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Ledina D, Ivić I, Tadin A, Bodulić K, LeDuc JW, Markotić A. A Comprehensive Analysis of Renal and Endothelium Dysfunction Markers Fourteen Years after Hemorrhagic Fever with Renal Syndrome Contraction. Life (Basel) 2024; 14:575. [PMID: 38792596 PMCID: PMC11122023 DOI: 10.3390/life14050575] [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: 04/04/2024] [Revised: 04/21/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
While the pathology of acute hemorrhagic fever with renal syndrome (HFRS) has been widely researched, details on the chronic HFRS sequelae remain mainly unexplored. In this study, we analyzed the clinical and laboratory characteristics of 30 convalescent HFRS patients 14 years after the disease contraction, mainly emphasizing several endothelial dysfunction parameters. Convalescent HFRS patients exhibited significantly higher serum levels of erythrocyte sedimentation rate, von Willebrand factor, uric acid, C-reactive protein and immunoglobulin A when compared to healthy individuals. Furthermore, 24 h urine analyses revealed significantly lower sodium and potassium urine levels, as well as significantly higher proteinuria, microalbumin levels and β2-microglobulin levels when compared to healthy individuals. First morning urine analysis revealed significantly higher levels of hematuria in convalescent HFRS patients. None of the additional analyzed endothelium dysfunction markers were significantly different in post-HFRS patients and healthy individuals, including serum and urine P-selectin, E-selectin, soluble intercellular adhesion molecule 1, vascular intercellular adhesion molecule 1 (sVCAM-1) and vascular endothelial growth factor (VEGF). However, binary logistic regression revealed a weak association of serum sVCAM-1 and urine VEGF levels with HFRS contraction. Generally, our findings suggest mild chronic inflammation and renal dysfunction levels in convalescent HFRS patients 14 years after the disease contraction.
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Affiliation(s)
- Dragan Ledina
- Department of Infectious Diseases, Split University Hospital, 21000 Split, Croatia; (D.L.); (I.I.)
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Ivo Ivić
- Department of Infectious Diseases, Split University Hospital, 21000 Split, Croatia; (D.L.); (I.I.)
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Ante Tadin
- Research Department, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia; (A.T.); (K.B.)
| | - Kristian Bodulić
- Research Department, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia; (A.T.); (K.B.)
| | - James W. LeDuc
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77550, USA;
| | - Alemka Markotić
- Research Department, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia; (A.T.); (K.B.)
- School of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
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Cvetko Krajinović L, Bodulić K, Laškaj R, Žibrat B, Svoboda Karić P, Kurolt IC, Kordun M, Topić A, Čivljak R, Skuhala T, Markotić A. Hemorrhagic Fever with Renal Syndrome Patients Exhibit Increased Levels of Lipocalin-2, Endothelin-1 and NT-proBNP. Life (Basel) 2023; 13:2189. [PMID: 38004329 PMCID: PMC10672301 DOI: 10.3390/life13112189] [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: 10/26/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Hemorrhagic fever with renal syndrome (HFRS) is an acute zoonotic disease caused by viruses of the Orthohantavirus genus. This syndrome is characterized by renal and cardiopulmonary implications detectable with different biomarkers. Here, we explored the role of serum and urine levels of lipocalin-2, endothelin-1 and N-terminal pro-brain natriuretic peptide (NT-proBNP) in HFRS pathology. A total of twenty-eight patients hospitalized due to a Puumala orthohantavirus infection were included, with serum and urine samples collected on patient admission (acute phase) and discharge (convalescent phase). In comparison to healthy individuals, patients exhibited significantly higher acute-phase serum and urine levels of lipocalin-2, serum levels of endothelin-1 and serum and urine levels of NT-proBNP. Patients in the convalescent phase showed a significant decrease in urine lipocalin-2, serum endothelin-1 and serum and urine NT-proBNP levels. We recorded a strong correlation between serum levels of lipocalin-2 and endothelin-1 and urine levels of lipocalin-2 with several kidney injury markers, such as serum creatinine, urea, urine white blood cell count and proteinuria. We also demonstrated an independent correlation of serum and urine lipocalin-2 levels with acute kidney injury in HFRS. All in all, our results show an involvement of NT-proBNP, lipocalin-2 and endothelin-1 in the renal and cardiac pathology of HFRS.
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Affiliation(s)
| | - Kristian Bodulić
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Renata Laškaj
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Branka Žibrat
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Petra Svoboda Karić
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Ivan-Christian Kurolt
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Mihaela Kordun
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Antea Topić
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Rok Čivljak
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10 000 Zagreb, Croatia
| | - Tomislava Skuhala
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10 000 Zagreb, Croatia
| | - Alemka Markotić
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
- Faculty of Medicine, University of Rijeka, 51 000 Rijeka, Croatia
- Faculty of Medicine, Catholic University of Croatia, 10 000 Zagreb, Croatia
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Martynova E, Stott-Marshall RJ, Shakirova V, Saubanova A, Bulatova A, Davidyuk YN, Kabwe E, Markelova M, Khaertynova I, Foster TL, Khaiboullina S. Differential Cytokine Responses and the Clinical Severity of Adult and Pediatric Nephropathia Epidemica. Int J Mol Sci 2023; 24:ijms24087016. [PMID: 37108178 PMCID: PMC10139191 DOI: 10.3390/ijms24087016] [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: 12/28/2022] [Revised: 03/01/2023] [Accepted: 03/17/2023] [Indexed: 04/29/2023] Open
Abstract
Nephropathia epidemica (NE), caused by the hantavirus infection, is endemic in Tatarstan Russia. The majority of patients are adults, with infection rarely diagnosed in children. This limited number of pediatric NE cases means there is an inadequate understanding of disease pathogenesis in this age category. Here, we have analyzed clinical and laboratory data in adults and children with NE to establish whether and how the disease severity differs between the two age groups. Serum cytokines were analyzed in samples collected from 11 children and 129 adult NE patients during an outbreak in 2019. A kidney toxicity panel was also used to analyze urine samples from these patients. Additionally, serum and urine samples were analyzed from 11 control children and 26 control adults. Analysis of clinical and laboratory data revealed that NE was milder in children than in adults. A variation in serum cytokine activation could explain the differences in clinical presentation. Cytokines associated with activation of Th1 lymphocytes were prominent in adults, while they were obscured in sera from pediatric NE patients. In addition, a prolonged activation of kidney injury markers was found in adults with NE, whilst only a short-lasting activation of these markers was observed in children with NE. These findings support previous observations of age differences in NE severity, which should be considered when diagnosing the disease in children.
