome Variants Likely Emerging in the Watershed Forests. Int J Mol Sci 2023; 24:ijms24021018. [PMID: 36674534 PMCID: PMC9865142 DOI: 10.3390/ijms24021018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Hemorrhagic fever with renal syndrome (HFRS) remains a prevalent zoonosis in the Republic of Tatarstan (RT), Russian Federation. Puumala orthohantavirus (PUUV), carried by bank voles (Myodes glareolus), is the principal zoonotic pathogen of HFRS in the RT. In this study, we sought to demonstrate the similarity of the PUUV genetic sequences detected in HFRS case patients and bank vole samples previously collected in some areas of the RT. Furthermore, we intended to identify the reassortant PUUV genomes and locate a potential site for their emergence. During 2019 outbreaks, the PUUV genome sequences of the S and M segments from 42 HFRS cases were analysed and compared with the corresponding sequences from bank voles previously trapped in the RT. Most of the PUUV strains from HFRS patients turned out to be closely related to those isolated from bank voles captured near the site of the human infection. We also found possible reassortant PUUV genomes in five patients while they were absent in bank voles. The location of the corresponding HFRS infection sites suggests that reassortant PUUV genomes could emerge in the bank voles that inhabit the forests on the watershed between the Kazanka River and Myosha River. These findings could facilitate the search for the naturally occurring reassortants of PUUV in bank vole populations.
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Affiliation(s)
- Emmanuel Kabwe
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
- Kazan Research Institute of Epidemiology and Microbiology, 420012 Kazan, Russia
| | - Anton F. Shamsutdinov
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
| | - Setora Suleimanova
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
| | - Ekaterina V. Martynova
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
| | - Ruzilya K. Ismagilova
- OpenLab “Omics Technology”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
| | - Venera G. Shakirova
- Medical Academy of the Ministry of Health of the Russian Federation, 420012 Kazan, Russia
| | | | - Guzel S. Isaeva
- Kazan Research Institute of Epidemiology and Microbiology, 420012 Kazan, Russia
| | - Albert A. Rizvanov
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
| | - Svetlana F. Khaiboullina
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
- Correspondence:
| | - Sergey P. Morzunov
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
- Department of Pathology, University of Nevada, Reno, NV 89557, USA
| | - Yuriy N. Davidyuk
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
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15
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Straeten FA, Meyer zu Hörste G. Cytotoxic corpus callosum lesion and mild CSF pleocytosis during hantavirus infection: a case report. Ther Adv Neurol Disord 2022; 15:17562864221144808. [PMID: 36601083 PMCID: PMC9806393 DOI: 10.1177/17562864221144808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/25/2022] [Indexed: 12/28/2022] Open
Abstract
A middle-aged, previously healthy male patient presented with high fever, headache, and aching limbs for 3 days. Laboratory results showed signs of acute kidney injury, elevated procalcitonin, and mild thrombocytopenia. On neurological examination, he had no focal neurological deficits, especially no meningism or visual disturbances. Cerebrospinal fluid (CSF) examination showed mild lymphocytic pleocytosis, and magnetic resonance imaging (MRI) revealed a lesion of the splenium corporis callosum. The patient received anti-infective treatment with acyclovir and ceftriaxone until laboratory results returned positive hantavirus IgM and IgG antibodies in the serum indicating an active hantavirus infection. The renal retention parameters and thrombocytopenia receded following treatment with intravenous fluids, analgesic, and antipyretic agents. MRI follow-up 10 days later showed a residual small FLAIR-positive lesion without any persistent callosal diffusion abnormality. The patient was discharged symptom-free after 8 days and had recovered fully 2 months later. The source of infection in this patient remained unclear. Cytotoxic lesions of the corpus callosum (CLCC) are secondary lesions usually with a good prognosis but require further investigation regarding their underlying etiology and should not be confounded with primary callosal lesions, such as ischemia or lymphoma.
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Affiliation(s)
| | - Gerd Meyer zu Hörste
- Department of Neurology with Institute of
Translational Neurology, University Hospital Muenster, Muenster,
Germany
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16
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Cirkovic V, Dellicour S, Stamenkovic G, Siljic M, Gligic A, Stanojevic M. Phylogeographic analysis of Tula hantavirus highlights a single introduction to central Europe. Virus Evol 2022; 8:veac112. [PMID: 37954511 PMCID: PMC10634634 DOI: 10.1093/ve/veac112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/07/2022] [Accepted: 12/21/2022] [Indexed: 11/14/2023] Open
Abstract
Orthohantaviruses are zoonotic pathogens of humans, unique among the bunyaviruses in not being transmitted by an arthropod vector. Tula orthohantavirus (TULV) is an old-world hantavirus, of yet unclear human pathogenicity, with few reported cases of clinically relevant human infection. So far, phylogeographic studies exploring the global pathways of hantaviral migration are scarce and generally do not focus on a specific hantavirus species. The aim of the present study was to reconstruct the dispersal history of TULV lineages across Eurasia based on S segment sequences sampled from different geographic areas. Maximum-likelihood and Bayesian inference methods were used to perform the phylogenetic analysis and phylogeographic reconstructions. Sampling time and trapping localities were obtained for a total of 735 TULV S segment sequences available in public databases at the time of the study. The estimated substitution rate of the analyzed partial S segment alignment was 2.26 × 10-3 substitutions/site/year (95 per cent highest posterior density interval: 1.79 × 10-3 to 2.75 × 10-3). Continuous phylogeography of TULV S segment sequences placed the potential root and origin of TULV spread in the Black Sea region. In our study, we detect a single-lineage introduction of TULV to Europe, followed by local viral circulation further on.
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Affiliation(s)
- Valentina Cirkovic
- Faculty of Medicine, University of
Belgrade, Dr Subotica 8, Belgrade 11000, Serbia
| | - Simon Dellicour
- Spatial Epidemiology Lab (SpELL), Université
Libre de Bruxelles, CP160/13, 50, av. FD Roosevelt, Bruxelles 1050,
Belgium
- Department of Microbiology, Immunology and
Transplantation, Rega Institute, KU Leuven, Herestraat 49, Leuven 3000,
Belgium
| | - Gorana Stamenkovic
- University of Belgrade, Institute for Biological Research ‘Siniša
Stanković’, Bulevar despota Stefana 142, Belgrade 11108, Serbia
| | - Marina Siljic
- Faculty of Medicine, University of
Belgrade, Dr Subotica 8, Belgrade 11000, Serbia
| | - Ana Gligic
- Institute of Virology, Vaccines and Sera Torlak, Vojvode
Stepe 458, Belgrade 11000, Serbia
| | - Maja Stanojevic
- Faculty of Medicine, University of
Belgrade, Dr Subotica 8, Belgrade 11000, Serbia
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17
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Sunil-Chandra NP, Fahlman Å, Waidyarathna S, Näslund J, Jayasundara MVML, Wesula LO, Bucht G. Evidence of orthohantavirus and leptospira infections in small mammals in an endemic area of Gampaha district in Sri Lanka. ONE HEALTH OUTLOOK 2022; 4:17. [PMID: 36514136 PMCID: PMC9749280 DOI: 10.1186/s42522-022-00073-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Orthohantaviruses and leptospira are emerging zoonotic pathogens of high public health significance. The epidemiology of orthohantavirus infections and leptospirosis is similar and presents related clinical pictures in humans. However, a paucity of data on actual reservoir hosts for orthohantaviruses and leptospira exists. Therefore, this study aimed at determining the occurrence of orthohantaviruses and leptospira in small mammals captured in an endemic region of Sri Lanka. METHODS Rodents and shrews were morphologically and/or genetically identified using morphological keys and DNA barcoding techniques targeting the cytochrome oxidase b subunit gene (Cytb). Lung tissues and sera were subsequently analyzed for the presence of orthohantavirus RNA using qRT-PCR. Sera of rats were tested for IgG antibodies against orthohantaviruses and leptospira. RESULTS Forty-three (43) small mammals representing: Rattus (R.) rattus (black rat) or R. tanezumi (Asian rat), Suncus murinus (Asian house shrew), R. norvegicus (brown rat) and Mus musculus (house mouse) were investigated. No orthohantavirus RNA was detected from the lung tissue or serum samples of these animals. Elevated levels of IgG antibodies against Puumala orthohantavirus (PUUV) and/or Seoul orthohantavirus (SEOV) antigens were detected in sera of 28 (72%) out of the 39 rats analysed. Interestingly, 36 (92%) of the 39 rats also showed presence of anti leptospira-IgG antibodies in their serum, representing dual infection or dual exposure in 26/39 (66.7%) of examined rats. CONCLUSIONS This project targets important public health questions concerning the occupational risk of orthohantavirus infections and/or leptospirosis in an endemic region of Sri Lanka. Most rats (72%) in our study displayed antibodies reacting to orthohantavirus NP antigens, related to PUUV and/or SEOV. No correlation between the orthohantavirus and leptospira IgG antibody levels were noticed. Finally, a combination of both morphological and DNA barcoding approaches revealed that several species of rats may play a role in the maintenance and transmission of orthohantavirus and leptospira in Sri Lanka.
