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Mačak Šafranko Ž, Jakopec L, Svaguša K, Cvetko Krajinović L, Tomasović D, Lukić LJ, Markotić A. Serum Concentrations of TIM-3, LAG-3, and PD-1 in Patients with Hemorrhagic Fever with Renal Syndrome. Life (Basel) 2024; 14:551. [PMID: 38792573 PMCID: PMC11121887 DOI: 10.3390/life14050551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 05/26/2024] Open
Abstract
Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne disease widespread in Europe and Asia. HFRS is caused by negative-sensed single-stranded RNA orthohantaviruses transmitted to humans through inhaling aerosolized excreta of infected rodents. Symptoms of HFRS include acute kidney injury, thrombocytopenia, hemorrhages, and hypotension. The immune response raised against viral antigens plays an important role in the pathogenesis of HFRS. Inhibitory co-receptors are essential in regulating immune responses, mitigating immunopathogenesis, and reducing tissue damage. Our research showed an increased soluble form of inhibitory co-receptors TIM-3, LAG-3, and PD-1 in HFRS patients associated with disease severity. Our study aimed to investigate the impact of HFRS on the concentrations of soluble forms of inhibitory receptors TIM-3, LAG-3, and PD-1 in the patient's serum and the potential correlation with key clinical parameters. Our study aimed to investigate the impact of HFRS on the concentrations of soluble forms of inhibitory receptors TIM-3, LAG-3, and PD-1 in the patient's serum and their possible association with relevant clinical parameters. Using multiplex immunoassay, we found elevated levels of TIM-3, LAG-3, and PD-1 proteins in the serum of HFRS patients. Furthermore, increased levels were associated with creatinine, urea, lactate dehydrogenase concentrations, and platelet count. These findings suggest that these proteins play a role in regulating the immune response and disease progression.
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Affiliation(s)
- Željka Mačak Šafranko
- Research Unit, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia
| | - Lana Jakopec
- Research Unit, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia
| | - Karla Svaguša
- Research Unit, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia
| | - Lidija Cvetko Krajinović
- Research Unit, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia
| | - Domagoj Tomasović
- Research Unit, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia
| | - Ljiljana Lukić
- Research Unit, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia
| | - Alemka Markotić
- Research Unit, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Faculty of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
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Zhao HD, Sun JJ, Liu HL. Potential clinical biomarkers in monitoring the severity of Hantaan virus infection. Cytokine 2023; 170:156340. [PMID: 37607412 DOI: 10.1016/j.cyto.2023.156340] [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: 07/10/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023]
Abstract
Hantavirus, which causes hemorrhagic fever with renal syndrome (HFRS) is almost prevalent worldwide. While Hantaan virus (HTNV) causes the most severe form of HFRS with typical clinical manifestations of thrombocytopenia, increased vascular permeability, and acute kidney injury. Although the knowledge of the pathogenesis of HFRS is still limited, immune dysfunction and pathological damage caused by disorders of immune regulation are proposed to play a vital role in the development of the disorder, and the endothelium is considered to be the primary target of hantaviruses. Here, we reviewed the production and function of multiple molecules, mainly focusing on their role in immune response, endothelium, vascular permeability regulation, and platelet and coagulation activation which are closely related to the pathogenesis of HTNV infection. meanwhile, the relationship between these molecules and characteristics of HTNV infection including the hospital duration, immune dysfunction, thrombocytopenia, leukocytosis, and acute kidney injury are also presented, to provide a novel insight into the potential role of these molecules as monitoring markers for HTNV infection.
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Affiliation(s)
- Han-Dong Zhao
- Central Laboratory of Virology, Shaanxi Provincial Hospital of Infectious Diseases, The Eighth Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an 710061, China
| | - Ju-Jun Sun
- Clinical Laboratory Center, XD Group Hospital, Xi'an 710077, China
| | - Hong-Li Liu
- Clinical Laboratory Center, Xi'an People's Hospital (Xi'an Fourth Hospital) Guang-Ren Hospital Affiliated to Xi'an Jiaotong University Health Science Center, Xi'an 710004, China.
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3
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He S, Han Q, Wang X, Zhang X, Li N, Liu Z. Aspartate aminotransferase to platelet ratio at admission can predict the prognosis of patients with hemorrhagic fever with renal syndrome. J Med Virol 2023; 95:e29126. [PMID: 37786231 DOI: 10.1002/jmv.29126] [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: 06/30/2023] [Revised: 07/30/2023] [Accepted: 09/05/2023] [Indexed: 10/04/2023]
Abstract
Early indicators are needed to predict the prognosis of patients with hemorrhagic fever with renal syndrome (HFRS). Aspartate aminotransferase to platelet ratio index (APRI) has been shown to be related to mortality risk of patients with various diseases. This study evaluated the prognostic value of APRI and other inflammatory scores in HFRS patients. Data of hospitalized HFRS patients from a tertiary hospital in northwest China were collected and the inflammatory scores such as APRI and neutrophil to lymphocyte count ratio (NLR) were calculated at the day of patient admission. Independent factors related to the survival of patients were determined by multivariate logistic regression. Receiver operating characteristic curve was used to analyze the predictive value, and area under the curve (AUC) and 95% confidence interval (CI) were calculated for quantification. Of the 317 HFRS patients included in study, 15 patients died. Age (OR: 1.10, 95% CI: 1.04-1.16, p = 0.001), NLR (OR: 1.11, 95% CI: 1.02-1.19, p = 0.01), and APRI (OR: 1.06, 95% CI: 1.03-1.10, p = 0.001) were quantitative objective factors independently associated with the survival of patients. APRI had an AUC of 0.95 (95% CI: 0.91-1.00, p < 0.001) for predicting the prognosis of patients, with a sensitivity of 93.3% and a specificity of 86.8%. The performance of APRI was better than that of age or NLR. Patients with an APRI ≥ 6.15 had significantly decreased survival compared with those with an APRI < 6.15. In conclusion, this simple index APRI calculated at admission can serve as a biomarker to identify HFRS patients at risk of poor prognosis.
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Affiliation(s)
- Shan He
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Postgraduate Department, Xi'an Medical University, Xi'an, Shaanxi, China
| | - Qunying Han
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaoyun Wang
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaoge Zhang
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Na Li
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhengwen Liu
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Lupuşoru G, Andronesi AG, Lupuşoru M, Ailincăi I, Sfeatcu R, Văcăroiu I, Banu M, Achim C, Ismail G. Hantavirus infections in the South‑Eastern European countries: A study of two cases and literature review. Exp Ther Med 2023; 26:430. [PMID: 37602312 PMCID: PMC10433441 DOI: 10.3892/etm.2023.12129] [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: 01/25/2023] [Accepted: 06/09/2023] [Indexed: 08/22/2023] Open
Abstract
Hantavirus infection is a rare zoonosis in South-Eastern Europe. Depending on the serotype involved, the virus can cause hemorrhagic fever with renal syndrome which is also known as endemic nephropathy, and cardiopulmonary syndrome. Prompt diagnosis of the disease is essential for reducing the risk of severe manifestations and complications like chronic kidney disease, secondary hypertension or even death because there is no specific treatment or vaccine approved. The present study reported two cases of hemorrhagic fever with renal syndrome diagnosed in the Department of Nephrology of The Fundeni Clinical Institute (Romania). In both patients, kidney needle biopsy played a major role in establishing the diagnosis. The difficulties encountered in diagnosing this disease were also emphasized, taking into consideration the rarity of this infection in South-Eastern Europe. The key literature data on the epidemiology, pathogenesis and management of this infection were further reviewed.
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Affiliation(s)
- Gabriela Lupuşoru
- Department of Nephrology, The ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology, The Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Andreea Gabriella Andronesi
- Department of Nephrology, The ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology, The Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Mircea Lupuşoru
- Department of Physiology, The ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ioana Ailincăi
- Department of Nephrology, The ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology, The Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Ruxandra Sfeatcu
- Department of Oral Health and Community Dentistry, The ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ileana Văcăroiu
- Department of Nephrology, The ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology, The St John Emergency Clinical Hospital, 042122 Bucharest, Romania
| | - Mihaela Banu
- Department of Anatomy, The ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Camelia Achim
- Department of Nephrology, The ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology, The Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Gener Ismail
- Department of Nephrology, The ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology, The Fundeni Clinical Institute, 022328 Bucharest, Romania
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Al-Eitan L, Alnemri M, Alkhawaldeh M, Mihyar A. Rodent-borne viruses in the region of Middle East. Rev Med Virol 2023:e2440. [PMID: 36924105 DOI: 10.1002/rmv.2440] [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: 08/29/2022] [Revised: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Abstract
Rodents are one of the most abundant mammal species in the world. They form more than two-fifth of all mammal species and there are approximately 4600 existing rodent species. Rodents are capable of transmitting deadly diseases, especially those that are caused by viruses. Viruses and their consequences have plagued the world for the last two centuries, three pandemics occurred during the last century only. The Middle East is situated at the crossroads of Africa and Asia, along with the Mediterranean Sea and the Indian Ocean, its geographic importance is gained through the diversity of topographies, biosphere, as well as climate aspects that make the region vulnerable to host emerging diseases. Refugee crises also play a major role in expected epidemic outbreaks in the region. Public health has always been the most important priority, and our aim in this review is to raise awareness among public health organisations across the Middle East about the dangers of rodent borne diseases that have been reported or are suspected to be found in the region.