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Affiliation(s)
- Ekaterina Martynova
- "Gene and Cell Technologies" Institute of Fundamental Medicine and Biology, Kazan Federal University, OpenLab, 420008 Kazan, Russia
| | - Robert J Stott-Marshall
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK
| | | | | | | | - Yuriy N Davidyuk
- "Gene and Cell Technologies" Institute of Fundamental Medicine and Biology, Kazan Federal University, OpenLab, 420008 Kazan, Russia
| | - Emmanuel Kabwe
- "Gene and Cell Technologies" Institute of Fundamental Medicine and Biology, Kazan Federal University, OpenLab, 420008 Kazan, Russia
| | - Maria Markelova
- "Gene and Cell Technologies" Institute of Fundamental Medicine and Biology, Kazan Federal University, OpenLab, 420008 Kazan, Russia
| | | | - Toshana L Foster
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK
| | - Svetlana Khaiboullina
- "Gene and Cell Technologies" Institute of Fundamental Medicine and Biology, Kazan Federal University, OpenLab, 420008 Kazan, Russia
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Mocanu A, Cajvan AM, Lazaruc TI, Lupu VV, Florescu L, Lupu A, Bogos RA, Ioniuc I, Scurtu G, Dragan F, Starcea IM. Hantavirus Infection in Children-A Pilot Study of Single Regional Center. Viruses 2023; 15:v15040872. [PMID: 37112856 PMCID: PMC10143646 DOI: 10.3390/v15040872] [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: 02/13/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Hantaviruses are infectious etiological agents of a group of rodent-borne hemorrhagic fevers, with two types of clinical manifestations in humans: hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS). According to available statistics, the disease occurs mainly in adults, but the lower incidence in the pediatric population might also be related to a lack of diagnosis possibilities or even unsatisfactory knowledge about the disease. MATERIALS AND METHODS The purpose of this study was to evaluate the cases of hemorrhagic fever with renal syndrome diagnosed and treated in the Department of Nephrology at St. Mary's Emergency Hospital for Children in Iasi, Romania, representative of the North-East of Romania. We also reviewed the specialized literature on the topic. RESULTS Between January 2017 and January 2022, eight cases of HFRS, all men, and seven from rural areas, aged 11-18 years old, were referred to our clinic because of an acute kidney injury (AKI). Seven cases were identified as Dobrava serotype while one case was determined by Haantan serotype. CONCLUSIONS HFRS should always be considered as a differential diagnosis when faced with a patient with AKI and thrombocytopenia. Dobrava serotype is the most common hantavirus subtype in the Balkans. For the specific prevention of human infections, mainly in high-risk groups, vaccines are needed. As far as we know, this is the first study on HFRS in Romanian children.
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Affiliation(s)
- Adriana Mocanu
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
- Nephrology Division, St. Mary's Emergency Hospital for Children, 700309 Iasi, Romania
| | - Ana-Maria Cajvan
- Nephrology Division, St. Mary's Emergency Hospital for Children, 700309 Iasi, Romania
| | - Tudor Ilie Lazaruc
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
- Nephrology Division, St. Mary's Emergency Hospital for Children, 700309 Iasi, Romania
| | - Vasile Valeriu Lupu
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Laura Florescu
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ancuta Lupu
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Roxana Alexandra Bogos
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
- Nephrology Division, St. Mary's Emergency Hospital for Children, 700309 Iasi, Romania
| | - Ileana Ioniuc
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Georgiana Scurtu
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Felicia Dragan
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Iuliana Magdalena Starcea
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
- Nephrology Division, St. Mary's Emergency Hospital for Children, 700309 Iasi, Romania
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Vaheri A, Smura T, Vauhkonen H, Hepojoki J, Sironen T, Strandin T, Tietäväinen J, Outinen T, Mäkelä S, Pörsti I, Mustonen J. Puumala Hantavirus Infections Show Extensive Variation in Clinical Outcome. Viruses 2023; 15:v15030805. [PMID: 36992513 PMCID: PMC10054505 DOI: 10.3390/v15030805] [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: 02/27/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
The clinical outcome of Puumala hantavirus (PUUV) infection shows extensive variation, ranging from inapparent subclinical infection (70-80%) to severe hemorrhagic fever with renal syndrome (HFRS), with about 0.1% of cases being fatal. Most hospitalized patients experience acute kidney injury (AKI), histologically known as acute hemorrhagic tubulointerstitial nephritis. Why this variation? There is no evidence that there would be more virulent and less virulent variants infecting humans, although this has not been extensively studied. Individuals with the human leukocyte antigen (HLA) alleles B*08 and DRB1*0301 are likely to have a severe form of the PUUV infection, and those with B*27 are likely to have a benign clinical course. Other genetic factors, related to the tumor necrosis factor (TNF) gene and the C4A component of the complement system, may be involved. Various autoimmune phenomena and Epstein-Barr virus infection are associated with PUUV infection, but hantavirus-neutralizing antibodies are not associated with lower disease severity in PUUV HFRS. Wide individual differences occur in ocular and central nervous system (CNS) manifestations and in the long-term consequences of nephropathia epidemica (NE). Numerous biomarkers have been detected, and some are clinically used to assess and predict the severity of PUUV infection. A new addition is the plasma glucose concentration associated with the severity of both capillary leakage, thrombocytopenia, inflammation, and AKI in PUUV infection. Our question, "Why this variation?" remains largely unanswered.