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Affiliation(s)
- N P Sunil-Chandra
- Department of Medical Microbiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
- Sri Lanka Institute of Biotechnology, Homagama, Sri Lanka.
| | - Åsa Fahlman
- Swedish Biodiversity Centre, Department of Rural and Urban Development, Faculty of Natural Resources and Agricultural Sciences, Swedish University of Agricultural Sciences, P.O. Box 7016, SE-750 07, Uppsala, Sweden
| | - Shantha Waidyarathna
- Department of Medical Microbiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Jonas Näslund
- Swedish Defence Research Agency, CBRN Defence and Security, Umeå, Sweden
| | - M V M L Jayasundara
- Department of Medical Microbiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Lwande Olivia Wesula
- Department of Clinical Microbiology, Section for Virology, Umeå University, SE-901 85, Umeå, Sweden
| | - Göran Bucht
- Swedish Defence Research Agency, CBRN Defence and Security, Umeå, Sweden
- Department of Clinical Microbiology, Section for Virology, Umeå University, SE-901 85, Umeå, Sweden
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18
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Exotic viral hepatitis: A review on epidemiology, pathogenesis, and treatment. J Hepatol 2022; 77:1431-1443. [PMID: 35817222 DOI: 10.1016/j.jhep.2022.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 12/04/2022]
Abstract
Certain "exotic" viruses are known to cause clinical diseases with potential liver involvement. These include viruses, beyond regular hepatotropic viruses (hepatitis A, -B(D), -C, -E, cytomegalovirus, Epstein-Barr virus), that can be found in (sub)tropical areas and can cause "exotic viral hepatitis". Transmission routes typically involve arthropods (Crimean Congo haemorrhagic fever, dengue, Rift Valley fever, yellow fever). However, some of these viruses are transmitted by the aerosolised excreta of rodents (Hantavirus, Lassa fever), or via direct contact or contact with bodily fluids (Ebola). Although some exotic viruses are associated with high fatality rates, such as Ebola for example, the clinical presentation of most exotic viruses can range from mild flu-like symptoms, in most cases, right through to being potentially fatal. A smaller percentage of people develop severe disease with haemorrhagic fever, possibly with (fulminant) hepatitis. Liver involvement is often caused by direct tropism for hepatocytes and Kupffer cells, resulting in virus-mediated and/or immune-mediated necrosis. In all exotic hepatitis viruses, PCR is the most sensitive diagnostic method. The determination of IgM/IgG antibodies is a reasonable alternative, but cross-reactivity can be a problem in the case of flaviviruses. Licenced vaccines are available for yellow fever and Ebola, and they are currently under development for dengue. Therapy for exotic viral hepatitis is predominantly supportive. To ensure that preventive measures can be introduced to control possible outbreaks, the timely detection of these viruses is very important.
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19
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Hönig V, Kamiš J, Maršíková A, Matějková T, Stopka P, Mácová A, Růžek D, Kvičerová J. Orthohantaviruses in Reservoir and Atypical Hosts in the Czech Republic: Spillover Infection and Indication of Virus-Specific Tissue Tropism. Microbiol Spectr 2022; 10:e0130622. [PMID: 36169417 PMCID: PMC9604079 DOI: 10.1128/spectrum.01306-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/02/2022] [Indexed: 12/30/2022] Open
Abstract
Orthohantaviruses (genus Orthohantavirus) are a diverse group of viruses that are closely associated with their natural hosts (rodents, shrews, and moles). Several orthohantaviruses cause severe disease in humans. Central and western Europe are areas with emerging orthohantavirus occurrences. In our study, several orthohantaviruses, including the pathogenic Kurkino virus (KURV), were detected in their natural hosts trapped at several study sites in the Czech Republic. KURV was detected mainly in its typical host, the striped field mouse (Apodemus agrarius). Nevertheless, spillover infections were also detected in wood mice (Apodemus sylvaticus) and common voles (Microtus arvalis). Similarly, Tula virus (TULV) was found primarily in common voles, and events of spillover to rodents of other host species, including Apodemus spp., were recorded. In addition, unlike most previous studies, different tissues were sampled and compared to assess their suitability for orthohantavirus screening and possible tissue tropism. Our data suggest possible virus-specific tissue tropism in rodent hosts. TULV was most commonly detected in the lung tissue, whereas KURV was more common in the liver, spleen, and brain. Moreover, Seewis and Asikkala viruses were detected in randomly found common shrews (Sorex araneus). In conclusion, we have demonstrated the presence of human-pathogenic KURV and the potentially pathogenic TULV in their typical hosts as well as their spillover to atypical host species belonging to another family. Furthermore, we suggest the possibility of virus-specific tissue tropism of orthohantaviruses in their natural hosts. IMPORTANCE Orthohantaviruses (genus Orthohantavirus, family Hantaviridae) are a diverse group of globally distributed viruses that are closely associated with their natural hosts. Some orthohantaviruses are capable of infecting humans and causing severe disease. Orthohantaviruses are considered emerging pathogens due to their ever-increasing diversity and increasing numbers of disease cases. We report the detection of four different orthohantaviruses in rodents and shrews in the Czech Republic. Most viruses were found in their typical hosts, Kurkino virus (KURV) in striped field mice (Apodemus agrarius), Tula virus (TULV) in common voles (Microtus arvalis), and Seewis virus in common shrews (Sorex araneus). Nevertheless, spillover infections of atypical host species were also recorded for KURV, TULV, and another shrew-borne orthohantavirus, Asikkala virus. In addition, indications of virus-specific patterns of tissue tropism were observed. Our results highlight the circulation of several orthohantaviruses, including KURV, which is pathogenic to humans, among rodents and shrews in the Czech Republic.
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Affiliation(s)
- Václav Hönig
- Laboratory of Arbovirology, Institute of Parasitology, Biology Centre CAS, České Budějovice, Czech Republic
- Laboratory of Emerging Viral Infections, Veterinary Research Institute, Brno, Czech Republic
| | - Jan Kamiš
- Laboratory of Arbovirology, Institute of Parasitology, Biology Centre CAS, České Budějovice, Czech Republic
- Department of Parasitology, Faculty of Science, University of South Bohemia, České Budějovice, Czech Republic
| | - Aneta Maršíková
- Department of Parasitology, Faculty of Science, University of South Bohemia, České Budějovice, Czech Republic
| | - Tereza Matějková
- Department of Zoology, Faculty of Science, Charles University, Biocev, Vestec, Czech Republic
| | - Pavel Stopka
- Department of Zoology, Faculty of Science, Charles University, Biocev, Vestec, Czech Republic
| | - Anna Mácová
- Department of Parasitology, Faculty of Science, University of South Bohemia, České Budějovice, Czech Republic
| | - Daniel Růžek
- Laboratory of Arbovirology, Institute of Parasitology, Biology Centre CAS, České Budějovice, Czech Republic
- Laboratory of Emerging Viral Infections, Veterinary Research Institute, Brno, Czech Republic
- Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Jana Kvičerová
- Department of Parasitology, Faculty of Science, University of South Bohemia, České Budějovice, Czech Republic
- Department of Zoology, Faculty of Science, Charles University, Biocev, Vestec, Czech Republic
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Trends and focuses of hantavirus researches: a global bibliometric analysis and visualization from 1980 to 2020. Arch Public Health 2022; 80:218. [PMID: 36182906 PMCID: PMC9526533 DOI: 10.1186/s13690-022-00973-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Abstract
Background There have been worldwide changes in the researches on hantaviruses in the past several decades. Nevertheless, there are few bibliometric analysis studies this field. We aim to evaluate and visualize the research focuses and trends of this field using a bibliometric analysis way to help understand the developmet and future hotspots of this field. Material and methods Publications related to hantavirus studies were culled from the Web of Science Core Collection to generate trend analysis. The articles and reviews were re-extracted and Countries, institutions, authors, references and keywords in this field were visually analyzed by using VOSviewer and CiteSpace. Results A total of 4408 studies were included and the number of publications regarding hantaviruses significantly increased yearly. Three thousand seven hundred sixteen research articles and reviews were retrieved to generate bibliometric analysis. These studies mainly come from 125 countries led by USA and China and 3312 institutions led by the University of Helsinki. Twelve thousand five hundred twenty nine authors were identified and Vaheri A were the most influential author. Journal of Virology was the journal with the most studies and citations. After analysis, Hemorrhagic fever with renal syndrome, Hantavirus cardiopulmonary syndrome, nephropathia epidemica and related genotypes, clinical symptoms and rodents were the most common keywords and developing areas. Conclusion Research on hantavirus is flourishing. Cooperation among different countries and institutions in this field must be strengthened in the future. The ecology and clinical symptoms of new genotypes, the vaccine development and factors that affect host population distribution and density are current and developing areas of study.
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Tuiskunen Bäck A, Rasmuson J, Thunberg T, Rankin G, Wigren Byström J, Andersson C, Sjödin A, Forsell M, Ahlm C. Clinical and genomic characterisation of a fatal Puumala orthohantavirus case with low levels of neutralising antibodies. Infect Dis (Lond) 2022; 54:766-772. [PMID: 35713235 PMCID: PMC9908776 DOI: 10.1080/23744235.2022.2076904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/11/2022] [Accepted: 05/07/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Orthohantaviruses are rodent-borne emerging viruses that cause haemorrhagic fever with renal syndrome (HFRS) in Eurasia and hantavirus pulmonary syndrome in America. Transmission between humans have been reported and the case-fatality rate ranges from 0.4% to 40% depending on virus strain. There is no specific and efficient treatment for patients with severe HFRS. Here, we characterised a fatal case of HFRS and sequenced the causing Puumala orthohantavirus (PUUV). METHODS PUUV RNA and virus specific neutralising antibodies were quantified in plasma samples from the fatal case and other patients with non-fatal PUUV infection. To investigate if the causing PUUV strain was different from previously known strains, Sanger sequencing was performed directly from the patient's plasma. Biopsies obtained from autopsy were stained for immunohistochemistry. RESULTS The patient had approximately tenfold lower levels of PUUV neutralising antibodies and twice higher viral load than was normally seen for patients with less severe PUUV infection. We could demonstrate unique mutations in the S and M segments of the virus that could have had an impact on the severity of infection. Due to the severe course of infection, the patient was treated with the bradykinin receptor inhibitor icatibant to reduce bradykinin-mediated vessel permeability and maintain vascular circulation. CONCLUSIONS Our data suggest that bradykinin receptor inhibitor may not be highly efficient to treat patients that are at an advanced stage of HFRS. Low neutralising antibodies and high viral load at admission to the hospital were associated with the fatal outcome and may be useful for future predictions of disease outcome.
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Affiliation(s)
- Anne Tuiskunen Bäck
- Infection and Immunology, Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Johan Rasmuson
- Infection and Immunology, Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Therese Thunberg
- Infection and Immunology, Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Gregory Rankin
- Medicine and Pulmonary Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Julia Wigren Byström
- Infection and Immunology, Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | | | - Andreas Sjödin
- CBRN Security and Defence, Swedish Defence Research Agency - FOI, Umeå, Sweden
| | - Mattias Forsell
- Infection and Immunology, Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Clas Ahlm
- Infection and Immunology, Department of Clinical Microbiology, Umeå University, Umeå, Sweden
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Fawcett SJ, Chen JS, Fawcett RW. Acute Hantavirus Infection Presenting with Fever and Altered Mentation in the Absence of Pulmonary or Renal Manifestations. Open Forum Infect Dis 2022; 9:ofac430. [PMID: 36119963 PMCID: PMC9472660 DOI: 10.1093/ofid/ofac430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022] Open
Abstract
Illness caused by hantaviruses is often severe and is typically characterized by diffuse pulmonary disease or renal insufficiency depending on the type of hantavirus. Here we report 2 cases of hantavirus infection that resulted in severe cognitive impairment but did not have any pulmonary or renal manifestations. These 2 cases may be indicative of previously underreported symptoms of hantavirus infection and might represent examples of hantavirus-related encephalopathy.