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Affiliation(s)
- Laith Al-Eitan
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Malek Alnemri
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Mishael Alkhawaldeh
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad Mihyar
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
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Sehgal A, Mehta S, Sahay K, Martynova E, Rizvanov A, Baranwal M, Chandy S, Khaiboullina S, Kabwe E, Davidyuk Y. Hemorrhagic Fever with Renal Syndrome in Asia: History, Pathogenesis, Diagnosis, Treatment, and Prevention. Viruses 2023; 15:v15020561. [PMID: 36851775 PMCID: PMC9966805 DOI: 10.3390/v15020561] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/30/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Hemorrhagic Fever with Renal Syndrome (HFRS) is the most frequently diagnosed zoonosis in Asia. This zoonotic infection is the result of exposure to the virus-contaminated aerosols. Orthohantavirus infection may cause Hemorrhagic Fever with Renal Syndrome (HRFS), a disease that is characterized by acute kidney injury and increased vascular permeability. Several species of orthohantaviruses were identified as causing infection, where Hantaan, Puumala, and Seoul viruses are most common. Orthohantaviruses are endemic to several Asian countries, such as China, South Korea, and Japan. Along with those countries, HFRS tops the list of zoonotic infections in the Far Eastern Federal District of Russia. Recently, orthohantavirus circulation was demonstrated in small mammals in Thailand and India, where orthohantavirus was not believed to be endemic. In this review, we summarized the current data on orthohantaviruses in Asia. We gave the synopsis of the history and diversity of orthohantaviruses in Asia. We also described the clinical presentation and current understanding of the pathogenesis of orthohantavirus infection. Additionally, conventional and novel approaches for preventing and treating orthohantavirus infection are discussed.
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Affiliation(s)
- Ayushi Sehgal
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala 147004, India
| | - Sanya Mehta
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala 147004, India
| | - Kritika Sahay
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala 147004, India
| | - Ekaterina Martynova
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia
| | - Albert Rizvanov
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia
| | - Manoj Baranwal
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala 147004, India
| | - Sara Chandy
- Childs Trust Medical Research Foundation, Kanchi Kamakoti Childs Trust Hospital, Chennai 600034, India
| | - Svetlana Khaiboullina
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia
| | - Emmanuel Kabwe
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia
- Kazan Research Institute of Epidemiology and Microbiology, Kazan 420012, Russia
| | - Yuriy Davidyuk
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia
- Correspondence:
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7
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AL-Eitan L, Alnemri M. Biosafety and Biosecurity in the Era of Biotechnology: The Middle East Region. JOURNAL OF BIOSAFETY AND BIOSECURITY 2022. [DOI: 10.1016/j.jobb.2022.11.002] [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] Open
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8
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Jiang H, Huang C, Bai X, Zhang F, Lin B, Wang S, Jia Z, Wang J, Liu J, Dang S, Zhao Y, Dou X, Cui F, Zhang W, Lian J, Wang G, Gao Z. Expert Consensus on the Prevention and Treatment of Hemorrhagic Fever with Renal Syndrome. INFECTIOUS DISEASES & IMMUNITY 2022; 2:224-232. [DOI: 10.1097/id9.0000000000000054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Abstract
Hemorrhagic fever with renal syndrome (HFRS) is an acute zoonosis with a global distribution. China is one of the countries with a high incidence of HFRS, which has long endangered the lives and health of the Chinese people. The Infectious Disease Branch of the Chinese Preventive Medicine Association and the Infectious Diseases Branch of the Chinese Medical Association organized national multidisciplinary experts, based on domestic and international research results combined with experts’ practical experiences, to reach this consensus after thorough discussion. This consensus contains 17 recommendations aimed at prevention and identification of important clinical issues to further standardize the prevention, diagnosis, and treatment of HFRS.
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Tariq M, Kim DM. Hemorrhagic Fever with Renal Syndrome: Literature Review, Epidemiology, Clinical Picture and Pathogenesis. Infect Chemother 2022; 54:1-19. [PMID: 35384417 PMCID: PMC8987181 DOI: 10.3947/ic.2021.0148] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/30/2022] [Indexed: 02/06/2023] Open
Abstract
Hantaviruses can cause two types of infections in humans: hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome. The old world hantaviruses, primarily Hantaan virus (HTNV), responsible for causing HFRS occurs endemically in Asia and Europe. Apodernus agraricus, a striped field mouse, is being considered as main host reservoir for HTNV. Infection in humans is typically accidental and occurs when virus-containing rodent excretions such as urine, feces, or saliva are aerosolized. The major clinical manifestations includes increased vascular permeability causing vascular leakage, acute kidney injury and coagulation abnormalities. The case fatality rate of HFRS varies around 5.0 - 10.0% depending on the causative viral agent. The direct effects of viral infection on endothelial cells, as well as the immunological response to the viral infection, have been suggested to play a key role in the pathogenesis of HFRS. This article summarizes the current knowledge of HFRS epidemiology in Korea and around the globe, etiology, host transmission, clinical presentation, pathogenesis, diagnostic techniques, treatment, and prevention.
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Affiliation(s)
- Misbah Tariq
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea.,Dow University of Health Sciences, Karachi, Pakistan
| | - Dong-Min Kim
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea.
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10
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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: 8] [Impact Index Per Article: 4.0] [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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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: 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: 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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12
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Yang Z, Hu Q, Feng Z, Sun Y. Development and validation of a nomogram for predicting severity in patients with hemorrhagic fever with renal syndrome: A retrospective study. Open Med (Wars) 2021; 16:944-954. [PMID: 34222669 PMCID: PMC8234813 DOI: 10.1515/med-2021-0307] [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: 02/03/2021] [Revised: 04/29/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022] Open
Abstract
Background Hemorrhagic fever with renal syndrome (HFRS) is a zoonotic disease caused by hantavirus infection. Patients with severe HFRS may develop multiple organ failure or even death, which makes HFRS a serious public health problem. Methods In this retrospective study, we included a total of 155 consecutive patients who were diagnosed with HFRS, of whom 109 patients served as a training cohort and 46 patients as an independent verification cohort. In the training set, the least absolute shrinkage and selection operator (LASSO) regression was used to screen the characteristic variables of the risk model. Multivariate logistic regression analysis was used to construct a nomogram containing the characteristic variables selected in the LASSO regression model. Results The area under the receiver operating characteristic curve (AUC) of the nomogram indicated that the model had good discrimination. The calibration curve exhibited that the nomogram was in good agreement between the prediction and the actual observation. Decision curve analysis and clinical impact curve suggested that the predictive nomogram had clinical utility. Conclusion In this study, we established a simple and feasible model to predict severity in patients with HFRS, with which HFRS would be better identified and patients can be treated early.
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Affiliation(s)
- Zheng Yang
- Department of Infectious Disease, Jingzhou Hospital, Yangtze University, Jingzhou, 434020, China
| | - Qinming Hu
- Department of Infectious Disease, Jingzhou Hospital, Yangtze University, Jingzhou, 434020, China
| | - Zhipeng Feng
- Department of Infectious Disease, Jingzhou Hospital, Yangtze University, Jingzhou, 434020, China
| | - Yi Sun
- Department of Dermatology, Jingzhou Hosiptal, Yangtze University, No. 60 Jingzhong Road, Jingzhou District, Hubei Province, Jingzhou, 434020, China
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İnce N, Öne K, Sav T, Sungur MA, Menemenlioğlu D. An evaluation of suspected cases of Hantavirus infection admitted to a tertiary care university hospital in Düzce, Turkey, between 2012 and 2018. Turk J Med Sci 2021; 51:288-296. [PMID: 33021756 PMCID: PMC7991866 DOI: 10.3906/sag-1912-123] [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: 12/15/2019] [Accepted: 10/06/2020] [Indexed: 11/06/2022] Open
Abstract
Background/aim Hantavirus is a rodent borne zoonosis caused by the members of the virus family Bunyaviridae, genus
Hantavirus
. In this study, we aimed to determine the role of peripheral blood leukocyte ratio in differential diagnosis of Hantavirus disease. Materials and methods The medical records of patients at the Düzce University Medical Faculty were examined retrospectively. A total of 20 patients diagnosed with hantavirus infection confirmed by serologic tests were included in the study (Group 1). The other group consisted of 30 patients suspected of hantavirus infection but found negative (Group 2). Demographic, clinical and laboratory characteristics, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte (LMR) ratios of both groups were compared. Results As a result of the istatistics analysis, no difference was found between the groups’ age, sex, and clinical complaints except lethargy-weakness (P = 0.004) and diarrhea (P < 0.001). Hemogram analysis showed a significant difference between the groups in terms of leukocyte, hemoglobin, hematocrit, platelet, mean platelet volume (P < 0.05) and PLR (P = 0.001) and LMR (P = 0.003) values from peripheral blood leukocyte ratios. Conclusion In conclusion, NLR, PLR, and LMR ratios may be useful for clinicians in differential diagnosis of Hantavirus in patients presenting with similar symptoms of Hantavirus disease.