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Affiliation(s)
- Antti Vaheri
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Teemu Smura
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Hanna Vauhkonen
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Jussi Hepojoki
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Tarja Sironen
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Tomas Strandin
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Johanna Tietäväinen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Tuula Outinen
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
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Prevalence of orthohantavirus in rodents: A systematic review and meta-analysis. Travel Med Infect Dis 2023; 51:102504. [PMID: 36402291 DOI: 10.1016/j.tmaid.2022.102504] [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: 10/06/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Orthohantaviruses are zoonotic diseases transmitted mainly by rodents, particularly mice and rats, associated with multiple outbreaks in different continents. Despite its epidemiological relevance, there is a lack of systematic reviews and meta-analyses. OBJECTIVE To determine the combined global prevalence of Orthohantavirus infection in rodents. METHODS A systematic literature review was carried out in six databases (Web of Sciences, Scopus, PubMed, SciELO, Lilacs, Google Scholar) to evaluate the proportion of rodents infected with Orthohantavirus, defined by molecular and immunological techniques. The meta-analysis used a random effects model for the pooled prevalence and 95% confidence intervals (95%CI). Heterogeneity measures, Cochrane's Q, the I2 index and the tau-squared test were estimated. RESULTS A total of 35,706 rodents (229 studies) were evaluated for ELISA, in which 3360 were found positive, for seroprevalence of 4.9% (95%CI 4.3-5.4%) (τ2 = 0.001; Q = 4027.708; I2 = 94.339%, p < 0.001). For PCR (N = 8812, 91 studies) it was 3.2% (95%CI 2.5-3.9%) (τ2 = 0.001; Q = 397.483; I2 = 77.358%; p < 0.001). For IFA (N = 555, 7 studies) it was 18.8% (95%CI 9.4-28.2%) (τ2 = 0.011; Q = 51.239; I2 = 88.29%, p < 0.001). At the genus level, the studies evaluated Oligoryzomys (8.98%), Reithrodontomys (8.98%), Peromyscus (8.20%), Rattus (8.20%), and Akodon (6.64%). CONCLUSIONS The global prevalence of Orthohantavirus is worrisome, with an increase in its report in certain regions, including Latin America. In this context, rodents have a role as reservoirs. The data of the present meta-analysis showed considerable seroprevalences with great variations by years, countries and Orthohantavirus species.
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Li R, Sun J, Chen Y, Fan X, Wang X, Zhang X, Zhang K, Han Q, Liu Z. Clinical and laboratory features and factors predicting disease severity in pediatric patients with hemorrhagic fever with renal syndrome caused by Hantaan virus. J Med Virol 2023; 95:e28339. [PMID: 36418181 DOI: 10.1002/jmv.28339] [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: 08/31/2022] [Revised: 11/04/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
The clinical features and factors associated with disease severity in children with hemorrhagic fever with renal syndrome (HFRS) have not been well characterized. This study analyzed the clinical and laboratory factors associated with disease severity in children with HFRS caused by Hantaan virus. Data in pediatric patients with HFRS were retrospectively collected from Xi'an Children's Hospital over a 9-year period. Independent factors associated with disease severity were identified. Nomogram predicting disease severity was constructed based on variables filtered by feature selection. In total, 206 children with HFRS were studied. Fever, digestive tract symptoms, headache, backache, bleeding, and renal injury signs were the common symptoms. Elevated white blood cell, reduced platelet, hematuria, proteinuria, coagulation abnormalities, increased blood urea nitrogen (BUN) and procalcitonin (PCT), decreased estimated glomerular filtration rate and low serum Na+ , Cl- , and Ca2+ were the common laboratory findings. In the 206 patients, 21 patients had critical type disease and 4 patients (1.9%) died. Hydrothorax, hypotension and cerebral edema/cerebral herniation at hospital admission were independent clinical characteristics, and neutrophil %, prothrombin activity, PCT, BUN, and Ca2+ at hospital admission were independent laboratory factors associated with critical disease. Feature selection identified BUN, PCT and prothrombin time as independent factors related to critical disease. A nomogram integrating BUN and PCT at admission was constructed and calibration showed high accuracy for the probability prediction of critical disease. In conclusion, this study characterized the clinical and laboratory features and constructed a nomogram predicting disease severity in pediatric HFRS, providing references for disease severity evaluation in managing children HFRS.
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Affiliation(s)
- Ruina Li
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, Shaanxi, China
| | - Jingkang Sun
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yuting Chen
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiude Fan
- 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
| | - Kun Zhang
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qunying Han
- 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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Abdominal CT findings in Puumala hantavirus-infected patients. Abdom Radiol (NY) 2022; 47:2552-2559. [PMID: 35441863 DOI: 10.1007/s00261-022-03467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Previous clinical studies have reported abdominal findings on ultrasonography or MRI in Puumala hantavirus-infected patients. PURPOSE To determine if abdominal computed tomography (CT) can lead to a diagnosis of Puumala virus infection in the presence of a suggestive clinical picture. MATERIAL AND METHODS CT findings were studied retrospectively in 30 patients who presented to the emergency department of two (Belgian) hospitals with serologically confirmed Puumala hantavirus infection. RESULTS The most frequent finding was perirenal fascial thickening (90%), followed by perirenal fat stranding (87%). Retroperitoneal fat stranding was found in 19 patients (64%) in the perivesical spaces along the fascia of the external iliac vessels with or without involvement of the presacral fat. Half of the patients had pelvic ascites, and pleural fluid was found in 7 of them. The right and left mean pole-to-pole kidney's lengths were respectively 125.7 mm and 127.8 mm in 28 patients. CONCLUSION Retroperitoneal fat stranding, perirenal fascial thickening and/or perirenal fat stranding were found in most patients with acute Puumala virus infection who have undergone CT. Although nonspecific, these findings may help to suggest Puumala hantavirus infection in the right clinical settings.