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Affiliation(s)
| | - Jeffrey S Chen
- Columbia Sands Medical Specialties, LLC , Redmond, OR , U.S
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Singh S, Numan A, Sharma D, Shukla R, Alexander A, Jain GK, Ahmad FJ, Kesharwani P. Epidemiology, virology and clinical aspects of hantavirus infections: an overview. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:1815-1826. [PMID: 33886400 DOI: 10.1080/09603123.2021.1917527] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
At the end of 2019 and 2020s, a wave of coronavirus disease 19 (COVID-19) epidemics worldwide has catalyzed a new era of 'communicable infectious diseases'. However, the world is not currently prepared to deal with the growing burden of COVID-19, with the unexpected arrival of Hantavirus infection heading to the next several healthcare emergencies in public. Hantavirus is a significant class of zoonotic pathogens of negative-sense single-stranded ribonucleic acid (RNA). Hemorrhagic renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS) are the two major clinical manifestations. Till date, there is no effective treatments or vaccines available, public awareness and precautionary measures can help to reduce the spread of hantavirus disease. In this study, we outline the epidemiology, virology, clinical aspects, and existing HFRS and HCPS management approaches. This review will give an understanding of virus-host interactions and will help for the early preparation and effective handling of further outbreaks in an ever-changing environment.
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Affiliation(s)
- Sima Singh
- Department of Pharmacy, University Institute of Pharma Sciences, Chandigarh University, Gharuan, Mohali, India
| | - Arshid Numan
- State Key Laboratory of ASIC and System, SIST, Fudan University, Shanghai, China
| | - Dinesh Sharma
- Pharmax Pharmaceuticals FZ LLC, Dubai Science Park - Al BarshaAl Barsha South, Dubai, United Arab Emirates
| | - Rahul Shukla
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research-Raebareli, Lucknow, India
| | - Amit Alexander
- Department of Pharmaceutical Technology (Formulations), National Institute of Pharmaceutical Education and Research, Guwahati, Sila Village, Nizsundarighopa, Changsari, Kamrup, Guwahati, Assam, India, 781101
| | - Gaurav Kumar Jain
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar, New Delhi, India
| | - Farhan Jalees Ahmad
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
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Identification of Dobrava-Belgrade Virus in Apodemus flavicollis from North-Eastern Italy during Enhanced Mortality. Viruses 2022; 14:v14061241. [PMID: 35746712 PMCID: PMC9229784 DOI: 10.3390/v14061241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/22/2022] Open
Abstract
Hantaviruses include several zoonotic pathogens that cause different syndromes in humans, with mortality rates ranging from 12 to 40%. Most commonly, humans get infected through the inhalation of aerosols or dust particles contaminated with virus-containing rodent excreta. Hantaviruses are specifically associated with the host species, and human cases depend on the presence and the dynamics of reservoir hosts. In this letter, we report the identification of Dobrava-Belgrade virus (DOBV) in the yellow-necked mouse (Apodemus flavicollis) from Italy. The virus was detected in the mountainous area of the province of Udine, bordering Austria and Slovenia, during an event of enhanced mortality in wild mice and voles. Despite serological evidence in rodents and humans that suggested the circulation of hantaviruses in Italy since 2000, this is the first virological confirmation of the infection. Phylogenetic analyses across the whole genome of the two detected viruses confirmed the host-specificity of DOBV sub-species and showed the highest identity with viruses identified in Slovenia and Croatia from both A. flavicollis and humans, with no signs of reassortment. These findings highlight the need for ecologists, veterinarians and medical doctors to come together in a coordinated approach in full compliance with the One Health concept.
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Abdominal CT findings in Puumala hantavirus-infected patients. Abdom Radiol (NY) 2022; 47:2552-2559. [PMID: 35441863 DOI: 10.1007/s00261-022-03467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Previous clinical studies have reported abdominal findings on ultrasonography or MRI in Puumala hantavirus-infected patients. PURPOSE To determine if abdominal computed tomography (CT) can lead to a diagnosis of Puumala virus infection in the presence of a suggestive clinical picture. MATERIAL AND METHODS CT findings were studied retrospectively in 30 patients who presented to the emergency department of two (Belgian) hospitals with serologically confirmed Puumala hantavirus infection. RESULTS The most frequent finding was perirenal fascial thickening (90%), followed by perirenal fat stranding (87%). Retroperitoneal fat stranding was found in 19 patients (64%) in the perivesical spaces along the fascia of the external iliac vessels with or without involvement of the presacral fat. Half of the patients had pelvic ascites, and pleural fluid was found in 7 of them. The right and left mean pole-to-pole kidney's lengths were respectively 125.7 mm and 127.8 mm in 28 patients. CONCLUSION Retroperitoneal fat stranding, perirenal fascial thickening and/or perirenal fat stranding were found in most patients with acute Puumala virus infection who have undergone CT. Although nonspecific, these findings may help to suggest Puumala hantavirus infection in the right clinical settings.
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Lee GY, Kim WK, No JS, Yi Y, Park HC, Jung J, Cho S, Lee J, Lee SH, Park K, Kim J, Song JW. Clinical and Immunological Predictors of Hemorrhagic Fever with Renal Syndrome Outcome during the Early Phase. Viruses 2022; 14:595. [PMID: 35337004 PMCID: PMC8954228 DOI: 10.3390/v14030595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
The ability to accurately predict the early progression of hemorrhagic fever with renal syndrome (HFRS) is crucial for reducing morbidity and mortality rates in severely affected patients. However, the utility of biomarkers for predicting clinical outcomes remains elusive in HFRS. The aims of the current study were to analyze the serum levels of immune function-related proteins and identify novel biomarkers that may help ascertain clinical outcomes of HFRS. Enzyme-linked immunosorbent assay, Luminex, and bioanalyzer assays were used to quantitatively detect 15 biomarkers in 49 serum samples of 26 patients with HFRS. High hemoglobin (HGB) and low urine output (UO) levels were identified as potential biomarkers associated with the acute HFRS. The serum soluble urokinase plasminogen activator receptor (suPAR) and C-X-C motif chemokine ligand 10 (CXCL10) values increased in the early phase of diseases. Elevated suPAR, interleukin-10 (IL-10), CXCL10, and decreased transforming growth factor-beta 3 (TGF-β3) were representative predictors of the disease severity. Upregulation of the HGB showed a significant correlation with high levels of suPAR and CXCL10. Reduced UO positively correlated with increased suPAR, CXCL10, and TGF-β2, and decreased vascular endothelial growth factor and TGF-β3. The changing HGB and UO criteria, high suPAR, IL-10, CXCL10, and low TGF-β3 of HFRS raise significant awareness for physicians regarding prospective biomarkers for monitoring early warning signs of HFRS. This study provides critical insights into the clinical and immunological biomarkers for disease severity and progression in patients with HFRS to identify early predictions of fatal outcomes.
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Affiliation(s)
- Geum-Young Lee
- Department of Microbiology, College of Medicine, Korea University, Seoul 02841, Korea; (G.-Y.L.); (S.C.); (J.L.); (K.P.); (J.K.)
| | - Won-Keun Kim
- Department of Microbiology, College of Medicine, Hallym University, Chuncheon 24252, Korea;
- Institute of Medical Science, College of Medicine, Hallym University, Chuncheon 24252, Korea
| | - Jin Sun No
- Division of High-Risk Pathogens, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea;
| | - Yongjin Yi
- Division of Nephrology, Department of Internal Medicine, Dankook University Hospital, Cheonan 31116, Korea;
| | - Hayne Cho Park
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Seoul 02841, Korea;
| | - Jaehun Jung
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon 21556, Korea;
| | - Seungchan Cho
- Department of Microbiology, College of Medicine, Korea University, Seoul 02841, Korea; (G.-Y.L.); (S.C.); (J.L.); (K.P.); (J.K.)
| | - Jingyeong Lee
- Department of Microbiology, College of Medicine, Korea University, Seoul 02841, Korea; (G.-Y.L.); (S.C.); (J.L.); (K.P.); (J.K.)
| | - Seung-Ho Lee
- Chem-Bio Technology Center, Agency for Defense Development, Daejeon 34075, Korea;
| | - Kyungmin Park
- Department of Microbiology, College of Medicine, Korea University, Seoul 02841, Korea; (G.-Y.L.); (S.C.); (J.L.); (K.P.); (J.K.)
- BK21 Graduate Program, Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Korea
| | - Jongwoo Kim
- Department of Microbiology, College of Medicine, Korea University, Seoul 02841, Korea; (G.-Y.L.); (S.C.); (J.L.); (K.P.); (J.K.)
- BK21 Graduate Program, Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Korea
| | - Jin-Won Song
- Department of Microbiology, College of Medicine, Korea University, Seoul 02841, Korea; (G.-Y.L.); (S.C.); (J.L.); (K.P.); (J.K.)
- BK21 Graduate Program, Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Korea
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Alcohol Consumption and Its Influence on the Clinical Picture of Puumala Hantavirus Infection. Viruses 2022; 14:v14030500. [PMID: 35336910 PMCID: PMC8948946 DOI: 10.3390/v14030500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 01/18/2023] Open
Abstract
Puumala hantavirus (PUUV) causes hemorrhagic fever with renal syndrome. Characteristic clinical findings include acute kidney injury (AKI), thrombocytopenia, and capillary leakage. Smoking increases the risk of severe AKI, but it is not known whether alcohol consumption predisposes patients to a more severe infection. Liver and pancreatic enzymes, as well as biomarkers of alcohol consumption (gamma-glutamyl transferase, GGT; carbohydrate-deficient transferrin, CDT; GGT-CDT combination; and ethyl glucuronide, EtG), were measured from 66 patients with acute PUUV infection during hospitalization and at the convalescence phase. Alcohol consumption was present in 41% of the study population, 15% showing signs of heavy drinking. Alcohol use did not affect the severity of PUUV induced AKI nor the overall clinical picture of the infection. Liver enzyme levels (GGT or alanine aminotransferase, ALT) were elevated in 64% of the patients, but the levels did not associate with the markers reflecting the severity of the disease. Serum amylase activities at the convalescent stage were higher than those at the acute phase (p < 0.001). No cases with acute pancreatitis were found. In conclusion, our findings indicate that alcohol consumption does not seem to affect the clinical course of an acute PUUV infection.