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Affiliation(s)
- Nevin İnce
- Department of Infectious Diseases and Clinical Microbiology, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Kürşad Öne
- Department of Nephrology, Internal Diseases, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Tansu Sav
- Department of Nephrology, Internal Diseases, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Dilek Menemenlioğlu
- Department of Microbiology Reference Laboratories, National Arboviruses and Viral Zoonoses Unit Public Health Institution of Turkey, Ankara, Turkey
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14
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Zhang L, Ma QS, Zhang Y, Sun BC, Zhao LY. Analysis of misdiagnosed cases of hemorrhagic fever with renal syndrome in children: two cases and literature review. BMC Nephrol 2019; 20:383. [PMID: 31646967 PMCID: PMC6813044 DOI: 10.1186/s12882-019-1562-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemorrhagic fever with renal syndrome (HFRS) is an acute disease caused by hantavirus infection and is clinically characterized by fever, various hemorrhagic manifestations and transient renal and hepatic dysfunctions. Although various cases of HFRS have been reported, cases in children have rarely been described. Herein, we report two atypical cases of HFRS in children without distinctive manifestations and typical disease clinically progresses. CASE PRESENTATION Patient 1 was a 11-year-old girl who attended our clinic for fever accompanying with acute renal failure, proteinuria and decreased level of complement 3 (C3) and thrombocytopenia without any hemorrhagic manifestations, acute glomerulonephritis was suspected first, especially lupus nephritis. Patient 2 was misdiagnosed as encephalitis at local hospital because of fever and headache for 4 days. With elevated liver transaminases, proteinuria and normal cerebrospinal fluid examination, HFRS was taken into consideration. Both of the two cases were supported and confirmed by serological test for Hantavirus. CONCLUSIONS Clinical manifestations of HFRS in children often presented atypically and were milder than adults. Febrile disease accompanying with thrombocytopenia may lead to the suspected diagnosis of HFRS.
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Affiliation(s)
- Li Zhang
- 0000 0004 1760 5735grid.64924.3dDepartment of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, 130021 Jilin China
| | - Qing-shan Ma
- 0000 0004 1760 5735grid.64924.3dDepartment of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, 130021 Jilin China
| | - Yan Zhang
- 0000 0004 1760 5735grid.64924.3dDepartment of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, 130021 Jilin China
| | - Bai-chao Sun
- 0000 0004 1760 5735grid.64924.3dDepartment of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, 130021 Jilin China
| | - Leng-yue Zhao
- 0000 0004 1760 5735grid.64924.3dDepartment of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, 130021 Jilin China
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15
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López R, Vial C, Graf J, Calvo M, Ferrés M, Mertz G, Cuiza A, Agüero B, Aguilera D, Araya D, Pailamilla I, Paratori F, Torres-Torres V, Vial PA. Platelet Count in Patients with Mild Disease at Admission is Associated with Progression to Severe Hantavirus Cardiopulmonary Syndrome. Viruses 2019; 11:v11080693. [PMID: 31366116 PMCID: PMC6724000 DOI: 10.3390/v11080693] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Hantavirus cardiopulmonary syndrome (HCPS) has a mortality up to 35–40% and its treatment is mainly supportive. A variable to predict progression from mild to severe disease is unavailable. This study was performed in patients with documented infection by Andes orthohantavirus, and the aim was to find a simple variable to predict progression to moderate/severe HCPS in patients with mild disease at admission. Methods: We performed a retrospective analysis of 175 patients between 2001 and 2018. Patients were categorized into mild, moderate, and severe disease according to organ failure and advanced support need at hospital admission (e.g., mechanical ventilation, vasopressors). Progression to moderate/severe disease was defined accordingly. Clinical and laboratory variables associated with progression were explored. Results: Forty patients with mild disease were identified; 14 of them progressed to moderate/severe disease. Only platelet count was different between those who progressed versus those that did not (37 (34–58) vs. 83 (64–177) K/mm3, p < 0.001). A ROC curve analysis showed an AUC = 0.889 (0.78–1.0) p < 0.001, with a platelet count greater than 115K /mm3 ruling out progression to moderate/severe disease. Conclusions: In patients with mild disease at presentation, platelet count could help to define priority of evacuation to tertiary care centers.
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Affiliation(s)
- René López
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago 7650567, Chile
- Escuela de Medicina. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile
| | - Cecilia Vial
- Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7590943, Chile
| | - Jerónimo Graf
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago 7650567, Chile
- Escuela de Medicina. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile
| | - Mario Calvo
- Instituto de Medicina, Universidad Austral de Chile, Valdivia 5110566, Chile
| | - Marcela Ferrés
- Departamento Enfermedades Infecciosas e Inmunología Pediátrica, Laboratorio Infectología y Virología Molecular, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331500, Chile
| | - Gregory Mertz
- University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Analía Cuiza
- Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7590943, Chile
| | - Begonia Agüero
- Escuela de Medicina. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile
| | - Dante Aguilera
- Escuela de Medicina. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile
| | - Diego Araya
- Escuela de Medicina. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile
| | - Ignacia Pailamilla
- Escuela de Medicina. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile
| | - Flavia Paratori
- Escuela de Medicina. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile
| | - Víctor Torres-Torres
- Escuela de Medicina. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile
| | - Pablo A Vial
- Escuela de Medicina. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile.
- Departamento de Pediatría, Clínica Alemana de Santiago, Santiago 7650567, Chile.
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16
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Kletenkov K, Martynova E, Davidyuk Y, Kabwe E, Shamsutdinov A, Garanina E, Shakirova V, Khaertynova I, Anokhin V, Tarlinton R, Rizvanov A, Khaiboullina S, Morzunov S. Δ ccr5 Genotype Is Associated with Mild Form of Nephropathia Epidemica. Viruses 2019; 11:v11070675. [PMID: 31340562 PMCID: PMC6669606 DOI: 10.3390/v11070675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/22/2019] [Accepted: 07/17/2019] [Indexed: 01/03/2023] Open
Abstract
Nephropathia Epidemica (NE), a mild form of hemorrhagic fever with renal syndrome (HFRS) and linked to hantavirus infection, is endemic in the Republic of Tatarstan. Several genetic markers of HFRS severity have been identified previously, including human leukocyte antigen (HLA) complexes and nucleotide polymorphism in the tumor necrosis factor alpha (TNFα) gene. Still, our understanding of the genetic markers of NE severity remains incomplete. The frequency of the C-C chemokine receptor type 5 (CCR5) gene wild type and gene with 32-base-pair deletion (Δ32CCR5) genotypes in 98 NE samples and 592 controls was analyzed using PCR. Along with the serum levels of 94 analytes, a lack of differences in the CCR5 genotype distribution between NE cases and the general population suggests that the CCR5 genotype does not affect susceptibility to hantavirus infection. However, in NE cases, significant variation in the serum levels of the host matrix metalloproteases between functional CCR5 homozygous and Δ32CCR5 heterozygous patients was detected. Also, the oliguric phase was longer, while thrombocyte counts were lower in functional CCR5 homozygous as compared to heterozygous NE cases. Our data, for the first time, presents the potential role of the CCR5 receptor genotype in NE pathogenesis. Our data suggests that NE pathogenesis in functional CCR5 homozygous and heterozygous NE patients differs, where homozygous cases may have more disintegration of the extracellular matrix and potentially more severe disease.