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Kuitunen I, Renko M. Changes in the Epidemiology of Zoonotic Infections in Children: A Nationwide Register Study in Finland. Pediatr Infect Dis J 2022; 41:e113-e119. [PMID: 34966137 PMCID: PMC8920006 DOI: 10.1097/inf.0000000000003440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Zoonotic infections are difficult to recognize in children. The age distributions and seasonal occurrences of these infections vary substantially, even among those transmitted by the same vectors, and their epidemiology may change over time. The aim was to report the incidences and trends of Borrelia burgdorferi, Puumala virus, Francisella tularensis and tick-borne encephalitis (TBE) virus infections in the pediatric population (age 0-19) of Finland. METHODS A nationwide survey based on the National Infectious Disease Register was conducted from 1996 to 2019 and all laboratory-confirmed cases were included. Age-stratified incidences per 100,000 person-years were calculated. RESULTS Cumulative incidences were B. burgdorferi 11.2, TBE 0.4, Puumala virus 6.4 and F. tularensis 2.5 per 100,000 person-years. An increasing trend in the incidences of B. burgdorferi and TBE was observed. Borrelia expanded geographically northward and inland. Tularemia follows a 2-4-year epidemic cycle and rates are similar across age groups. Puumala incidences are highest in the older children. DISCUSSION Borrelia infections increased most rapidly in children 5-9 years of age and overall expanded geographically in Finland. Tularemia epidemic cycles were shorter than those previously reported. These results will help clinicians to identify these infections in different geographic areas and age groups in Finland.
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Affiliation(s)
- Ilari Kuitunen
- From the Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli
| | - Marjo Renko
- From the Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
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Vaheri A, Henttonen H, Mustonen J. Hantavirus Research in Finland: Highlights and Perspectives. Viruses 2021; 13:v13081452. [PMID: 34452318 PMCID: PMC8402838 DOI: 10.3390/v13081452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 01/24/2023] Open
Abstract
Finland has the highest incidence of hantavirus infections globally, with a significant impact on public health. The large coverage of boreal forests and the cyclic dynamics of the dominant forest rodent species, the bank vole Myodes glareolus, explain most of this. We review the relationships between Puumala hantavirus (PUUV), its host rodent, and the hantavirus disease, nephropathia epidemica (NE), in Finland. We describe the history of NE and its diagnostic research in Finland, the seasonal and multiannual cyclic dynamics of PUUV in bank voles impacting human epidemiology, and we compare our northern epidemiological patterns with those in temperate Europe. The long survival of PUUV outside the host and the life-long shedding of PUUV by the bank voles are highlighted. In humans, the infection has unique features in pathobiology but rarely long-term consequences. NE is affected by specific host genetics and risk behavior (smoking), and certain biomarkers can predict the outcome. Unlike many other hantaviruses, PUUV causes a relatively mild disease and is rarely fatal. Reinfections do not exist. Antiviral therapy is complicated by the fact that when symptoms appear, the patient already has a generalized infection. Blocking vascular leakage measures counteracting pathobiology, offer a real therapeutic approach.
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Affiliation(s)
- Antti Vaheri
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
- Correspondence: ; Tel.: +358-505552884
| | - Heikki Henttonen
- Wildlife Ecology, Natural Resources Institute Finland, 00790 Helsinki, Finland;
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
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Lozynskyi I, Shulgan A, Zarichna O, Ben I, Kessler W, Cao X, Nesterova O, Glass GE, Spruill-Harrell B, Taylor MK, Williams EP, Jonsson CB. Seroprevalence of Old World Hantaviruses and Crimean Congo Hemorrhagic Fever Viruses in Human Populations in Northwestern Ukraine. Front Cell Infect Microbiol 2020; 10:589464. [PMID: 33194835 PMCID: PMC7642871 DOI: 10.3389/fcimb.2020.589464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022] Open
Abstract
In Ukraine, a retrospective review of clinical case reports by public health officials suggest that human cases of febrile illnesses associated with hemorrhage may be due to infections of Crimean-Congo hemorrhagic fever virus (CCHFV) and Old World hantaviruses. In a serosurvey of 966 healthy individuals in the Lviv Oblast, Ukraine, bordering Poland, we found that 1.6% showed cross-reactivity to hantaviral antigens by an immunofluorescence assay (IFA) and 1.7% of the study participants had antibodies cross-reactive to CCHFV by enzyme-linked immunosorbent assay (ELISA). Demographic variables and history of exposures obtained through questionnaires were assessed by logistic regression models for association with seroprevalence for both viruses with no significant risk factors found. Analysis of spatial distribution identified two clusters of samples positive for antibodies to both hantaviruses and CCHFV, which, however, were not statistically significant (p > 0.05). In general, the study results suggest that the population of the study area is exposed to hantaviruses and CCHFV. Further surveillance for respective pathogens in Ukraine is warranted and prospective surveillance of febrile patients with unidentified febrile illness.