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Sheftel BI, Yakushov VD. Impacts of Climate Warming on Terrestrial Species in the Middle Yenisei Taiga. CONTEMP PROBL ECOL+ 2022. [DOI: 10.1134/s1995425522010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Serum Cytokine Alterations Associated with Age of Patients with Nephropathia Epidemica. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4685288. [PMID: 35059462 PMCID: PMC8766188 DOI: 10.1155/2022/4685288] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/13/2021] [Indexed: 12/29/2022]
Abstract
Nephropathia epidemica (NE) is a zoonotic disease caused by hantaviruses transmitted from rodents, endemic in the Republic of Tatarstan, Russia. The disease presents clinically with mild, moderate, and severe forms, and time-dependent febrile, oliguric, and polyuric stages of the disease are also recognized. The patient's cytokine responses have been suggested to play a central role in disease pathogenesis; however, little is known about the different patterns of cytokine expression in NE in cohorts of different ages and sexes. Serum samples and clinical records were collected from 139 patients and 57 controls (healthy donors) and were used to analyze 48 analytes with the Bio-Plex multiplex magnetic bead-based antibody detection kits. Principal component analysis of 137 patient and 55 controls (for which there was full data) identified two components that individually accounted for >15% of the total variance in results and together for 38% of the total variance. PC1 represented a proinflammatory TH17/TH2 cell antiviral cytokine profile and PC2 a more antiviral cytokine profile with patients tending to display one or the other of these. Severity of disease and stage of illness did not show any correlation with PC1 profiles; however, significant differences were seen in patients with high PC1 profiles vs. lower for a number of individual clinical parameters: High PC1 patients showed a reduced number of febrile days, but higher maximum urine output, higher creatinine levels, and lower platelet levels. Overall, the results of this study point towards a stronger proinflammatory profile occurring in younger NE patients, this being associated with markers of acute kidney injury and low levels of high-density cholesterol. This is consistent with previous work indicating that the pathology of NE is immune driven, with an inflammatory immune response being associated with disease and that this immune response is more extreme in younger patients.
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Koehler FC, Di Cristanziano V, Späth MR, Hoyer-Allo KJR, Wanken M, Müller RU, Burst V. OUP accepted manuscript. Clin Kidney J 2022; 15:1231-1252. [PMID: 35756741 PMCID: PMC9217627 DOI: 10.1093/ckj/sfac008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Indexed: 01/18/2023] Open
Abstract
Hantavirus-induced diseases are emerging zoonoses with endemic appearances and frequent outbreaks in different parts of the world. In humans, hantaviral pathology is characterized by the disruption of the endothelial cell barrier followed by increased capillary permeability, thrombocytopenia due to platelet activation/depletion and an overactive immune response. Genetic vulnerability due to certain human leukocyte antigen haplotypes is associated with disease severity. Typically, two different hantavirus-caused clinical syndromes have been reported: hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). The primarily affected vascular beds differ in these two entities: renal medullary capillaries in HFRS caused by Old World hantaviruses and pulmonary capillaries in HCPS caused by New World hantaviruses. Disease severity in HFRS ranges from mild, e.g. Puumala virus-associated nephropathia epidemica, to moderate, e.g. Hantaan or Dobrava virus infections. HCPS leads to a severe acute respiratory distress syndrome with high mortality rates. Due to novel insights into organ tropism, hantavirus-associated pathophysiology and overlapping clinical features, HFRS and HCPS are believed to be interconnected syndromes frequently involving the kidneys. As there are no specific antiviral treatments or vaccines approved in Europe or the USA, only preventive measures and public awareness may minimize the risk of hantavirus infection. Treatment remains primarily supportive and, depending on disease severity, more invasive measures (e.g., renal replacement therapy, mechanical ventilation and extracorporeal membrane oxygenation) are needed.
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Affiliation(s)
- Felix C Koehler
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Veronica Di Cristanziano
- Institute of Virology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Martin R Späth
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - K Johanna R Hoyer-Allo
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Manuel Wanken
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Severity Biomarkers in Puumala Hantavirus Infection. Viruses 2021; 14:v14010045. [PMID: 35062248 PMCID: PMC8778356 DOI: 10.3390/v14010045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/16/2021] [Accepted: 12/23/2021] [Indexed: 12/12/2022] Open
Abstract
Annually, over 10,000 cases of hemorrhagic fever with renal syndrome (HFRS) are diagnosed in Europe. Puumala hantavirus (PUUV) causes most of the European HFRS cases. PUUV causes usually a relatively mild disease, which is rarely fatal. However, the severity of the infection varies greatly, and factors affecting the severity are mostly unrevealed. Host genes are known to have an effect. The typical clinical features in PUUV infection include acute kidney injury, thrombocytopenia, and increased vascular permeability. The primary target of hantavirus is the endothelium of the vessels of different organs. Although PUUV does not cause direct cytopathology of the endothelial cells, remarkable changes in both the barrier function of the endothelium and the function of the infected endothelial cells occur. Host immune or inflammatory mechanisms are probably important in the development of the capillary leakage. Several immunoinflammatory biomarkers have been studied in the context of assessing the severity of HFRS caused by PUUV. Most of them are not used in clinical practice, but the increasing knowledge about the biomarkers has elucidated the pathogenesis of PUUV infection.
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Douglas KO, Payne K, Sabino-Santos G, Agard J. Influence of Climatic Factors on Human Hantavirus Infections in Latin America and the Caribbean: A Systematic Review. Pathogens 2021; 11:pathogens11010015. [PMID: 35055965 PMCID: PMC8778283 DOI: 10.3390/pathogens11010015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND With the current climate change crisis and its influence on infectious disease transmission there is an increased desire to understand its impact on infectious diseases globally. Hantaviruses are found worldwide, causing infectious diseases such as haemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS)/hantavirus pulmonary syndrome (HPS) in tropical regions such as Latin America and the Caribbean (LAC). These regions are inherently vulnerable to climate change impacts, infectious disease outbreaks and natural disasters. Hantaviruses are zoonotic viruses present in multiple rodent hosts resident in Neotropical ecosystems within LAC and are involved in hantavirus transmission. METHODS We conducted a systematic review to assess the association of climatic factors with human hantavirus infections in the LAC region. Literature searches were conducted on MEDLINE and Web of Science databases for published studies according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria. The inclusion criteria included at least eight human hantavirus cases, at least one climatic factor and study from > 1 LAC geographical location. RESULTS In total, 383 papers were identified within the search criteria, but 13 studies met the inclusion criteria ranging from Brazil, Chile, Argentina, Bolivia and Panama in Latin America and a single study from Barbados in the Caribbean. Multiple mathematical models were utilized in the selected studies with varying power to generate robust risk and case estimates of human hantavirus infections linked to climatic factors. Strong evidence of hantavirus disease association with precipitation and habitat type factors were observed, but mixed evidence was observed for temperature and humidity. CONCLUSIONS The interaction of climate and hantavirus diseases in LAC is likely complex due to the unknown identity of all vertebrate host reservoirs, circulation of multiple hantavirus strains, agricultural practices, climatic changes and challenged public health systems. There is an increasing need for more detailed systematic research on the influence of climate and other co-related social, abiotic, and biotic factors on infectious diseases in LAC to understand the complexity of vector-borne disease transmission in the Neotropics.
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Affiliation(s)
- Kirk Osmond Douglas
- Centre for Biosecurity Studies, Cave Hill Campus, The University of the West Indies, Cave Hill, St. Michael BB11000, Barbados
- Correspondence:
| | - Karl Payne
- Centre for Resource Management and Environmental Studies, Cave Hill Campus, The University of the West Indies, Cave Hill, St. Michael BB11000, Barbados;
| | - Gilberto Sabino-Santos
- School of Public Health and Tropical Medicine, Tulane University, 1324 Tulane Ave Suite 517, New Orleans, LA 70112, USA;
- Centre for Virology Research, Ribeirao Preto Medical School, University of Sao Paulo, 3900 Av. Bandeirantes, Ribeirao Preto 14049-900, SP, Brazil
| | - John Agard
- Department of Life Sciences, The University of the West Indies, St. Augustine 999183, Trinidad and Tobago;
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Occupational Hantavirus Infections in Agricultural and Forestry Workers: A Systematic Review and Metanalysis. Viruses 2021; 13:v13112150. [PMID: 34834957 PMCID: PMC8621010 DOI: 10.3390/v13112150] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 12/25/2022] Open
Abstract
Hantaviruses are zoonotic pathogens that can cause serious human disorders, including hemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome. As the main risk factor for human infections is the interaction with rodents, occupational groups such as farmers and forestry workers are reportedly at high risk, but no summary evidence has been collected to date. Therefore, we searched two different databases (PubMed and EMBASE), focusing on studies reporting the prevalence of hantaviruses in farmers and forestry workers. Data were extracted using a standardized assessment form, and results of such analyses were systematically reported, summarized and compared. We identified a total of 42 articles, including a total of 28 estimates on farmers, and 22 on forestry workers, with a total workforce of 15,043 cases (821 positive cases, 5.5%). A pooled seroprevalence of 3.7% (95% confidence interval [95% CI] 2.2–6.2) was identified in farmers, compared to 3.8% (95% CI 2.6–5.7) in forestry workers. Compared to the reference population, an increased occurrence was reported for both occupational groups (odds ratio [OR] 1.875, 95% CI 1.438–2.445 and OR 2.892, 95% CI 2.079–4.023 for farmers and forestry workers, respectively). In summary, our analyses stress the actual occurrence of hantaviruses in selected occupational groups. Improved understanding of appropriate preventive measures, as well as further studies on hantavirus infection rates in reservoir host species (rodents, shrews, and bats) and virus transmission to humans, is needed to prevent future outbreaks.