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Affiliation(s)
- Konstantin Kletenkov
- Openlab "Gene and Cell Technologies", Institute of Fundamental Medicine and Biology Kazan Federal University, Kazan 420008, Republic of Tatarstan, Russian
| | - Ekaterina Martynova
- Openlab "Gene and Cell Technologies", Institute of Fundamental Medicine and Biology Kazan Federal University, Kazan 420008, Republic of Tatarstan, Russian
| | - Yuriy Davidyuk
- Openlab "Gene and Cell Technologies", Institute of Fundamental Medicine and Biology Kazan Federal University, Kazan 420008, Republic of Tatarstan, Russian
| | - Emmanuel Kabwe
- Openlab "Gene and Cell Technologies", Institute of Fundamental Medicine and Biology Kazan Federal University, Kazan 420008, Republic of Tatarstan, Russian
| | - Anton Shamsutdinov
- Openlab "Gene and Cell Technologies", Institute of Fundamental Medicine and Biology Kazan Federal University, Kazan 420008, Republic of Tatarstan, Russian
| | - Ekaterina Garanina
- Openlab "Gene and Cell Technologies", Institute of Fundamental Medicine and Biology Kazan Federal University, Kazan 420008, Republic of Tatarstan, Russian
| | - Venera Shakirova
- Department of Infectious Diseases, Kazan State Medical Academy, Kazan 420012, the Republic of Tatarstan, Russian
| | - Ilsiyar Khaertynova
- Department of Infectious Diseases, Kazan State Medical Academy, Kazan 420012, the Republic of Tatarstan, Russian
| | - Vladimir Anokhin
- Department of Pediatric Infectious Diseases, Kazan State Medical University, Kazan 420012, Republic of Tatarstan, Russian
| | - Rachael Tarlinton
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough LE12 5RD, UK
| | - Albert Rizvanov
- Openlab "Gene and Cell Technologies", Institute of Fundamental Medicine and Biology Kazan Federal University, Kazan 420008, Republic of Tatarstan, Russian
| | - Svetlana Khaiboullina
- Openlab "Gene and Cell Technologies", Institute of Fundamental Medicine and Biology Kazan Federal University, Kazan 420008, Republic of Tatarstan, Russian
- Department of Microbiology and Immunology, University of Nevada, Reno, NV 89557, USA
| | - Sergey Morzunov
- Department of Pathology, University of Nevada, Reno, NV 89557, USA.
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17
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Wu M, Luan YY, Lu JF, Li H, Zhan HC, Chen YH, Zhang F, Tian YY, Yang ZL, Yao YM, Feng YW. Platelet count as a new biomarker for acute kidney injury induced by hemorrhagic shock. Platelets 2019; 31:94-102. [PMID: 30810451 DOI: 10.1080/09537104.2019.1581921] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of this study was to investigate the association between nadir platelet count and acute kidney injury (AKI) or 28-day all-cause mortality induced by hemorrhagic shock (HS), and to determine the cutoff value of nadir platelet count in HS clinical practice. This retrospective study included hospitalized patients enrolled in a tertiary-care teaching hospital from January 1, 2010 to December 31, 2015. Clinical data from HS admitted to the intensive care unit (ICU) were evaluated. Nadir platelet count was defined as the lowest values in the first 48 h. Multivariate logistic regression and Cox proportional hazards regression were used to assess the correlation between nadir platelet count and AKI or 28-day all-cause mortality induced by HS, respectively; the area under receiver operating characteristic (AU-ROC) and Youde's index were used to determine the optimal cutoff value of nadir platelet count. Kaplan-Meier's method and log-rank test were assessed for the 28-day all-cause mortality in AKI and non-AKI groups. Of 1589 patients screened, 84 patients (mean age,37.1 years; 58 males) were included in the primary analysis in which 30 patients with AKI. Multiple logistic results indicated that nadir platelet count was a risk factor of AKI (OR = 0.71,95% confidence interval [CI] 0.54-0.93, P < 0.05). Cox regression analysis revealed that nadir platelet count was independent risk factors for 28-day all-cause mortality (Hazard ratios [HR]0.89,95%CI 0.76-0.99, P < 0.05). Kaplan-Meier curve showed that 28-day all-cause mortality was significantly higher in patients with AKI than non-AKI (P < 0.001).These results suggest that nadir platelet count in the first 48 h is a new biomarker for AKI and 28-day all-cause mortality induced by HS. Moreover, the risk for AKI and 28-day all-cause mortality in HS patients decreased by 29% and 11%, respectively, for every 10 × 109/L increase in platelet count. Additional studies are needed to investigate whether elevation of nadir platelet count reduces the risk in different genders.
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Affiliation(s)
- Ming Wu
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China.,Graduate School, Guangdong Medical University, Zhanjiang, China
| | - Ying-Yi Luan
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China.,Trauma Research Center, First Hospital Affiliated to the Chinese PLA General Hospital, Beijing, China
| | - Jun-Fu Lu
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China.,Department of Critical Care Medicine, Central People's Hospital of Zhanjiang, Zhanjiang, China
| | - Haoli Li
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China
| | - Hai-Chao Zhan
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China
| | - Yan-Hong Chen
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China
| | - Fan Zhang
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China
| | - Yu-Yu Tian
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China
| | - Zi-Long Yang
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China.,Graduate School, Guangdong Medical University, Zhanjiang, China
| | - Yong-Ming Yao
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China.,Trauma Research Center, First Hospital Affiliated to the Chinese PLA General Hospital, Beijing, China
| | - Yong-Wen Feng
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China
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18
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Parente Filho SLA, Lima LMB, Dantas GLDA, Silva DDA, Rolim VDM, Oliveira Filho AMPD, Melo ITVE, Silva Junior GBD, Daher EDF. Prognostic factors among critically ill patients with community-acquired acute bacterial meningitis and acute kidney injury. Rev Bras Ter Intensiva 2018; 30:153-159. [PMID: 29995079 PMCID: PMC6031427 DOI: 10.5935/0103-507x.20180030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 01/10/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate prognostic factors among critically ill patients with community-acquired bacterial meningitis and acute kidney injury. METHODS A retrospective study including patients admitted to a tertiary infectious disease hospital in Fortaleza, Brazil diagnosed with community-acquired bacterial meningitis complicated with acute kidney injury. Factors associated with death, mechanical ventilation and use of vasopressors were investigated. RESULTS Forty-one patients were included, with a mean age of 41.6 ± 15.5 years; 56% were males. Mean time between intensive care unit admission and acute kidney injury diagnosis was 5.8 ± 10.6 days. Overall mortality was 53.7%. According to KDIGO criteria, 10 patients were classified as stage 1 (24.4%), 18 as stage 2 (43.9%) and 13 as stage 3 (31.7%). KDIGO 3 significantly increased mortality (OR = 6.67; 95%CI = 1.23 - 36.23; p = 0.028). Thrombocytopenia was not associated with higher mortality, but it was a risk factor for KDIGO 3 (OR = 5.67; 95%CI = 1.25 - 25.61; p = 0.024) and for mechanical ventilation (OR = 6.25; 95%CI = 1.33 - 29.37; p = 0.02). Patients who needed mechanical ventilation by 48 hours from acute kidney injury diagnosis had higher urea (44.6 versus 74mg/dL, p = 0.039) and sodium (138.6 versus 144.1mEq/L; p = 0.036). CONCLUSION Mortality among critically ill patients with community-acquired bacterial meningitis and acute kidney injury is high. Acute kidney injury severity was associated with even higher mortality. Thrombocytopenia was associated with severer acute kidney injury. Higher urea was an earlier predictor of severer acute kidney injury than was creatinine.
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Affiliation(s)
- Sérgio Luiz Arruda Parente Filho
- Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Clínica, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brasil
| | - Livia Maria Barbosa Lima
- Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Clínica, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brasil
| | - Gilberto Loiola de Alencar Dantas
- Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Clínica, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brasil
| | - Débora de Almeida Silva
- Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Clínica, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brasil
| | - Victor de Matos Rolim
- Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Clínica, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brasil
| | - Antônio Mendes Ponte de Oliveira Filho
- Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Clínica, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brasil
| | - Iamê Tavares Vale E Melo
- Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Clínica, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brasil
| | - Geraldo Bezerra da Silva Junior
- Programa de Pós-Graduação em Saúde Pública, Centro de Ciências da Saúde, Faculdade de Medicina, Universidade de Fortaleza - Fortaleza (CE), Brasil
| | - Elizabeth De Francesco Daher
- Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Clínica, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brasil
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19
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Hentzien M, Mestrallet S, Halin P, Pannet LA, Lebrun D, Dramé M, Bani-Sadr F, Galempoix JM, Strady C, Reynes JM, Penalba C, Servettaz A. Bioclinical Test to Predict Nephropathia Epidemica Severity at Hospital Admission. Emerg Infect Dis 2018; 24:1045-1054. [PMID: 29774835 PMCID: PMC6004848 DOI: 10.3201/eid2406.172160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We conducted a multicenter, retrospective cohort study of hospitalized patients with serologically proven nephropathia epidemica (NE) living in Ardennes Department, France, during 2000-2014 to develop a bioclinical test predictive of severe disease. Among 205 patients, 45 (22.0%) had severe NE. We found the following factors predictive of severe NE: nephrotoxic drug exposure (p = 0.005, point value 10); visual disorders (p = 0.02, point value 8); microscopic or macroscopic hematuria (p = 0.04, point value 7); leukocyte count >10 × 109 cells/L (p = 0.01, point value 9); and thrombocytopenia <90 × 109/L (p = 0.003, point value 11). When point values for each factor were summed, we found a score of <10 identified low-risk patients (3.3% had severe disease), and a score >20 identified high-risk patients (45.3% had severe disease). If validated in future studies, this test could be used to stratify patients by severity in research studies and in clinical practice.