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Affiliation(s)
- Ihor Lozynskyi
- Research Institute of Epidemiology and Hygiene of Danylo Halytskyi, Lviv National Medical University, Lviv, Ukraine
| | - Anna Shulgan
- Research Institute of Epidemiology and Hygiene of Danylo Halytskyi, Lviv National Medical University, Lviv, Ukraine
| | - Olha Zarichna
- Research Institute of Epidemiology and Hygiene of Danylo Halytskyi, Lviv National Medical University, Lviv, Ukraine
| | - Iryna Ben
- Research Institute of Epidemiology and Hygiene of Danylo Halytskyi, Lviv National Medical University, Lviv, Ukraine
| | - William Kessler
- Department of Geography, University of Florida, Gainesville, FL, United States
| | - Xueyuan Cao
- College of Nursing, The University of Tennessee Health Science Center, Memphis, TN, United States
| | | | - Gregory E Glass
- Department of Geography, University of Florida, Gainesville, FL, United States
| | - Briana Spruill-Harrell
- Department of Microbiology, Immunology and Biochemistry, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Mariah K Taylor
- Department of Microbiology, Immunology and Biochemistry, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Evan P Williams
- Department of Microbiology, Immunology and Biochemistry, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Colleen B Jonsson
- Department of Microbiology, Immunology and Biochemistry, The University of Tennessee Health Science Center, Memphis, TN, United States
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Abstract
Puumala virus (PUUV) is the most common hantavirus in Europe. It is known to cause nephropathia epidemica, which is considered a mild type of hemorrhagic fever with renal syndrome. However, it does not only involve the kidneys and is rarely accompanied by symptomatic hemorrhage. We review the imaging abnormalities caused by PUUV infection, from head to pelvis, emphasizing the broad spectrum of possible findings and bringing further support to a previously suggested denomination "Hantavirus disease" that would encompass all clinical manifestations. Although non-specific, knowledge of radiological appearances is useful to support clinically suspected PUUV infection, before confirmation by serology.
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Affiliation(s)
- Olivier Lebecque
- Department of Radiology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Michaël Dupont
- Department of Radiology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
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13
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Clinical course of hantavirus-induced nephropathia epidemica in children compared to adults in Germany-analysis of 317 patients. Pediatr Nephrol 2019; 34:1247-1252. [PMID: 30874941 DOI: 10.1007/s00467-019-04215-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/13/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hantavirus infections are endemic worldwide, and its incidence in Europe has been steadily increasing. In Western Europe, hantavirus infections are typically caused by Puumala hantavirus and cause nephropathia epidemica (NE), a mild form of haemorrhagic fever with renal syndrome. Up to now, there is only little data about the course of acute NE in children, but it has been suggested that hantavirus infections take a lighter course in children when compared to adults. We performed a retrospective analysis of adults and children diagnosed with acute NE in two counties in South-Western Germany to investigate if there are differences in the course of the disease. METHODS We reviewed the medical records of 295 adults and 22 children with acute NE regarding clinical presentation, laboratory findings, complications and outcome. RESULTS Acute kidney injury (AKI) and thrombocytopenia occurred at similar frequencies and severity in both groups. Sudden onset of fever and back/loin pain were two of the three most common symptoms in both adults and children. However, adults presented more frequently with arthralgia and visual disturbances, whereas abdominal pain and nausea/vomiting could be detected more often in children. No significant differences were found in the incidence of complications (haemodialysis, long-term outcome of kidney function, length of hospital stay). CONCLUSIONS The clinical course of acute NE was similar in adults and children with high frequency of AKI as well as thrombocytopenia, but with full recovery of all patients.
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Dzagurova TK, Tkachenko EA, Ishmukhametov AA, Balovneva MV, Klempa B, Kruger DH. Severe hantavirus disease in children. J Clin Virol 2018; 101:66-68. [PMID: 29428460 DOI: 10.1016/j.jcv.2018.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/23/2018] [Accepted: 01/28/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Very recently, a novel European hantavirus, Sochi virus, has been discovered which causes severe courses of hantavirus disease with a case fatality rate of about 15 percent. OBJECTIVES We aimed to study to which extent and with which clinical severity children were affected by Sochi virus infection. STUDY DESIGN Sochi virus infection of patients was confirmed by molecular, serological, and epizoonotic studies. Clinical and laboratory parameters were analyzed for the age group of up to 15 years (n = 6) in comparison to all older patients (n = 56). RESULTS 9.7 percent of patients with hantavirus disease studied (6/62) were up to 15 years old. The children showed moderate to severe clinical courses similarly to the situation in adults. CONCLUSIONS While children are in general considered to be less affected by hantavirus infections than adults, in case of highly pathogenic hantaviruses, such as Sochi virus, frequency of clinical cases as well as their clinical course are comparable between children and adults. Therefore, hantavirus disease, particularly in regions endemic to highly pathogenic hantaviruses, should be considered in cases of unclear fever and kidney/pulmonary failure in children.
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Affiliation(s)
- Tamara K Dzagurova
- Chumakov Federal Scientific Center for Research and Development of Immune-and Biological Products of Russian Academy of Sciences, Moscow, Russia
| | - Evgeniy A Tkachenko
- Chumakov Federal Scientific Center for Research and Development of Immune-and Biological Products of Russian Academy of Sciences, Moscow, Russia; 1th Moscow State Medical University "I. M. Sechenov", Moscow, Russia
| | - Aydar A Ishmukhametov
- Chumakov Federal Scientific Center for Research and Development of Immune-and Biological Products of Russian Academy of Sciences, Moscow, Russia; 1th Moscow State Medical University "I. M. Sechenov", Moscow, Russia
| | - Mariya V Balovneva
- Chumakov Federal Scientific Center for Research and Development of Immune-and Biological Products of Russian Academy of Sciences, Moscow, Russia
| | - Boris Klempa
- Institute of Medical Virology, Helmut-Ruska-Haus, Charité School of Medicine, Berlin, Germany; Biomedical Research Center, Institute of Virology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Detlev H Kruger
- Institute of Medical Virology, Helmut-Ruska-Haus, Charité School of Medicine, Berlin, Germany.