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Riccò M, Ferraro P, Peruzzi S, Balzarini F, Ranzieri S. Hantaviruses in Agricultural and Forestry Workers: Knowledge, Attitudes and Practices in Italian Physicians. Trop Med Infect Dis 2021; 6:169. [PMID: 34564553 PMCID: PMC8482122 DOI: 10.3390/tropicalmed6030169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/04/2021] [Accepted: 09/17/2021] [Indexed: 12/11/2022] Open
Abstract
Hantaviruses are viral pathogens usually endemic in rodent populations. Human exposure follows inhalation of dusts contaminated with rodent excreta, and most individuals have been infected in occupational settings heavily contaminated with rodent droppings, such as agricultural and forestry. To date, knowledge, attitudes and practices of medical professionals, especially occupational physicians (OP), regarding hantavirus disease in at-risk workers have been scarcely investigated. We investigated these topics through a structured questionnaire administered through an online survey of 223 medical professionals (42.2% of them working as OP). Adequate general knowledge of hantavirus disease was found in 48.9% of respondents, with OP exhibiting a better understanding of clinical features of human hantavirus infections. OP aware of the endemic status of hantavirus in North-Eastern Italy exhibited higher risk perception for agricultural workers (odds ratio 21,193, 95% confidence interval 3.666-122.505). On the contrary, a better knowledge of hantaviruses was association with acknowledging an increased risk of hantavirus infection in forestry workers (odds ratio 5.880, 95% confidence interval 1.620-21.343). Hantavirus in Italy represent an often-overlooked biological risk in occupational settings. The lack of preventive immunization, the inappropriate risk perception and the unsatisfying awareness of hantavirus issues collectively stress the importance of appropriate information campaigns among health care providers.
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Affiliation(s)
- Matteo Riccò
- Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), AUSL-IRCCS di Reggio Emilia, Via Amendola n.2, I-42122 Reggio Emilia, RE, Italy
| | - Pietro Ferraro
- Department of Prevention, Occupational Health and Safety Service of the Local Health Unit of Foggia, ASL Foggia, Piazza Pavoncelli 11, I-41121 Foggia, FG, Italy;
| | - Simona Peruzzi
- Laboratorio Analisi Chimico Cliniche e Microbiologiche, Ospedale Civile di Guastalla, AUSL-IRCCS di Reggio Emilia, I-42016 Guastalla, RE, Italy;
| | - Federica Balzarini
- Dipartimento P.A.A.P.S.S., Servizio Autorizzazione e Accreditamento, Agenzia di Tutela della Salute (ATS) di Bergamo, Via Galliccioli, 4, I-24121 Bergamo, BG, Italy;
| | - Silvia Ranzieri
- Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, I-43126 Parma, PR, Italy;
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Davidyuk YN, Kabwe E, Shamsutdinov AF, Knyazeva AV, Martynova EV, Ismagilova RK, Trifonov VA, Savitskaya TA, Isaeva GS, Urbanowicz RA, Khaiboullina SF, Rizvanov AA, Morzunov SP. The Distribution of Puumala orthohantavirus Genome Variants Correlates with the Regional Landscapes in the Trans-Kama Area of the Republic of Tatarstan. Pathogens 2021; 10:pathogens10091169. [PMID: 34578200 PMCID: PMC8471081 DOI: 10.3390/pathogens10091169] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022] Open
Abstract
In the European part of Russia, the highest number of hemorrhagic fever with renal syndrome (HFRS) cases are registered in the Volga Federal District (VFD), which includes the Republic of Tatarstan (RT). Puumala orthohantavirus (PUUV) is the main causative agent of HFRS identified in the RT. The goal of the current study is to analyze the genetic variations of the PUUV strains and possible presence of chimeric and reassortant variants among the PUUV strains circulating in bank vole populations in the Trans-Kama area of the RT. Complete S segment CDS as well as partial M and L segment coding nucleotide sequences were obtained from 40 PUUV-positive bank voles and used for the analysis. We found that all PUUV strains belonged to RUS genetic lineage and clustered in two subclades corresponding to the Western and Eastern Trans-Kama geographic areas. PUUV strains from Western Trans-Kama were related to the previously identified strain from Teteevo in the Pre-Kama area. It can be suggested that the PUUV strains were introduced to the Teteevo area as a result of the bank voles’ migration from Western Trans-Kama. It also appears that physical obstacles, including rivers, could be overcome by migrating rodents under favorable circumstances. Based on results of the comparative and phylogenetic analyses, we propose that bank vole distribution in the Trans-Kama area occurred upstream along the river valleys, and that watersheds could act as barriers for migrations. As a result, the diverged PUUV strains could be formed in closely located populations. In times of extensive bank vole population growth, happening every 3–4 years, some regions of watersheds may become open for contact between individual rodents from neighboring populations, leading to an exchange of the genetic material between divergent PUUV strains.
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Affiliation(s)
- Yuriy N. Davidyuk
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (Y.N.D.); (E.K.); (A.F.S.); (A.V.K.); (E.V.M.); (A.A.R.)
| | - Emmanuel Kabwe
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (Y.N.D.); (E.K.); (A.F.S.); (A.V.K.); (E.V.M.); (A.A.R.)
- Kazan Research Institute of Epidemiology and Microbiology, 420012 Kazan, Russia; (V.A.T.); (T.A.S.); (G.S.I.)
| | - Anton F. Shamsutdinov
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (Y.N.D.); (E.K.); (A.F.S.); (A.V.K.); (E.V.M.); (A.A.R.)
| | - Anna V. Knyazeva
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (Y.N.D.); (E.K.); (A.F.S.); (A.V.K.); (E.V.M.); (A.A.R.)
| | - Ekaterina V. Martynova
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (Y.N.D.); (E.K.); (A.F.S.); (A.V.K.); (E.V.M.); (A.A.R.)
| | - Ruzilya K. Ismagilova
- OpenLab “Omics Technology”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia;
| | - Vladimir A. Trifonov
- Kazan Research Institute of Epidemiology and Microbiology, 420012 Kazan, Russia; (V.A.T.); (T.A.S.); (G.S.I.)
- Medical Academy of the Ministry of Health of the Russian Federation, 420012 Kazan, Russia
| | - Tatiana A. Savitskaya
- Kazan Research Institute of Epidemiology and Microbiology, 420012 Kazan, Russia; (V.A.T.); (T.A.S.); (G.S.I.)
| | - Guzel S. Isaeva
- Kazan Research Institute of Epidemiology and Microbiology, 420012 Kazan, Russia; (V.A.T.); (T.A.S.); (G.S.I.)
| | - Richard A. Urbanowicz
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L3 5RF, UK;
| | - Svetlana F. Khaiboullina
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (Y.N.D.); (E.K.); (A.F.S.); (A.V.K.); (E.V.M.); (A.A.R.)
- Correspondence: (S.F.K.); (S.P.M.)
| | - Albert A. Rizvanov
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (Y.N.D.); (E.K.); (A.F.S.); (A.V.K.); (E.V.M.); (A.A.R.)
| | - Sergey P. Morzunov
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (Y.N.D.); (E.K.); (A.F.S.); (A.V.K.); (E.V.M.); (A.A.R.)
- Department of Pathology, University of Nevada, Reno, NV 89557, USA
- Correspondence: (S.F.K.); (S.P.M.)
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Riccò M, Peruzzi S, Ranzieri S, Balzarini F, Valente M, Marchesi F, Bragazzi NL. Hantavirus infections in Italy: not reported doesn't mean inexistent. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021324. [PMID: 34487097 PMCID: PMC8477108 DOI: 10.23750/abm.v92i4.10661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND Hantaviruses can cause serious human diseases including hemorrhagic fever with renal syndrome (HFRS) and Hantavirus Cardiopulmonary Syndrome (HCPS). European Hantavirus are usually associated with HFRS, and their geographical distribution mirrors the ecology of reservoir host species. Epidemiology of HFRS is well-studied in Western Europe, but data from Italy are fragmentary. METHODS We searched into two different databases (PubMed and EMBASE), focusing on studies reporting the prevalence of Hantaviruses in Italy. Data were extracted using a standardized assessment form, and results of the analyses were systematically reported, summarized and compared. RESULTS We identified a total of 18 articles, including 12 reports (total population: 5,336 subjects, 1981-2019) and 6 case reports (1984-2019). In total, 200 subjects exhibited some degree of seropositivity, with a pooled seroprevalence of 1.7% (95% confidence interval 0.7%-4.0%) in the general population. Higher occurrence was reported in selected subgroups, i.e. acute (28.7%, 95%CI 22.1-36.2) and chronic (6.6%, 95%CI 4.7-9.1) renal failure, forestry workers (3.0%, 95%CI 1.4-6.5, actual range 0.0 to 10.8%). CONCLUSIONS In the last decade, no human cases of hantavirus infection have been officially reported in Italy. However, our analysis stresses the actual occurrence of Hantavirus among general population and in selected population groups. Further studies on hantavirus infection rates in reservoir host species (rodents, shrews, and bats) and virus transmission to humans are needed to prevent outbreaks in the future.
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Affiliation(s)
- Matteo Riccò
- AUSL - IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza negli ambienti di Lavoro (SPSAL), Via Amendola n.2, I-42122 Reggio Emilia (RE), Italy .
| | - Simona Peruzzi
- AUSL-IRCCS di Reggio Emilia, Laboratorio Analisi Chimico Cliniche e Microbiologiche, Ospedale Civile di Guastalla, Via Donatori di Sangue n.1, I-42016 Guastalla (RE), Italy;.
| | - Silvia Ranzieri
- University of Parma, Department of Medicine and Surgery, School of Occupational Medicine; Via Gramsci n.14, 43126; Parma (PR), Italy.
| | - Federica Balzarini
- University "Vita e Salute", San Raffaele Hospital; Via Olgettina n. 58, 20132; Milan (MI), Italy.
| | - Marina Valente
- University of Parma, Department of Medicine and Surgery, School of General Surgery; Via Gramsci n.14, 43126; Parma (PR), Italy .
| | - Federico Marchesi
- University of Parma, Department of Medicine and Surgery, School of General Surgery; Via Gramsci n.14, 43126; Parma (PR), Italy .
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, University of York, Toronto (ON), Canada.