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20
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Krishnan H, Rayes J, Miyashita T, Ishii G, Retzbach EP, Sheehan SA, Takemoto A, Chang Y, Yoneda K, Asai J, Jensen L, Chalise L, Natsume A, Goldberg GS. Podoplanin: An emerging cancer biomarker and therapeutic target. Cancer Sci 2018; 109:1292-1299. [PMID: 29575529 PMCID: PMC5980289 DOI: 10.1111/cas.13580] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/02/2018] [Accepted: 03/10/2018] [Indexed: 01/13/2023] Open
Abstract
Podoplanin (PDPN) is a transmembrane receptor glycoprotein that is upregulated on transformed cells, cancer associated fibroblasts and inflammatory macrophages that contribute to cancer progression. In particular, PDPN increases tumor cell clonal capacity, epithelial mesenchymal transition, migration, invasion, metastasis and inflammation. Antibodies, CAR-T cells, biologics and synthetic compounds that target PDPN can inhibit cancer progression and septic inflammation in preclinical models. This review describes recent advances in how PDPN may be used as a biomarker and therapeutic target for many types of cancer, including glioma, squamous cell carcinoma, mesothelioma and melanoma.
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Affiliation(s)
- Harini Krishnan
- Department of Physiology and BiophysicsStony Brook UniversityStony BrookNYUSA
| | - Julie Rayes
- Institute of Cardiovascular ScienceCollege of Medical and Dental SciencesUniversity of BirminghamEdgbastonBirminghamUK
| | - Tomoyuki Miyashita
- Division of PathologyExploratory Oncology Research and Clinical Trial CenterNational Cancer CenterKashiwaChibaJapan
- Laboratory of Cancer BiologyDepartment of Integrated BiosciencesGraduate School of Frontier SciencesThe University of TokyoKashiwaChibaJapan
| | - Genichiro Ishii
- Division of PathologyExploratory Oncology Research and Clinical Trial CenterNational Cancer CenterKashiwaChibaJapan
- Laboratory of Cancer BiologyDepartment of Integrated BiosciencesGraduate School of Frontier SciencesThe University of TokyoKashiwaChibaJapan
| | - Edward P. Retzbach
- Graduate School of Biomedical Sciences and Department of Molecular BiologyRowan University School of Osteopathic MedicineStratfordNJUSA
| | - Stephanie A. Sheehan
- Graduate School of Biomedical Sciences and Department of Molecular BiologyRowan University School of Osteopathic MedicineStratfordNJUSA
| | - Ai Takemoto
- Division of Experimental ChemotherapyThe Cancer Chemotherapy CenterJapanese Foundation for Cancer ResearchTokyoJapan
| | - Yao‐Wen Chang
- Graduate Institute of Biomedical SciencesCollege of MedicineChang Gung UniversityTaoyuanTaiwanChina
| | - Kazue Yoneda
- Second Department of Surgery (Chest Surgery)University of Occupational and Environmental healthKitakyushuFukuokaJapan
| | - Jun Asai
- Department of DermatologyKyoto Prefectural University of Medicine Graduate School of Medical ScienceKyotoJapan
| | - Lasse Jensen
- Division of Cardiovascular MedicineDepartment of Medical and Health SciencesLinköping UniversityLinköpingSweden
| | - Lushun Chalise
- Department of NeurosurgeryNagoya University School of MedicineNagoyaJapan
| | - Atsushi Natsume
- Department of NeurosurgeryNagoya University School of MedicineNagoyaJapan
| | - Gary S. Goldberg
- Graduate School of Biomedical Sciences and Department of Molecular BiologyRowan University School of Osteopathic MedicineStratfordNJUSA
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21
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The podoplanin-CLEC-2 axis inhibits inflammation in sepsis. Nat Commun 2017; 8:2239. [PMID: 29269852 PMCID: PMC5740111 DOI: 10.1038/s41467-017-02402-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 11/28/2017] [Indexed: 12/26/2022] Open
Abstract
Platelets play a critical role in vascular inflammation through the podoplanin and collagen/fibrin receptors, C-type-lectin-like-2 (CLEC-2) and glycoprotein VI (GPVI), respectively. Both receptors regulate endothelial permeability and prevent peri-vascular bleeding in inflammation. Here we show that platelet-specific deletion of CLEC-2 but not GPVI leads to enhanced systemic inflammation and accelerated organ injury in two mouse models of sepsis-intra-peritoneal lipopolysaccharide and cecal ligation and puncture. CLEC-2 deficiency is associated with reduced numbers of podoplanin-expressing macrophages despite increased cytokine and chemokine levels in the infected peritoneum. Pharmacological inhibition of the interaction between CLEC-2 and podoplanin regulates immune cell infiltration and the inflammatory reaction during sepsis, suggesting that activation of podoplanin underlies the anti-inflammatory action of platelet CLEC-2. We suggest podoplanin-CLEC-2 as a novel anti-inflammatory axis regulating immune cell recruitment and activation in sepsis.
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22
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A scoring model for predicting prognosis of patients with severe fever with thrombocytopenia syndrome. PLoS Negl Trop Dis 2017; 11:e0005909. [PMID: 28934195 PMCID: PMC5626493 DOI: 10.1371/journal.pntd.0005909] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 10/03/2017] [Accepted: 08/27/2017] [Indexed: 12/04/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging epidemic infectious disease caused by the SFTS bunyavirus (SFTSV) with an estimated high case-fatality rate of 12.7% to 32.6%. Currently, the disease has been reported in mainland China, Japan, Korea, and the United States. At present, there is no specific antiviral therapy for SFTSV infection. Considering the higher mortality rate and rapid clinical progress of SFTS, supporting the appropriate treatment in time to SFTS patients is critical. Therefore, it is very important for clinicians to predict these SFTS cases who are more likely to have a poor prognosis or even more likely to decease. In the present study, we established a simple and feasible model for assessing the severity and predicting the prognosis of SFTS patients with high sensitivity and specificity. This model may aid the physicians to immediately initiate prompt treatment to block the rapid development of the illness and reduce the fatality of SFTS patients. Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a novel SFTS bunyavirus (SFTSV) with an estimated high case-fatality rate. However, there is no specific antiviral therapy for SFTSV infection. Symptomatic treatment and supportive therapy are the most essential part of case management. It is very important for clinicians to identify critical patients at admission. In this study, we established a simple and feasible scoring system for assessing the severity and predicting the prognosis of SFTS patients with objective parameters. This model may help the physicians to perform intervention measures in advance, control the disease progression and improve the prognosis.
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Rista E, Pilaca A, Akshija I, Rama A, Harja E, Puca E, Bino S, Cadri V, Kota M, Nestor T, Arjan H. Hemorrhagic fever with renal syndrome in Albania. Focus on predictors of acute kidney injury in HFRS. J Clin Virol 2017; 91:25-30. [PMID: 28411480 DOI: 10.1016/j.jcv.2017.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Hemorrhagic fever with renal syndrome (HFRS) is a rodent borne zoonosis, caused by the members of the family Bunyaviridae, genus Hantavirus. The main clinical features of the infection by this virus family are fever, thrombocytopenia and acute kidney injury. OBJECTIVE The aim of our study was to identify, for the first time, characteristic features of HFRS in the Albanian population. STUDY DESIGN The study comprised 33 consecutive patients admitted with suspected HFRS from April 2011-April 2016 at one center. Clinical diagnosis was confirmed by ELISA and real-time PCR. Statistical analysis was performed to identify prognostic markers and indicators of disease severity. RESULTS The virus strain causing HFRS was Dobrava type in all 33 cases. The disease outbreaks occurred during the period June-July. Mean hospital stay was 15.7±6.9days. 29 (88%) of the patients were male. The mean age was 39.7±14.1. 16 (48.5%) patients were from Northeast Albania. 8 (24.2%) patients required dialysis. The strongest correlation was the inverse relationship of nadir platelet count with urea and creatinine, p<0.0001, p<0.0079 respectively. Creatinine and hyponatremia were inversely correlated p=0.0007, whereas hyponatremia and nadir platelet count had the highest sensitivity and specificity for development of severe AKI, 92.6%, 100%; 88.9%, 83.3% respectively. Mortality rate was 9.09%. CONCLUSION HFRS is a severe viral disease in Albania caused by Dobrava strain. It is associated with high mortality, 9.09% in our cohort. In our study, thrombocytopenia, urinary volume, hyponatremia were indicators of more severe disease.