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15
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Mustonen J, Outinen T, Laine O, Pörsti I, Vaheri A, Mäkelä S. Kidney disease in Puumala hantavirus infection. Infect Dis (Lond) 2017; 49:321-332. [PMID: 28049381 DOI: 10.1080/23744235.2016.1274421] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Acute kidney injury (AKI) remains a predominant clinical expression of nephropathia epidemica (NE). Its pathogenesis is not yet fully understood. Here, we describe the tissue injury comprehensively and present new data aimed to characterize the injury and explain its pathophysiology. When compared to tubulointerstitial nephritis of a wide variety of other aetiologies, a high degree of proteinuria is a distinguished trait of NE, a finding that is also helpful in the clinical suspicion of the disease. Recently, novel biomarkers for the prediction of severe AKI, including neutrophil gelatinase-associated lipocalin (NGAL), have been identified and ultrastructural tissue changes have been more accurately described. A role for soluble urokinase-type plasminogen activator (suPAR) in the pathogenesis of NE has been suggested, and data on gene polymorphisms, in relation to the severity of AKI have been presented. Smoking is a risk factor for NE and smoking is also associated with aggravated AKI in NE. Although no specific treatment is in sight, recent case reports concerning therapy directed against vascular permeability and vasodilation are of interest. In fact, future work trying to explain the pathophysiology of AKI might need concentrated efforts towards the mechanisms of increased vascular permeability and vasodilatation, which irrespective of organ manifestation, are two major determinants of NE.
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Affiliation(s)
- Jukka Mustonen
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Tuula Outinen
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Outi Laine
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Ilkka Pörsti
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Antti Vaheri
- c Department of Virology, Medicum , University of Helsinki , Helsinki , Finland
| | - Satu Mäkelä
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
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16
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Warvsten A, Björnfors M, Arvidsson M, Vaziri-Sani F, Jönsson I, Olsson GE, Ahlm C, Larsson HE, Lernmark Å, Nilsson AL. Islet autoantibodies present in association with Ljungan virus infection in bank voles (Myodes glareolus) in northern Sweden. J Med Virol 2016; 89:24-31. [PMID: 27283793 DOI: 10.1002/jmv.24597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 01/27/2023]
Abstract
Bank voles are known reservoirs for Puumala hantavirus and probably also for Ljungan virus (LV), a suggested candidate parechovirus in type 1 diabetes etiology and pathogenesis. The aim of this study was to determine whether wild bank voles had been exposed to LV and if exposure associated to autoantibodies against insulin (IAA), glutamic acid decarboxylase 65 (GADA), or islet autoantigen-2 (IA-2A). Serum samples from bank voles (Myodes glareolus) captured in early summer or early winter of 1997 and 1998, respectively, were analyzed in radio binding assays for antibodies against Ljungan virus (LVA) and Puumala virus (PUUVA) as well as for IAA, GADA, and IA-2A. LVA was found in 25% (189/752), IAA in 2.5% (18/723), GADA in 2.6% (15/615), and IA-2A in 2.5% (11/461) of available bank vole samples. LVA correlated with both IAA (P = 0.007) and GADA (P < 0.001), but not with IA-2A (P = 0.999). There were no correlations with PUUVA, detected in 17% of the bank voles. Compared to LVA negative bank voles, LVA positive animals had higher levels of both IAA (P = 0.002) and GADA (P < 0.001), but not of IA-2A (P = 0.205). Levels of LVA as well as IAA and GADA were higher in samples from bank voles captured in early summer. In conclusion, LVA was detected in bank voles and correlated with both IAA and GADA but not with IA-2A. These observations suggest that exposure to LV may be associated with islet autoimmunity. It remains to be determined if islet autoantibody positive bank voles may develop diabetes in the wild. J. Med. Virol. 89:24-31, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Anna Warvsten
- Department of Clinical Sciences, Skåne University Hospital SUS, Lund University/CRC, Malmö, Sweden
| | - Martin Björnfors
- Department of Clinical Sciences, Skåne University Hospital SUS, Lund University/CRC, Malmö, Sweden
| | - Michael Arvidsson
- Department of Clinical Sciences, Skåne University Hospital SUS, Lund University/CRC, Malmö, Sweden
| | - Fariba Vaziri-Sani
- Department of Clinical Sciences, Skåne University Hospital SUS, Lund University/CRC, Malmö, Sweden
| | - Ida Jönsson
- Department of Clinical Sciences, Skåne University Hospital SUS, Lund University/CRC, Malmö, Sweden
| | - Gert E Olsson
- Swedish University of Agricultural Sciences, Umeå, Sweden
| | - Clas Ahlm
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
| | - Helena Elding Larsson
- Department of Clinical Sciences, Skåne University Hospital SUS, Lund University/CRC, Malmö, Sweden
| | - Åke Lernmark
- Department of Clinical Sciences, Skåne University Hospital SUS, Lund University/CRC, Malmö, Sweden
| | - Anna-Lena Nilsson
- Department of Clinical Sciences, Skåne University Hospital SUS, Lund University/CRC, Malmö, Sweden. .,Department of Paediatrics, Östersund Hospital, Östersund, Sweden.
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17
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Bellomo CM, Pires-Marczeski FC, Padula PJ. Viral load of patients with hantavirus pulmonary syndrome in Argentina. J Med Virol 2015; 87:1823-30. [PMID: 26087934 DOI: 10.1002/jmv.24260] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 12/29/2022]
Abstract
Hantavirus causes severe illness including pneumonia, which leads to hospitalization and often death. At present, there is no specific treatment available. The hantavirus pathogenesis is not well understood, but most likely both virus-mediated and host-mediated mechanisms, are involved. The aim of this study was to correlate viral load in samples of hantavirus pulmonary syndrome cases and hantavirus infected individuals, with clinical epidemiological parameters and disease outcome. The variables that could potentially be related with viral load were analyzed. The retrospective study included 73 cases or household contacts, with different clinical evolution. Viral load was measured by reverse-transcription and real time polymerase chain reaction. There was no statistically significant association between blood viral RNA levels and severity of disease. However, viral load was inversely correlated with IgG response in a statistically significant manner. The level of viral RNA was significantly higher in patients infected with Andes virus South lineage, and was markedly low in persons infected with Laguna Negra virus. These results suggest that the infecting viral genotype is associated with disease severity, and that high viral load is associated with a low specific IgG response. Sex, age and disease severity were not related with viral load. Further investigations increasing strikingly the number of cases and also limiting the variables to be studied are necessary.