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Bauer PK, Krause R, Fabian E, Aumüller ML, Schiller D, Adelsmayr G, Fuchsjäger M, Rechberger E, Schöfl R, Krejs GJ. Clinical-Pathological Conference Series from the Medical University of Graz : Case No 172: A 45-year-old truck driver with fever, vomiting, thrombocytopenia and renal failure. Wien Klin Wochenschr 2021; 133:1222-1230. [PMID: 34402989 PMCID: PMC8599315 DOI: 10.1007/s00508-021-01921-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 10/27/2022]
Affiliation(s)
- Philipp K Bauer
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Robert Krause
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Elisabeth Fabian
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Marja-Liisa Aumüller
- Department of Internal Medicine I, Barmherzige Schwestern Hospital, Ried, Austria
| | - Dietmar Schiller
- Department of Internal Medicine IV, Elisabethinen Hospital, Linz, Austria
| | - Gabriel Adelsmayr
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Ernst Rechberger
- Department of Internal Medicine I, Barmherzige Schwestern Hospital, Ried, Austria
| | - Rainer Schöfl
- Department of Internal Medicine IV, Elisabethinen Hospital, Linz, Austria
| | - Guenter J Krejs
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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Aminikhah M, Forsman JT, Koskela E, Mappes T, Sane J, Ollgren J, Kivelä SM, Kallio ER. Rodent host population dynamics drive zoonotic Lyme Borreliosis and Orthohantavirus infections in humans in Northern Europe. Sci Rep 2021; 11:16128. [PMID: 34373474 PMCID: PMC8352996 DOI: 10.1038/s41598-021-95000-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023] Open
Abstract
Zoonotic diseases, caused by pathogens transmitted between other vertebrate animals and humans, pose a major risk to human health. Rodents are important reservoir hosts for many zoonotic pathogens, and rodent population dynamics affect the infection dynamics of rodent-borne diseases, such as diseases caused by hantaviruses. However, the role of rodent population dynamics in determining the infection dynamics of rodent-associated tick-borne diseases, such as Lyme borreliosis (LB), caused by Borrelia burgdorferi sensu lato bacteria, have gained limited attention in Northern Europe, despite the multiannual abundance fluctuations, the so-called vole cycles, that characterise rodent population dynamics in the region. Here, we quantify the associations between rodent abundance and LB human cases and Puumala Orthohantavirus (PUUV) infections by using two time series (25-year and 9-year) in Finland. Both bank vole (Myodes glareolus) abundance as well as LB and PUUV infection incidence in humans showed approximately 3-year cycles. Without vector transmitted PUUV infections followed the bank vole host abundance fluctuations with two-month time lag, whereas tick-transmitted LB was associated with bank vole abundance ca. 12 and 24 months earlier. However, the strength of association between LB incidence and bank vole abundance ca. 12 months before varied over the study years. This study highlights that the human risk to acquire rodent-borne pathogens, as well as rodent-associated tick-borne pathogens is associated with the vole cycles in Northern Fennoscandia, yet with complex time lags.
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Affiliation(s)
- Mahdi Aminikhah
- Department of Ecology and Genetics, University of Oulu, PO Box 3000, 90014, Oulu, Finland.
| | - Jukka T Forsman
- Natural Resources Institute Finland (Luke), University of Oulu, Paavo Havaksen tie 3, 90014, Oulu, Finland
| | - Esa Koskela
- Department of Biological and Environmental Science, University of Jyväskylä, P.O. Box 35, 40014, Jyväskylä, Finland
| | - Tapio Mappes
- Department of Biological and Environmental Science, University of Jyväskylä, P.O. Box 35, 40014, Jyväskylä, Finland
| | - Jussi Sane
- Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland
| | - Jukka Ollgren
- Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland
| | - Sami M Kivelä
- Department of Ecology and Genetics, University of Oulu, PO Box 3000, 90014, Oulu, Finland
| | - Eva R Kallio
- Department of Biological and Environmental Science, University of Jyväskylä, P.O. Box 35, 40014, Jyväskylä, Finland.
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Coagulopathy in Acute Puumala Hantavirus Infection. Viruses 2021; 13:v13081553. [PMID: 34452419 PMCID: PMC8402851 DOI: 10.3390/v13081553] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 12/26/2022] Open
Abstract
Puumala hantavirus (PUUV) causes a hemorrhagic fever with renal syndrome (HFRS), also called nephropathia epidemica (NE), which is mainly endemic in Europe and Russia. The clinical features include a low platelet count, altered coagulation, endothelial activation, and acute kidney injury (AKI). Multiple connections between coagulation pathways and inflammatory mediators, as well as complement and kallikrein–kinin systems, have been reported. The bleeding symptoms are usually mild. PUUV-infected patients also have an increased risk for disseminated intravascular coagulation (DIC) and thrombosis.
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40
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Razzauti M, Castel G, Cosson JF. Impact of Landscape on Host-Parasite Genetic Diversity and Distribution Using the Puumala orthohantavirus-Bank Vole System. Microorganisms 2021; 9:microorganisms9071516. [PMID: 34361952 PMCID: PMC8306195 DOI: 10.3390/microorganisms9071516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
In nature, host specificity has a strong impact on the parasite's distribution, prevalence, and genetic diversity. The host's population dynamics is expected to shape the distribution of host-specific parasites. In turn, the parasite's genetic structure is predicted to mirror that of the host. Here, we study the tandem Puumala orthohantavirus (PUUV)-bank vole system. The genetic diversity of 310 bank voles and 33 PUUV isolates from 10 characterized localities of Northeast France was assessed. Our findings show that the genetic diversity of both PUUV and voles, was positively correlated with forest coverage and contiguity of habitats. While the genetic diversity of voles was weakly structured in space, that of PUUV was found to be strongly structured, suggesting that the dispersion of voles was not sufficient to ensure a broad PUUV dissemination. Genetic diversity of PUUV was mainly shaped by purifying selection. Genetic drift and extinction events were better reflected than local adaptation of PUUV. These contrasting patterns of microevolution have important consequences for the understanding of PUUV distribution and epidemiology.
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Affiliation(s)
- Maria Razzauti
- CBGP, INRAE, CIRAD, IRD, Montpellier SupAgro, Université Montpellier, 34000 Montpellier, France;
- Correspondence:
| | - Guillaume Castel
- CBGP, INRAE, CIRAD, IRD, Montpellier SupAgro, Université Montpellier, 34000 Montpellier, France;
| | - Jean-François Cosson
- UMR BIPAR, Animal Health Laboratory, ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, Université Paris-Est, 94700 Maisons-Alfort, France;
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Lupuşoru G, Lupuşoru M, Ailincăi I, Bernea L, Berechet A, Spătaru R, Ismail G. Hanta hemorrhagic fever with renal syndrome: A pathology in whose diagnosis kidney biopsy plays a major role (Review). Exp Ther Med 2021; 22:984. [PMID: 34345266 PMCID: PMC8311249 DOI: 10.3892/etm.2021.10416] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/14/2021] [Indexed: 11/05/2022] Open
Abstract
Hantavirus infection belongs to a group of zoonoses rare in the Balkan Peninsula, causing two major syndromes, depending on the viral serotype involved: Hemorrhagic fever with renal syndrome (HFRS) also known as endemic nephropathy and cardiopulmonary syndrome (CPS). Because there is no specific treatment or vaccine for this condition approved in the USA or Europe, the key to minimizing the risk of adverse progression to chronic kidney disease, secondary hypertension or even death is primarily the recognition and early diagnosis of this condition with prompt therapeutic intervention. The aim of this study was to review the literature data on the epidemiology, pathogenesis and management of this disease and to identify several aspects related to the difficulties encountered in diagnosing this pathology, taking into consideration that the disease is not endemic in this geographical area.
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Affiliation(s)
- Gabriela Lupuşoru
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Uronephrology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mircea Lupuşoru
- Department of Physiology I, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ioana Ailincăi
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Lavinia Bernea
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Andreea Berechet
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Radu Spătaru
- Department of Pediatric Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Gener Ismail
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Uronephrology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Hautala N, Partanen T, Kubin AM, Kauma H, Hautala T. Central Nervous System and Ocular Manifestations in Puumala Hantavirus Infection. Viruses 2021; 13:1040. [PMID: 34072819 PMCID: PMC8229408 DOI: 10.3390/v13061040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 12/21/2022] Open
Abstract
Puumala hantavirus (PUUV), carried and spread by the bank vole (Myodes glareolus), causes a mild form of hemorrhagic fever with renal syndrome (HFRS) called nephropathia epidemica (NE). Acute high fever, acute kidney injury (AKI), thrombocytopenia, and hematuria are typical features of this syndrome. In addition, headache, blurred vision, insomnia, vertigo, and nausea are commonly associated with the disease. This review explores the mechanisms and presentations of ocular and central nervous system involvement in acute NE.
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Affiliation(s)
- Nina Hautala
- Medical Research Center, PEDEGO Research Unit, Department of Ophthalmology, Oulu University Hospital and University of Oulu, 90029 Oulu, Finland; (N.H.); (A.-M.K.)
| | - Terhi Partanen
- Research Unit of Internal Medicine, Department of Internal Medicine, Division of Infectious Diseases, Oulu University and Oulu University Hospital, 90014 Oulu, Finland; (T.P.); (H.K.)
| | - Anna-Maria Kubin
- Medical Research Center, PEDEGO Research Unit, Department of Ophthalmology, Oulu University Hospital and University of Oulu, 90029 Oulu, Finland; (N.H.); (A.-M.K.)
| | - Heikki Kauma
- Research Unit of Internal Medicine, Department of Internal Medicine, Division of Infectious Diseases, Oulu University and Oulu University Hospital, 90014 Oulu, Finland; (T.P.); (H.K.)
| | - Timo Hautala
- Research Unit of Internal Medicine, Department of Internal Medicine, Division of Infectious Diseases, Oulu University and Oulu University Hospital, 90014 Oulu, Finland; (T.P.); (H.K.)