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Affiliation(s)
- Elvana Rista
- Department of Nephrology, Hygeia Hospital Tirana, Tirana, Albania.
| | - Arben Pilaca
- Department of Internal Medicine, Hygeia Hospital Tirana, Tirana, Albania
| | - Ilir Akshija
- Department of Statistics, University Hospital Center "Mother Theresa", Tirana, Albania
| | - Ariol Rama
- Department of Clinical Laboratory, Hygeia Hospital Tirana, Tirana, Albania
| | - Endri Harja
- Department of Internal Medicine, Hygeia Hospital Tirana, Tirana, Albania
| | - Edmond Puca
- Department of Infectious Diseases, University Hospital Center "Mother Theresa", Tirana, Albania
| | - Silvia Bino
- Department of Public Health, University Hospital "Mother Theresa", Tirana, Albania
| | - Vilma Cadri
- Department of Nephrology, University Hospital Center "Mother Theresa" Tirana, Albania
| | - Majlinda Kota
- Biologist/virologist National Virology Laboratory Infectious Disease Control Department Public Health Institute, Tirana, Albania
| | - Thereska Nestor
- Department of Nephrology, University Hospital Center "Mother Theresa" Tirana, Albania
| | - Harxhi Arjan
- Department of Infectious Diseases, University Hospital Center "Mother Theresa", Tirana, Albania
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Krautkrämer E, Nusshag C, Baumann A, Schäfer J, Hofmann J, Schnitzler P, Klempa B, Witkowski PT, Krüger DH, Zeier M. Clinical characterization of two severe cases of hemorrhagic fever with renal syndrome (HFRS) caused by hantaviruses Puumala and Dobrava-Belgrade genotype Sochi. BMC Infect Dis 2016; 16:675. [PMID: 27842513 PMCID: PMC5109704 DOI: 10.1186/s12879-016-2012-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/07/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hantavirus disease belongs to the emerging infections. The clinical picture and severity of infections differ between hantavirus species and may even vary between hantavirus genotypes. The mechanisms that lead to the broad variance of severity in infected patients are not completely understood. Host- and virus-specific factors are considered. CASE PRESENTATION We analyzed severe cases of hantavirus disease in two young women. The first case was caused by Puumala virus (PUUV) infection in Germany; the second case describes the infection with Dobrava-Belgrade virus (DOBV) in Russia. Symptoms, laboratory parameters and cytokine levels were analyzed and compared between the two patients. Serological and sequence analysis revealed that PUUV was the infecting agent for the German patient and the infection of the Russian patient was caused by Dobrava-Belgrade virus genotype Sochi (DOBV-Sochi). The symptoms in the initial phase of the diseases did not differ noticeably between both patients. However, deterioration of laboratory parameter values was prolonged and stronger in DOBV-Sochi than in PUUV infection. Circulating endothelial progenitor cells (cEPCs), known to be responsible for endothelial repair, were mobilized in both infections. Striking differences were observed in the temporal course and level of cytokine upregulation. Levels of angiopoietin-2 (Ang-2), vascular endothelial growth factor (VEGF), and stromal derived factor-1 (SDF-1α) were increased in both infections; but, sustained and more pronounced elevation was observed in DOBV-Sochi infection. CONCLUSIONS Severe hantavirus disease caused by different hantavirus species did not differ in the general symptoms and clinical characteristics. However, we observed a prolonged clinical course and a late and enhanced mobilization of cytokines in DOBV-Sochi infection. The differences in cytokine deregulation may contribute to the observed variation in the clinical course.
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Affiliation(s)
- Ellen Krautkrämer
- Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg, 69120, Germany.
| | - Christian Nusshag
- Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg, 69120, Germany
| | - Alexandra Baumann
- Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg, 69120, Germany
| | - Julia Schäfer
- Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg, 69120, Germany
| | - Jörg Hofmann
- Institute of Medical Virology, Charité Medical School, Berlin, Germany
| | - Paul Schnitzler
- Department of Virology, University of Heidelberg, Heidelberg, Germany
| | - Boris Klempa
- Institute of Medical Virology, Charité Medical School, Berlin, Germany.,Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Peter T Witkowski
- Institute of Medical Virology, Charité Medical School, Berlin, Germany
| | - Detlev H Krüger
- Institute of Medical Virology, Charité Medical School, Berlin, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg, 69120, Germany
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25
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Outinen TK, Laine OK, Mäkelä S, Pörsti I, Huhtala H, Vaheri A, Mustonen J. Thrombocytopenia associates with the severity of inflammation and variables reflecting capillary leakage in Puumala Hantavirus infection, an analysis of 546 Finnish patients. Infect Dis (Lond) 2016; 48:682-7. [PMID: 27299174 DOI: 10.1080/23744235.2016.1192719] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Hantaviruses cause hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS) in humans. Hantavirus infections are characterized by thrombocytopenia. Our objective was to assess the association of thrombocytopenia with disease severity in HFRS induced by Puumala hantavirus (PUUV). METHODS Altogether 546 patients treated for acute serologically confirmed PUUV infection during 1982-2013 at Tampere University Hospital, Finland, were examined. Blood platelet count was determined daily and analysed in relation to different variables reflecting disease severity. The patients were divided into two groups according to the minimum platelet count: severe thrombocytopenia (<69 × 10(9)/L, i.e. below median) and no severe thrombocytopenia (≥69 × 10(9)/L). RESULTS Thrombocytopenia (platelet count <150 × 10(9)/L) was detected in 90% of patients, and in 28% of patients platelet count was <50 × 10(9)/L. Patients with severe thrombocytopenia had longer stay (8 versus 7 days, p = 0.002) and greater weight gain (2.8 versus 2.0 kg, p < 0.001) at the hospital, higher blood leukocyte count (11.2 × 10(9)/L versus 9.6 × 10(9)/L, p < 0.001), plasma C-reactive protein (81 versus 59 mg/L, p < 0.001), maximum hematocrit (0.44 versus 0.42, p < 0.001), urinary protein excretion (1.7 versus 1.1 g/24 h, p = 0.002), and lower plasma albumin concentration (27 versus 32 g/L, p < 0.001) than patients without severe thrombocytopenia (comparisons between medians). Maximum creatinine concentration did not differ between patients with or without severe thrombocytopenia (median 235 versus 214 μmol/L, p = 0.217). CONCLUSIONS The severity of thrombocytopenia associates with the degree of inflammation and variables reflecting capillary leakage, but not with the severity of acute kidney injury in PUUV infected Finnish patients.
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Affiliation(s)
- Tuula K Outinen
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Outi K Laine
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland ;,b School of Medicine , University of Tampere , Tampere , Finland
| | - Satu Mäkelä
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland ;,b School of Medicine , University of Tampere , Tampere , Finland
| | - Ilkka Pörsti
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland ;,b School of Medicine , University of Tampere , Tampere , Finland
| | - Heini Huhtala
- c School of Health Sciences , University of Tampere , Tampere , Finland
| | - Antti Vaheri
- d Department of Virology, Medicum, Faculty of Medicine , University of Helsinki , Helsinki , Finland
| | - Jukka Mustonen
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland ;,b School of Medicine , University of Tampere , Tampere , Finland
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Sutherland SM, Chawla LS, Kane-Gill SL, Hsu RK, Kramer AA, Goldstein SL, Kellum JA, Ronco C, Bagshaw SM. Utilizing electronic health records to predict acute kidney injury risk and outcomes: workgroup statements from the 15(th) ADQI Consensus Conference. Can J Kidney Health Dis 2016; 3:11. [PMID: 26925247 PMCID: PMC4768420 DOI: 10.1186/s40697-016-0099-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/15/2015] [Indexed: 02/08/2023] Open
Abstract
The data contained within the electronic health record (EHR) is "big" from the standpoint of volume, velocity, and variety. These circumstances and the pervasive trend towards EHR adoption have sparked interest in applying big data predictive analytic techniques to EHR data. Acute kidney injury (AKI) is a condition well suited to prediction and risk forecasting; not only does the consensus definition for AKI allow temporal anchoring of events, but no treatments exist once AKI develops, underscoring the importance of early identification and prevention. The Acute Dialysis Quality Initiative (ADQI) convened a group of key opinion leaders and stakeholders to consider how best to approach AKI research and care in the "Big Data" era. This manuscript addresses the core elements of AKI risk prediction and outlines potential pathways and processes. We describe AKI prediction targets, feature selection, model development, and data display.
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Affiliation(s)
- Scott M Sutherland
- Division of Nephrology, Department of Pediatrics, Stanford University, 300 Pasteur Drive, Room G-306, Stanford, CA 94304 USA
| | - Lakhmir S Chawla
- Departments of Medicine and Critical Care, George Washington University Medical Center, Washington, DC USA
| | - Sandra L Kane-Gill
- Departments of Pharmacy, Critical Care Medicine and Clinical Translational Sciences, University of Pittsburgh, Pittsburgh, PA USA
| | - Raymond K Hsu
- Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, CA USA
| | - Andrew A Kramer
- Prescient Healthcare Consulting, LLC, Charlottesville, VA USA
| | - Stuart L Goldstein
- Division of Pediatric Nephrology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA
| | - John A Kellum
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Sean M Bagshaw
- Division of Critical Care, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Jiang H, Du H, Wang LM, Wang PZ, Bai XF. Hemorrhagic Fever with Renal Syndrome: Pathogenesis and Clinical Picture. Front Cell Infect Microbiol 2016; 6:1. [PMID: 26870699 PMCID: PMC4737898 DOI: 10.3389/fcimb.2016.00001] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/05/2016] [Indexed: 01/08/2023] Open
Abstract
Hantaan virus (HTNV) causes hemorrhagic fever with renal syndrome (HFRS), which is a zoonosis endemic in eastern Asia, especially in China. The reservoir host of HTNV is field mouse (Apodemus agraricus). The main manifestation of HFRS, including acute kidney injury, increases vascular permeability, and coagulation abnormalities. In this paper, we review the current knowledge of the pathogenesis of HFRS including virus factor, immunity factor and host genetic factors. Furthermore, the treatment and prevention will be discussed.