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Affiliation(s)
- Carla María Bellomo
- Departamento Virología, Servicio Biología Molecular, Instituto Nacional de Enfermedades Infecciosas INEI, Administración Nacional de Laboratorios e Institutos de Salud "Dr. C. G. Malbrán", Buenos Aires, Argentina.,Instituto Nacional de Enfermedades Infecciosas (INEI), Administración Nacional de Laboratorios e Institutos de Salud "Dr. C. G. Malbrán", Buenos Aires, Argentina
| | - Fanny Clara Pires-Marczeski
- Departamento Virología, Servicio Biología Molecular, Instituto Nacional de Enfermedades Infecciosas INEI, Administración Nacional de Laboratorios e Institutos de Salud "Dr. C. G. Malbrán", Buenos Aires, Argentina.,Instituto Nacional de Enfermedades Infecciosas (INEI), Administración Nacional de Laboratorios e Institutos de Salud "Dr. C. G. Malbrán", Buenos Aires, Argentina
| | - Paula Julieta Padula
- Departamento Virología, Servicio Biología Molecular, Instituto Nacional de Enfermedades Infecciosas INEI, Administración Nacional de Laboratorios e Institutos de Salud "Dr. C. G. Malbrán", Buenos Aires, Argentina.,Instituto Nacional de Enfermedades Infecciosas (INEI), Administración Nacional de Laboratorios e Institutos de Salud "Dr. C. G. Malbrán", Buenos Aires, Argentina
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18
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Latus J, Kitterer D, Dippon J, Müller S, Artunc F, Segerer S, Alscher MD, Braun N. Polyuria in Hantavirus Infection Reflects Disease Severity and Is Associated with Prolonged Hospital Stay: A Systematic Analysis of 335 Patients from Southern Germany. NEPHRON. EXPERIMENTAL NEPHROLOGY 2014; 128:000368934. [PMID: 25531933 DOI: 10.1159/000368934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/08/2014] [Indexed: 02/28/2024]
Abstract
Background/Aims: Puumala virus (PUUV) infection leads to nephropathia epidemica (NE), especially in endemic areas in Central Europe. The clinical course of NE is characterized by acute kidney injury (AKI) with thrombocytopenia followed by polyuria to a different degree. The prevalence of polyuria and its associated risk factors have not been reported in a large cohort of NE patients. Methods: Clinical and laboratory data during the acute phase of the disease were obtained from the medical reports and files of 335 patients who received in-hospital treatment during acute hantavirus infection. Comprehensive statistical models were developed to estimate the probability of polyuria. Results: The median age at diagnosis was 47 years (interquartile range, IQR 40-59) and 48% of the patients developed polyuria with a urinary output of 5,100 ml/day (IQR 4,200-7,300). The hospital stay was significantly longer in the polyuric group compared to the nonpolyuric group [8 days (IQR 6-10) vs. 6 days (IQR 5-8); p = 0.04]. Using logistic regression analysis, male gender (odds ratio, OR = 1.6; 95% confidence interval, CI 1.05-2.58; p = 0.03), oliguria/anuria during NE (OR = 2.56; 95% CI 1.65-4.01; p < 0.001), severe AKI (OR = 1.87; 95% CI 1.22-2.9; p < 0.001), and hematuria (OR = 1.78; 95% CI 1.02-3.15; p = 0.04) were significantly associated with the development of polyuria. In a multivariate model, the probability of polyuria was 0.19 (SEM ± 0.05) in female patients presenting with mild/moderate AKI without anuria/oliguria. Conclusions: Almost 50% of hospitalized NE patients developed polyuria, which was associated with a prolonged hospital stay. The probability of the development of polyuria was lowest in female patients with mild/moderate, non-oliguric/anuric AKI. © 2014 S. Karger AG, Basel.
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Affiliation(s)
- Joerg Latus
- Division of Nephrology, Department of Internal Medicine, Robert Bosch Hospital, Stuttgart, Germany
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19
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Laine O, Leppänen I, Koskela S, Antonen J, Mäkelä S, Sinisalo M, Vaheri A, Mustonen J. Severe Puumala virus infection in a patient with a lymphoproliferative disease treated with icatibant. Infect Dis (Lond) 2014; 47:107-11. [PMID: 25496418 DOI: 10.3109/00365548.2014.969304] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Early identification of patients at risk of a severe course of hantaviral disease and lack of effective medication represent a global challenge in the treatment of this emerging infection. We describe a 67-year-old female patient with a history of chronic lymphoproliferative disease involving the spleen and an extremely severe acute Puumala hantavirus infection. She was treated with the bradykinin receptor antagonist icatibant and recovered. She is the second patient with a spleen abnormality and severe Puumala infection treated with icatibant in our hospital. We suggest that patients with spleen abnormalities may be more susceptible to severe hantavirus disease. The activation of the kinin-kallikrein system and the formation of bradykinin in hantavirus-infected endothelial cells indicate that the role of bradykinin receptor antagonist icatibant in the treatment of hantavirus disease is worth studying.