- Research Unit of Biomedicine, University of Oulu, 90029 Oulu, Finland
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Douglas KO, Samuels TA, Iheozor-Ejiofor R, Vapalahti O, Sironen T, Gittens-St. Hilaire M. Serological Evidence of Human Orthohantavirus Infections in Barbados, 2008 to 2016. Pathogens 2021; 10:pathogens10050571. [PMID: 34066699 PMCID: PMC8151097 DOI: 10.3390/pathogens10050571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Hantavirus pulmonary syndrome (HPS) is well-known in South and North America; however, not enough data exist for the Caribbean. The first report of clinical orthohantavirus infection was obtained in Barbados, but no other evidence of clinical orthohantavirus infections among adults in the Caribbean has been documented. Methods: Using enzyme linked immunosorbent assay (ELISA) tests followed by confirmatory testing with immunofluorescent assays (IFA), immunochromatographic (ICG) tests, and pseudotype focus reduction neutralization tests (pFRNT), we retrospectively and prospectively detected orthohantavirus-specific antibodies among patients with febrile illness in Barbados. Results: The orthohantavirus prevalence rate varied from 5.8 to 102.6 cases per 100,000 persons among febrile patients who sought medical attention annually between 2008 and 2016. Two major orthohantavirus epidemics occurred in Barbados during 2010 and 2016. Peak orthohantavis infections were observed observed during the rainy season (August) and prevalence rates were significantly higher in females than males and in patients from urban parishes than rural parishes. Conclusions: Orthohantavirus infections are still occurring in Barbados and in some patients along with multiple pathogen infections (CHIKV, ZIKV, DENV and Leptospira). Orthohantavirus infections are more prevalent during periods of high rainfall (rainy season) with peak transmission in August; females are more likely to be infected than males and infections are more likely among patients from urban rather than rural parishes in Barbados.
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Affiliation(s)
- Kirk Osmond Douglas
- Centre for Biosecurity Studies, University of the West Indies, Cave Hill, St. Michael BB11000, Barbados
- Correspondence: ; Tel.: +1-(246)-417-7468
| | - Thelma Alafia Samuels
- Epidemiology Research Unit, Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Mona, Kingston 7, Jamaica;
| | - Rommel Iheozor-Ejiofor
- Department of Virology, Faculty of Medicine, Medicum, University of Helsinki, Haartmaninkatu 3, 00290 Helsinki, Finland; (R.I.-E.); (O.V.); (T.S.)
| | - Olli Vapalahti
- Department of Virology, Faculty of Medicine, Medicum, University of Helsinki, Haartmaninkatu 3, 00290 Helsinki, Finland; (R.I.-E.); (O.V.); (T.S.)
| | - Tarja Sironen
- Department of Virology, Faculty of Medicine, Medicum, University of Helsinki, Haartmaninkatu 3, 00290 Helsinki, Finland; (R.I.-E.); (O.V.); (T.S.)
| | - Marquita Gittens-St. Hilaire
- Best-dos Santos Public Health Laboratory, Enmore #6, Lower Collymore Rock, St. Michael BB11155, Barbados;
- Faculty of Medical Sciences, University of the West Indies, Cave Hill, St. Michael BB11000, Barbados
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Martynova E, Davidyuk Y, Kabwe E, Garanina EE, Shakirova V, Pavelkina V, Uskova Y, Stott RJ, Foster TL, Markelova M, Goyal M, Gupta A, Bhola M, Kumar V, Baranwal M, Rizvanov AA, Khaiboullina SF. Cytokine, Chemokine, and Metalloprotease Activation in the Serum of Patients with Nephropathia Epidemica from the Republic of Tatarstan and the Republic of Mordovia, Russia. Pathogens 2021; 10:pathogens10050527. [PMID: 33925451 PMCID: PMC8145562 DOI: 10.3390/pathogens10050527] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/18/2021] [Accepted: 04/24/2021] [Indexed: 12/31/2022] Open
Abstract
Nephropathia Epidemica (NE), endemic to several Volga regions of Russia, including the Republic of Tatarstan (RT) and the Republic of Mordovia (RM), is a mild form of hemorrhagic fever with renal syndrome caused by infection with rodent-borne orthohantaviruses. Although NE cases have been reported for decades, little is known about the hantavirus strains associated with human infection in these regions. There is also limited understanding of the pathogenesis of NE in the RT and the RM. To address these knowledge gaps, we conducted comparative analyses of patients with NE in the RT and the RM. Clinical symptoms were more severe in patients with NE from the RM with longer observed duration of fever symptoms and hospitalization. Analysis of patient sera showed changes in the levels of numerous cytokines, chemokines, and matrix metalloproteases (MMPs) in patients with NE from both the RT and the RM, suggesting leukocyte activation, extracellular matrix degradation, and leukocyte chemotaxis. Interestingly, levels of several cytokines were distinctly different between patients NE from the RT when compared with those from the RM. These differences were not related to the genetic variation of orthohantaviruses circulating in those regions, as sequence analysis showed that Puumala virus (PUUV) was the causative agent of NE in these regions. Additionally, only the “Russia” (RUS) genetic lineage of PUUV was detected in the serum samples of patients with NE from both the RT and the RM. We therefore conclude that differences in serum cytokine, chemokine, and MMP levels between the RT and the RM are related to environmental factors and lifestyle differences that influence individual immune responses to orthohantavirus infection.
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Affiliation(s)
- Ekaterina Martynova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (Y.D.); (E.K.); (E.E.G.); (M.M.); (A.A.R.); (S.F.K.)
- Correspondence:
| | - Yuriy Davidyuk
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (Y.D.); (E.K.); (E.E.G.); (M.M.); (A.A.R.); (S.F.K.)
| | - Emmanuel Kabwe
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (Y.D.); (E.K.); (E.E.G.); (M.M.); (A.A.R.); (S.F.K.)
| | - Ekaterina E. Garanina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (Y.D.); (E.K.); (E.E.G.); (M.M.); (A.A.R.); (S.F.K.)
| | - Venera Shakirova
- Infectious Diseases Department, Kazan State Medical Academy, 420012 Kazan, Russia;
| | - Vera Pavelkina
- Infectious Diseases Department, National Research Ogarev Mordovia State University, 430005 Saransk, Russia; (V.P.); (Y.U.)
| | - Yulia Uskova
- Infectious Diseases Department, National Research Ogarev Mordovia State University, 430005 Saransk, Russia; (V.P.); (Y.U.)
| | - Robert J. Stott
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Science, Sutton Bonington Campus, The University of Nottingham, Loughborough LE12 5RD, UK; (R.J.S.); (T.L.F.)
| | - Toshana L. Foster
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Science, Sutton Bonington Campus, The University of Nottingham, Loughborough LE12 5RD, UK; (R.J.S.); (T.L.F.)
| | - Maria Markelova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (Y.D.); (E.K.); (E.E.G.); (M.M.); (A.A.R.); (S.F.K.)
| | - Mehendi Goyal
- Doconvid.ai, Bestech Business Tower, Mohali 160055, India;
| | - Abhimat Gupta
- Department of Computer Science and Engineering, Thapar Institute of Engineering and Technology, Patiala 147004, India;
| | - Mannan Bhola
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala 147004, India; (M.B.); (M.B.)
| | - Vinay Kumar
- Department of Electronics and Communication Engineering, Thapar Institute of Engineering and Technology, Patiala 147004, India;
| | - Manoj Baranwal
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala 147004, India; (M.B.); (M.B.)
| | - Albert A. Rizvanov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (Y.D.); (E.K.); (E.E.G.); (M.M.); (A.A.R.); (S.F.K.)
| | - Svetlana F. Khaiboullina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (Y.D.); (E.K.); (E.E.G.); (M.M.); (A.A.R.); (S.F.K.)
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Dowall SD, Graham VA, Aram M, Findlay-Wilson S, Salguero FJ, Emery K, Hewson R. Hantavirus infection in type I interferon receptor-deficient (A129) mice. J Gen Virol 2021; 101:1047-1055. [PMID: 32667279 PMCID: PMC7660455 DOI: 10.1099/jgv.0.001470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Type I interferon receptor knockout mice (strain A129) were assessed as a disease model of hantavirus infection. A range of infection routes (intramuscular, intraperitoneal and intranasal) were assessed using minimally passaged Seoul virus (strain Humber). Dissemination of virus to the spleen, kidney and lung was observed at 5 days after intramuscular and intraperitoneal challenge, which was resolved by day 14. In contrast, intranasal challenge of A129 mice demonstrated virus tropism to the lung, which was maintained to day 14 post-challenge. These data support the use of the A129 mouse model for future infection studies and the in vivo evaluation of interventions.
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Affiliation(s)
- Stuart D Dowall
- National Infection Service, Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK
| | - Victoria A Graham
- National Infection Service, Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK
| | - Marilyn Aram
- National Infection Service, Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK
| | - Stephen Findlay-Wilson
- National Infection Service, Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK
| | - Francisco J Salguero
- National Infection Service, Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK
| | - Kirsty Emery
- National Infection Service, Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK
| | - Roger Hewson
- National Infection Service, Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK
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46
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Khan A, Khan M, Ullah S, Wei DQ. Hantavirus: The Next Pandemic We Are Waiting For? Interdiscip Sci 2021; 13:147-152. [PMID: 33486690 PMCID: PMC7826498 DOI: 10.1007/s12539-020-00413-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022]
Abstract
Hantaviruses, albeit reported more than 40 years ago, are now considered emerging viruses’ because of their growing importance as human pathogens. Hantavirus created focal news when the paradoxical spread was reported during the world’s pandemic battle of the COVID-19, killing a man in Yunnan province of China, further jeopardizing the existing of the human race on the planet earth. In recent years an increasing number of infections and human-to-human transmission is creating a distressing situation. In this short communication, we have focused on the biology, pathogenesis, immunology, epidemiology and future perspective of the Hantaviruses. Our understandings of hantavirus related pandemics and syndrome are limited, the contributing environmental factors, the cellular and viral dynamics in transmission from natural reservoirs to humans and finally, the virology in humans is quite intricate. Priorities for future research suggest that setting up scientific collaboration, the funding, and encouragement of health ministries and the research institutes should take admirable steps to build an understanding of this virus. Discovering new drugs or other therapeutic molecules such as vaccines takes a longer time. Thus with the recent artificial intelligence (AI) technology, the rifle for impending new medicines should be hastened. Last but not least, a data-sharing platform should be provided where all the researchers should share and make available all the necessary information such as genomics, proteomics, host-factors, and other epigenetics information, which will encourage the research collaboration in the preparation against the Hantaviruses.