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Affiliation(s)
- Hong Jiang
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University Xi'an, China
| | - Hong Du
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University Xi'an, China
| | - Li M Wang
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University Xi'an, China
| | - Ping Z Wang
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University Xi'an, China
| | - Xue F Bai
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University Xi'an, China
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Abstract
BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a serious complication of visceral leishmaniasis (VL). The aim of this study is to describe demographical, clinical and laboratory features of HLH in children with VL. METHODS This is a retrospective cohort of children with HLH and VL admitted to a tertiary hospital in Northeast, Brazil, from January 2012 to April 2014. Clinical and laboratory data at admission and during hospital stay were reviewed. Acute kidney injury (AKI) was defined according to the pediatric Risk, Injury, Failure, Loss, End-stage kidney disease criteria. RESULTS A total 127 VL children were admitted, and 35 children had diagnosis of HLH. Mean age was 4.2 ± 4.3 years, with 62.9% males. Mean hospital stay was 29 ± 12 days. Main signs and symptoms were fever (100%), splenomegaly (94.2%) and hepatomegaly (60%). Laboratory findings showed pancytopenia, albumin 3.03 ± 0.77 g/dL, fibrinogen 236.1 ± 117.2 mg/dL, total calcium 8.2 ± 1.2 mEq/L, lactate dehydrogenase 1804 ± 1019 mg/dL, alkaline phosphatase 1275.4 ± 2160.5 IU/L, total bilirubin 1.9 ± 2.4 mg/dL, direct bilirubin 0.67 ± 1.02 mg/dL, indirect bilirubin 1.2 ± 2.2 mg/dL, aspartate aminotransferase 140.0 ± 145.3 IU/L, alanine aminotransferase 71.4 ± 81.1 IU/L, ferritin 4296.5 ± 8028.8 ng/dL and triglycerides 333 ± 141 mg/dL. AKI was observed in 16 children (45.7%), predominantly mild forms (93.75% "risk"). AKI group presented lower levels of platelets (69,131 ± 40,247 vs. 138,678 ± 127,494/mm, P = 0.035) than non-AKI. No patient required dialysis and there was no death. CONCLUSIONS HLH was not a rare complication of VL. Main symptoms were compatible with both VL and HLH. Main laboratory findings reflected HLH pathophysiology. Mild forms of AKI were a common complication of HLH. Despite the disease severity and complications, mortality was low.
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Skarphedinsson S, Thiesson HC, Shakar SA, Tepel M. Factors predicting kidney damage in Puumala virus infected patients in Southern Denmark. Eur J Clin Microbiol Infect Dis 2015. [PMID: 26205664 DOI: 10.1007/s10096-015-2446-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In Europe, infections with Puumala hantavirus cause nephropathia epidemica. Presently the risk factors predicting severe kidney damage after Puumala virus infection are not well known. The objective of the study was to investigate environmental and individual factors predicting severe kidney damage caused by serologically established Puumala infections. In a nationwide cohort study we investigated all serologically established Puumala infections in Southern Denmark from 1996 to 2012. A total of 184 patients had serologically verified Puumala virus infection. In patients with Puumala virus infections the decrease of platelet counts preceded acute kidney failure. Multivariable logistic regression demonstrated that recent activities in the forest, platelet counts, and flu-like symptoms predicted estimated glomerular filtration rates less than 30 mL/min/1.73 m(²), but not age, gender, fever, nor abdominal pain. Severe kidney damage in Puumala infections in Southern Denmark is associated with the risk of recent activities in the forest.
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Affiliation(s)
- S Skarphedinsson
- Clinical Center of Emerging and Vectorborne Infections, Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - H C Thiesson
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - S A Shakar
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - M Tepel
- Department of Nephrology, Odense University Hospital, Odense, Denmark. .,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark. .,Institute for Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense University Hospital and University of Southern Denmark, Winsløwparken 21.3, 5000, Odense C, Denmark.
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30
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Outinen TK, Mäkelä S, Clement J, Paakkala A, Pörsti I, Mustonen J. Community Acquired Severe Acute Kidney Injury Caused by Hantavirus-Induced Hemorrhagic Fever with Renal Syndrome Has a Favorable Outcome. Nephron Clin Pract 2015; 130:182-90. [PMID: 26139246 DOI: 10.1159/000433563] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Puumala hantavirus (PUUV) induces an acute tubulointerstitial nephritis and acute kidney injury (AKI). Our aim was to evaluate the prognosis of severe AKI associated with PUUV infection. METHODS We examined 556 patients who were treated at Tampere University Hospital during 1982-2013 for acute, serologically confirmed PUUV infection. Plasma creatinine was measured during hospitalization, convalescence, and 1, 2, and 5 years after the acute infection. RESULTS Plasma creatinine concentration was elevated (>100 μmol/l) in 459 (83%) patients, while altogether 189 patients (34%) had severe AKI defined as Kidney Disease: Improving Global Outcomes (KDIGO) stage 3, that is, plasma creatinine ≥353.6 μmol/l (4.0 mg/dl) or need of dialysis. There were no fatal cases during the hospitalization or the following 3 months. Fatality rate during the years following PUUV infection did not differ between patients who had suffered from severe AKI versus those without severe AKI. Post-hospitalization plasma creatinine values were available for 188 (34%) patients. One month after the acute infection, patients with prior severe AKI had higher median plasma creatinine concentration (82 µmol/l, range 54-184) than patients without severe AKI (74 µmol/l, range 55-109, p = 0.005). After 1 year, no significant difference existed in median plasma creatinine concentrations between patients with (71 µmol/l, range 36-123) and without prior severe AKI (72 µmol/l, range 34-116, p = 0.711). After 5 years all but 1 patient had normal creatinine levels. CONCLUSIONS In contrast to the worldwide well-accepted KDIGO criteria, severe AKI associated with PUUV infection is not associated with excess fatality but has a very good prognosis, both in the short and long terms.
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Affiliation(s)
- Tuula K Outinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Wang M, Wang J, Kang Z, Zhao Q, Wang X, Hui L. Kinetics and Immunodominance of Virus-Specific T Cell Responses During Hantaan Virus Infection. Viral Immunol 2015; 28:265-71. [PMID: 25945718 DOI: 10.1089/vim.2014.0135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Immunodominant T cell responses are important for protection against virus challenge. However, studies screening for the immunodominant T cell responses and following their kinetics in acute Hantaan virus (HTNV) infection are very limited. Herein, the HTNV nucleocapsid protein-specific T cell responses were longitudinally screened in 15 patients with acute HTNV infection, eight of whom had a particularly severe hemorrhagic fever with renal syndrome (HFRS). An extremely impaired IFN-γ-producing T cell response was observed in patients with severe HFRS at the early stage of infection, especially to the immunodominant epitopes detected in the mild to moderate group, namely peptides N127-141, N139-153, N241-255, and N355-369. The initially insufficient T cell response to the immunodominant epitopes may play a role in influencing the severity of HTNV infection. These findings provide information that may aid the design of future vaccines against hantaviruses.
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Affiliation(s)
- Meiliang Wang
- 1Center for Experimental Medicine, Lanzhou General Hospital, Lanzhou Military Command, Lanzhou, China
| | - Jiuping Wang
- 2Department of Infectious Diseases, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Zhenhua Kang
- 3Department of Colorectal and Anal Surgery, The First Hospital of Jilin University, Changchun, China
| | - Qiuling Zhao
- 4Department of Nutriment, Lanzhou General Hospital, Lanzhou Military Command, Lanzhou, China
| | - Xiaohui Wang
- 1Center for Experimental Medicine, Lanzhou General Hospital, Lanzhou Military Command, Lanzhou, China.,5Gansu Key Laboratory of Stem Cell and Gene Therapy, Lanzhou, China
| | - Ling Hui
- 1Center for Experimental Medicine, Lanzhou General Hospital, Lanzhou Military Command, Lanzhou, China.,5Gansu Key Laboratory of Stem Cell and Gene Therapy, Lanzhou, China
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Abstract
While the interactions between Gram-positive bacteria and platelets have been well characterized, there is a paucity of data on the interaction between other pathogens and platelets. However, thrombocytopenia is a common feature with many infections especially viral hemorrhagic fever. The little available data on these interactions indicate a similarity with bacteria-platelet interactions with receptors such as FcγRIIa and Toll-Like Receptors (TLR) playing key roles with many pathogens. This review summarizes the known interactions between platelets and pathogens such as viruses, fungi and parasites.