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Affiliation(s)
- Abbas Khan
- Department of Bioinformatics and Biological Statistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240, P.R. China.
| | - Mazhar Khan
- The CAS Key Laboratory of Innate Immunity and Chronic Diseases, Hefei National Laboratory for Physical Sciences at Microscale, School of Life Sciences, CAS Center for Excellence in Molecular Cell Science, University of Science and Technology of China (USTC), Collaborative Innovation Center of Genetics and Development, Hefei, 230027, P.R. China
| | - Saeed Ullah
- Saidue group of Teaching Hospital, Swat, Khyber Pakhtunkhwa, Pakistan
| | - Dong-Qing Wei
- Department of Bioinformatics and Biological Statistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240, P.R. China.,State Key Laboratory of Microbial Metabolism, Shanghai-Islamabad-Belgrade Joint Innovation Center on Antibacterial Resistances, Joint Laboratory of International Cooperation in Metabolic and Developmental Sciences, Ministry of Education and School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200030, P.R. China.,Peng Cheng Laboratory, Vanke Cloud City Phase I Building 8, Xili Street, Nashan District, Shenzhen, Guangdong, 518055, P.R. China
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Munir N, Jahangeer M, Hussain S, Mahmood Z, Ashiq M, Ehsan F, Akram M, Ali Shah SM, Riaz M, Sana A. Hantavirus diseases pathophysiology, their diagnostic strategies and therapeutic approaches: A review. Clin Exp Pharmacol Physiol 2021; 48:20-34. [PMID: 32894790 DOI: 10.1111/1440-1681.13403] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/20/2022]
Abstract
Hantaviruses are enveloped negative (-) single-stranded RNA viruses belongs to Hantaviridae family, hosted by small rodents and entering into the human body through inhalation, causing haemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS) also known as hantavirus cardiopulmonary syndrome (HCPS). Hantaviruses infect approximately more than 200 000 people annually all around the world and its mortality rate is about 35%-40%. Hantaviruses play significant role in affecting the target cells as these inhibit the apoptotic factor in these cells. These viruses impair the integrity of endothelial barrier due to an excessive innate immune response that is proposed to be central in the pathogenesis and is a hallmark of hantavirus disease. A wide range of different diagnostic tools including polymerase chain reaction (PCR), focus reduction neutralization test (FRNT), enzyme-linked immunosorbent assay (ELISA), immunoblot assay (IBA), immunofluorescence assay (IFA), and other molecular techniques are used as detection tools for hantavirus in the human body. Now the availability of therapeutic modalities is the major challenge to control this deadly virus because still no FDA approved drug or vaccine is available. Antiviral agents, DNA-based vaccines, polyclonal and monoclonal antibodies neutralized the viruses so these techniques are considered as the hope for the treatment of hantavirus disease. This review has been compiled to provide a comprehensive overview of hantaviruses disease, its pathophysiology, diagnostic tools and the treatment approaches to control the hantavirus infection.
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Affiliation(s)
- Naveed Munir
- Department of Biochemistry, Government College University Faisalabad, Faisalabad, Pakistan
| | - Muhammad Jahangeer
- Department of Biochemistry, Government College University Faisalabad, Faisalabad, Pakistan
| | - Shoukat Hussain
- Department of Biochemistry, Government College University Faisalabad, Faisalabad, Pakistan
| | - Zahed Mahmood
- Department of Biochemistry, Government College University Faisalabad, Faisalabad, Pakistan
| | - Mehvish Ashiq
- Department of Chemistry, The Women University Multan, Multan, Pakistan
| | - Fatima Ehsan
- Department of Biochemistry, Government College University Faisalabad, Faisalabad, Pakistan
| | - Muhammad Akram
- Department of Eastern Medicine, Directorate of Medical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Syed Muhammad Ali Shah
- Department of Eastern Medicine, Directorate of Medical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Muhammad Riaz
- Department of Allied Health Sciences, Sargodha Medical College, University of Sargodha, Sargodha, Pakistan
| | - Aneezah Sana
- Department of Biochemistry, Government College University Faisalabad, Faisalabad, Pakistan
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Lwande OW, Mohamed N, Bucht G, Ahlm C, Olsson G, Evander M. Seewis hantavirus in common shrew (Sorex araneus) in Sweden. Virol J 2020; 17:198. [PMID: 33375950 PMCID: PMC7770741 DOI: 10.1186/s12985-020-01477-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Rodent borne hantaviruses are emerging viruses infecting humans through inhalation. They cause hemorrhagic fever with renal syndrome and hemorrhagic cardiopulmonary syndrome. Recently, hantaviruses have been detected in other small mammals such as Soricomorpha (shrews, moles) and Chiroptera (bats), suggested as reservoirs for potential pandemic viruses and to play a role in the evolution of hantaviruses. It is important to study the global virome in different reservoirs, therefore our aim was to investigate whether shrews in Sweden carried any hantaviruses. Moreover, to accurately determine the host species, we developed a molecular method for identification of shrews. Method Shrews (n = 198), caught during 1998 in Sweden, were screened with a pan-hantavirus PCR using primers from a conserved region of the large genome segment. In addition to morphological typing of shrews, we developed a molecular based typing method using sequencing of the mitochondrial cytochrome C oxidase I (COI) and cytochrome B (CytB) genes. PCR amplified hantavirus and shrew fragments were sequenced and phylogenetically analysed. Results Hantavirus RNA was detected in three shrews. Sequencing identified the virus as Seewis hantavirus (SWSV), most closely related to previous isolates from Finland and Russia. All three SWSV sequences were retrieved from common shrews (Sorex araneus) sampled in Västerbotten County, Sweden. The genetic assay for shrew identification was able to identify native Swedish shrew species, and the genetic typing of the Swedish common shrews revealed that they were most similar to common shrews from Russia. Conclusion We detected SWSV RNA in Swedish common shrew samples and developed a genetic assay for shrew identification based on the COI and CytB genes. This was the first report of presence of hantavirus in Swedish shrews.
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Affiliation(s)
| | - Nahla Mohamed
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden
| | - Göran Bucht
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden
| | - Clas Ahlm
- Department of Clinical Microbiology, Infection and Immunology, Umeå University, Umeå, Sweden
| | - Gert Olsson
- Department of Wildlife, Fish, and Environmental Studies, Swedish University of Agricultural Sciences, Umeå, Sweden
| | - Magnus Evander
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden.
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Hoornweg TE, Zutt I, de Vries A, Maas M, Hoogerwerf MN, Avšič-Županc T, Korva M, Reimerink JHJ, Reusken CBEM. Development of a Comparative European Orthohantavirus Microneutralization Assay With Multi- Species Validation and Evaluation in a Human Diagnostic Cohort. Front Cell Infect Microbiol 2020; 10:580478. [PMID: 33415084 PMCID: PMC7783042 DOI: 10.3389/fcimb.2020.580478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/16/2020] [Indexed: 12/30/2022] Open
Abstract
Orthohantaviruses (family Hantaviridae, order Bunyavirales) can cause two serious syndromes in humans: hemorrhagic fever with renal syndrome (HFRS), associated with the Old World orthohantaviruses, and hantavirus cardiopulmonary syndrome (HCPS), associated with orthohantaviruses in the Americas. In Europe, four different orthohantaviruses (DOBV, PUUV, SEOV, and TULV) are associated with human disease. As disease severity and zoonotic source differ between orthohantavirus species, conclusive determination of the infecting species by either RT-PCR or comparative virus neutralization test (VNT) is of importance. Currently, the focus reduction neutralization test (FRNT) is considered the ‘Gold Standard’ for orthohantavirus VNTs, however this test is laborious and time-consuming. Consequently, more high-throughput alternatives are needed. In this study, we developed a comparative orthohantavirus microneutralization test (MNT) including all four human pathogenic orthohantavirus species circulating in Europe. The assay was validated using RT-PCR-confirmed rodent (n=17) and human sera (n=17), DOBV-suspected human sera (n=3) and cohorts of orthohantavirus-negative rodent (n=3) and human sera (n=85). 16/17 RT-PCR-confirmed rodent sera and 18/20 of the RT-PCR-confirmed and DOBV-suspected human sera were serotyped successfully, while for the remaining rodent (n=1) and human sera (n=2) no neutralizing titers could be detected. All negative control sera tested negative in the MNT. The assay was subsequently evaluated using a clinical cohort of 50 orthohantavirus patients. Orthohantavirus infection was confirmed in all 50 patients, and 47/50 (94%) sera were serotyped successfully, confirming PUUV as the major cause of orthohantavirus infections in Netherlands. Notably, two previously unrecognized SEOV cases from 2013 were diagnosed using the MNT, underlining the added value of the MNT in a diagnostic setting. In conclusion, we demonstrate the successful development and clinical implementation of a comparative European orthohantavirus MNT to determine the infecting virus species in European HFRS patients. Identification of the causative species is needed for an adequate Public Health response and can support individual patient care. For many labs, the implementation of orthohantavirus neutralization tests has not been a straightforward procedure. This issue will be addressed by the rollout of the comparative MNT to multiple European laboratories to support patient diagnostics, surveillance and Public Health responses.
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Affiliation(s)
- Tabitha E Hoornweg
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Ilse Zutt
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Ankje de Vries
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Miriam Maas
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Marieke N Hoogerwerf
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Tatjana Avšič-Županc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miša Korva
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Johan H J Reimerink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Chantal B E M Reusken
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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Schwab S, Lissmann S, Schäfer N, Isaak A, Klingmüller D, Attenberger U, Eis-Hübinger AM, Hofmann J, Strassburg CP, Lutz P. When polyuria does not stop: a case report on an unusual complication of hantavirus infection. BMC Infect Dis 2020; 20:713. [PMID: 32993515 PMCID: PMC7526136 DOI: 10.1186/s12879-020-05429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The clinical features, course and outcome of hantavirus infection is highly variable. Symptoms of the central nervous system may occur, but often present atypically and diagnostically challenging. Even though the incidence of hantavirus infection is increasing worldwide, this case is the first to describe diabetes insipidus centralis as a complication of hantavirus infection in the Western world.
Case presentation
A 49-year old male presenting with severe headache, nausea and photophobia to our neurology department was diagnosed with acute haemorrhage in the pituitary gland by magnetic resonance imaging. In the following days, the patient developed severe oliguric acute kidney failure. Diagnostic workup revealed a hantavirus infection, so that the pituitary haemorrhage resulting in hypopituitarism was seen as a consequence of hantavirus-induced hypophysitis. Under hormone replacement and symptomatic therapy, the patient’s condition and kidney function improved considerably, but significant polyuria persisted, which was initially attributed to recovery from kidney injury. However, water deprivation test revealed central diabetes insipidus, indicating involvement of the posterior pituitary gland. The amount of urine production normalized with desmopressin substitution.
Conclusion
Our case report highlights that neurological complications of hantavirus infection should be considered in patients with atypical clinical presentation.
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