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Affiliation(s)
- Ana Lopez Alonso
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland , Dublin , Ireland
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Ma Y, Yuan B, Zhuang R, Zhang Y, Liu B, Zhang C, Zhang Y, Yu H, Yi J, Yang A, Jin B. Hantaan virus infection induces both Th1 and ThGranzyme B+ cell immune responses that associated with viral control and clinical outcome in humans. PLoS Pathog 2015; 11:e1004788. [PMID: 25836633 PMCID: PMC4383613 DOI: 10.1371/journal.ppat.1004788] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 03/05/2015] [Indexed: 01/22/2023] Open
Abstract
Hantaviruses infection causing severe emerging diseases with high mortality rates in humans has become public health concern globally. The potential roles of CD4(+)T cells in viral control have been extensively studied. However, the contribution of CD4(+)T cells to the host response against Hantaan virus (HTNV) infection remains unclear. Here, based on the T-cell epitopes mapped on HTNV glycoprotein, we studied the effects and characteristics of CD4(+)T-cell responses in determining the outcome of hemorrhagic fever with renal syndrome. A total of 79 novel 15-mer T-cell epitopes on the HTNV glycoprotein were identified, among which 20 peptides were dominant target epitopes. Importantly, we showed the presence of both effective Th1 responses with polyfunctional cytokine secretion and ThGranzyme B(+) cell responses with cytotoxic mediators production against HTNV infection. The HTNV glycoprotein-specific CD4(+)T-cell responses inversely correlated with the plasma HTNV RNA load in patients. Individuals with milder disease outcomes showed broader epitopes targeted and stronger CD4(+)T-cell responses against HTNV glycoproteins compared with more severe patients. The CD4(+)T cells characterized by broader antigenic repertoire, stronger polyfunctional responses, better expansion capacity and highly differentiated effector memory phenotype(CD27-CD28-CCR7-CD45RA-CD127(hi)) would elicit greater defense against HTNV infection and lead to much milder outcome of the disease. The host defense mediated by CD4(+)T cells may through the inducing antiviral condition of the host cells and cytotoxic effect of ThGranzyme B+ cells. Thus, these findings highlight the efforts of CD4(+)T-cell immunity to HTNV control and provide crucial information to better understand the immune defense against HTNV infection.
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Affiliation(s)
- Ying Ma
- Department of Immunology, the Fourth Military Medical University, Xi’an, China
- * E-mail:
| | - Bin Yuan
- Institute of Orthopaedics of Xijing Hospital, the Fourth Military Medical University, Xi’an, China
| | - Ran Zhuang
- Department of Immunology, the Fourth Military Medical University, Xi’an, China
| | - Yusi Zhang
- Department of Immunology, the Fourth Military Medical University, Xi’an, China
| | - Bei Liu
- Department of Immunology, the Fourth Military Medical University, Xi’an, China
| | - Chunmei Zhang
- Department of Immunology, the Fourth Military Medical University, Xi’an, China
| | - Yun Zhang
- Department of Immunology, the Fourth Military Medical University, Xi’an, China
| | - Haitao Yu
- Department of Infectious Diseases of Tangdu Hospital, the Fourth Military Medical University, Xi’an, China
| | - Jing Yi
- Department of Immunology, the Fourth Military Medical University, Xi’an, China
| | - Angang Yang
- Department of Immunology, the Fourth Military Medical University, Xi’an, China
| | - Boquan Jin
- Department of Immunology, the Fourth Military Medical University, Xi’an, China
- * E-mail:
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Plasma pentraxin-3 and coagulation and fibrinolysis variables during acute Puumala hantavirus infection and associated thrombocytopenia. Blood Coagul Fibrinolysis 2015; 25:612-7. [PMID: 24751477 DOI: 10.1097/mbc.0000000000000117] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thrombocytopenia and altered coagulation characterize all hantavirus infections. To further assess the newly discovered predictive biomarkers of disease severity during acute Puumala virus (PUUV) infection, we studied the associations between them and the variables reflecting coagulation, fibrinolysis and endothelial activation. Nineteen hospital-treated patients with serologically confirmed acute PUUV infection were included. Acutely, plasma levels of pentraxin-3 (PTX3), cell-free DNA (cf-DNA), complement components SC5b-9 and C3 and interleukin-6 (IL-6) were recorded as well as platelet ligands and markers of coagulation and fibrinolysis. High values of plasma PTX3 associated with thrombin formation (prothrombin fragments F1+2; r = 0.46, P = 0.05), consumption of platelet ligand fibrinogen (r = -0.70, P < 0.001) and natural anticoagulants antithrombin (AT) (r = -0.74, P < 0.001), protein C (r = -0.77, P < 0.001) and protein S free antigen (r = -0.81, P < 0.001) and a decreased endothelial marker ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 domain 13) (r = -0.48, P = 0.04). Plasma level of AT associated with C3 (r = 0.76, P < 0.001), IL-6 (r = -0.56, P = 0.01) and cf-DNA (r = -0.47, P = 0.04). High cf-DNA coincided with increased prothrombin fragments F1+2 (r = 0.47, P = 0.04). Low C3 levels reflecting the activation of complement system through the alternative route predicted loss of all natural anticoagulants (for protein C r = 0.53, P = 0.03 and for protein S free antigen r = 0.64, P = 0.004). Variables depicting altered coagulation follow the new predictive biomarkers of disease severity, especially PTX3, in acute PUUV infection. The findings are consistent with the previous observations of these biomarkers also being predictive for low platelet count and underline the cross-talk of inflammation and coagulation systems in acute PUUV infection.
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Zhang Y, Ma Y, Zhang C, Zhang Y, Zhuang R, Liu B, Yi J, Jin B. Soluble Scavenger Receptor CD163 Is Associated with Severe Acute Kidney Injury in Patients with Hantaan Virus Infection. Viral Immunol 2015; 28:241-6. [PMID: 25789628 DOI: 10.1089/vim.2014.0112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
CD163, a hemoglobin scavenger receptor for haptoglobin-hemoglobin complexes, is expressed by monocytes/macrophages and is often shed as soluble CD163 (sCD163) in response to inflammatory stimuli. This scavenger receptor is reported to dampen the inflammatory response, and high plasma levels of sCD163, which are thought to reflect the total level of CD163 expression, may predict the severity of disease. To understand the role of sCD163 in the pathogenesis of hemorrhagic fever with renal syndrome (HFRS) better, the concentrations of sCD163 in plasma from 66 patients were quantified, and the relationships between sCD163 level and disease course, severity, and clinical parameters were analyzed. The level of plasma sCD163 in HFRS patients was elevated from fever onset and during the course of the disease, and it peaked in the oliguria stage at 874.5 (549.9-1138.0) ng/mL compared with controls at 192.8 (54.9-282.1) ng/mL. The correlations between plasma sCD163 and renal dysfunction suggest that sCD163 may play an important role in the development of acute renal failure in patients infected with Hantaan virus.
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Affiliation(s)
- Yusi Zhang
- Department of Immunology, The Fourth Military Medical University , Xi'an, China
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Fan H, Zhao Y, Song FC. Acute pancreatitis associated with hemorrhagic fever with renal syndrome: clinical analysis of 12 cases. Ren Fail 2013; 35:1330-3. [PMID: 23964665 DOI: 10.3109/0886022x.2013.828187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Acute pancreatitis is one of the rare complications of hemorrhagic fever with renal syndrome (HFRS), which easy to be misdiagnosed as acute abdomen, usually critically ill, poor treatment effect, highly mortality. In this study, we retrospectively analyzed to explore the clinical characteristics, 12 cases of hemorrhagic fever with renal syndrome complicated with acute pancreatitis treatment methods and prognosis. METHODS We conducted a retrospective study of HFRS in patients complicated with acute pancreatitis. 12 cases were collected from Ningbo first hospital between January 2001 and December 2012. Clinical information and laboratory parameters were obtained by reviewing literature and records. RESULTS Twelve from 156 cases (7.69%) HFRS complicated with acute pancreatitis. Men comprised more than half (75%) of the sample population, the mean age was (38 ± 19) years. Abdominal pain was the main clinical manifestations in all the patients, all of their serum amylase and serum lipase were increased, 10 patients were given the total abdomen CT examination, eight cases showed enlargement of the pancreas and surrounding leakage, two cases showed pancreatic necrosis and hemorrhage. Three cases complicated with pulmonary edema. In 12 cases, four of them received hemodialysis treatment, one gives surgical intervention. Eight cases were complete remission, three cases were partial remission and one case was death. CONCLUSIONS Acute pancreatitis is one of rare of the serious complications of HFRS, whereas the correct diagnosis and clear the cause of disease is critical for improve the quality of life of patients and reduce the mortality, timely hemodialysis treatment is effective, early intervention can improve the prognosis.
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Affiliation(s)
- Heng Fan
- Department of Intensive Care Unit, Ningbo First Hospital , Ningbo , China
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