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Affiliation(s)
- Outi Laine
- From the Department of Internal Medicine, Tampere University Hospital , Tampere , Finland
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20
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Eckerle I, Jakob E, Hofmann J, Schmidt-Bacher A, Ettinger J, Schnitzler P. Atypical severe Puumala hantavirus infection and virus sequence analysis of the patient and regional reservoir host. Zoonoses Public Health 2013; 59 Suppl 2:110-5. [PMID: 22958255 DOI: 10.1111/j.1863-2378.2011.01452.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Nephropathia epidemica (NE) caused by Puumala hantavirus (PUUV) is a mild variant of haemorrhagic fever with renal syndrome, which is endemic in Germany. We describe the case of a 67-year-old man initially presenting with acute bilateral angle-closure glaucoma, an atypical clinical presentation of PUUV infection. Subsequently, the patient developed a severe course of disease additionally complicated by profound hepatitis and interstitial nephritis, both phenomena which are rarely described in association with hantavirus infection. Serologic diagnosis was complicated by delayed antibody production until the 10th day of illness; however, PUUV RNA was detectable early in disease. To further analyse this unusual case, sequencing of the PUUV S segment was performed from the patient and regional reservoir host which showed a close relation.
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Affiliation(s)
- I Eckerle
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
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21
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Hofmann J, Führer A, Bolz M, Waldschläger-Terpe J, Meier M, Lüdders D, Enders M, Oltmann A, Meisel H, Krüger DH. Hantavirus infections by Puumala or Dobrava-Belgrade virus in pregnant women. J Clin Virol 2012; 55:266-9. [PMID: 22877560 DOI: 10.1016/j.jcv.2012.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 07/06/2012] [Accepted: 07/18/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Hantavirus infection in humans usually occurs via inhalation of infectious aerosolized excreta of rodents. Horizontal human-to-human transmission was reported only for the highly virulent Andes virus. The likelihood of vertical transmission and the clinical outcome of hantavirus infections in pregnancy is still unpredictable. OBJECTIVES Very few data were published about the impact of hantaviruses in pregnancy. Here we present four cases of pregnant women infected by European hantaviruses. The risk of vertical virus transmission was investigated. STUDY DESIGN Four pregnant women with clinical signs of acute hantavirus disease were investigated for hantavirus IgM and IgG after onset of clinical symptoms. Furthermore, the newborns were tested for presence of viral RNA and antibodies in cord blood and, if any parameter was found positive, 8-12 months after delivery. RESULTS Four women suffered from a hantavirus infection, two of them due to infection by Puumala virus and two by Dobrava-Belgrade virus. Three women delivered healthy babies by vaginal route and one woman by Caesarean section (week 28). In no case hantavirus RNA was detected in cord blood after delivery or in the 8-12 month old babies. Hantavirus IgG was detectable in the cord blood of 3 babies (but not in the preterm child); these antibodies disappeared after 8-12 months indicating a passive transfer of immunoglobulins. No child had any clinical sign of hantavirus infection. CONCLUSIONS In this study, the absence of vertical hantavirus transmission was demonstrated for pregnant women with onset of hantavirus disease between gestation weeks 14 and 28.
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Affiliation(s)
- Jörg Hofmann
- Institute of Medical Virology, Helmut-Ruska-Haus, Charité University Medicine, Berlin, Germany.
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Vaheri A, Henttonen H, Voutilainen L, Mustonen J, Sironen T, Vapalahti O. Hantavirus infections in Europe and their impact on public health. Rev Med Virol 2012; 23:35-49. [PMID: 22761056 DOI: 10.1002/rmv.1722] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/04/2012] [Accepted: 05/08/2012] [Indexed: 11/09/2022]
Abstract
Hantaviruses (genus Hantavirus, family Bunyaviridae) are enveloped tri-segmented negative-stranded RNA viruses each carried by a specific rodent or insectivore host species. Several different hantaviruses known to infect humans circulate in Europe. The most common is Puumala (PUUV) carried by the bank vole; another two important, genetically closely related ones are Dobrava-Belgrade (DOBV) and Saaremaa viruses (SAAV) carried by Apodemus mice (species names follow the International Committee on Taxonomy of Viruses nomenclature). Of the two hantaviral diseases, hemorrhagic fever with renal syndrome (HFRS) and hantaviral cardiopulmonary syndrome, the European viruses cause only HFRS: DOBV with often severe symptoms and a high case fatality rate, and PUUV and SAAV more often mild disease. More than 10,000 HFRS cases are diagnosed annually in Europe and in increasing numbers. Whether this is because of increasing recognition by the medical community or due to environmental factors such as climate change, or both, is not known. Nevertheless, in large areas of Europe, the population has a considerable seroprevalence but only relatively few HFRS cases are reported. Moreover, no epidemiological data are available from many countries. We know now that cardiac, pulmonary, ocular and hormonal disorders are, besides renal changes, common during the acute stage of PUUV and DOBV infection. About 5% of hospitalized PUUV and 16%-48% of DOBV patients require dialysis and some prolonged intensive-care treatment. Although PUUV-HFRS has a low case fatality rate, complications and long-term hormonal, renal, and cardiovascular consequences commonly occur. No vaccine or specific therapy is in general use in Europe. We conclude that hantaviruses have a significant impact on public health in Europe.
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Affiliation(s)
- Antti Vaheri
- Department of Virology, Haartman Institute, and Research Programs Unit, Infection Biology, University of Helsinki, Helsinki, Finland.
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Sundberg E, Hultdin J, Nilsson S, Ahlm C. Evidence of disseminated intravascular coagulation in a hemorrhagic fever with renal syndrome-scoring models and severe illness. PLoS One 2011; 6:e21134. [PMID: 21731657 PMCID: PMC3121717 DOI: 10.1371/journal.pone.0021134] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 05/20/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Viral hemorrhagic fevers (VHF) are considered to be a serious threat to public health worldwide with up to 100 million cases annually. The general hypothesis is that disseminated intravascular coagulation (DIC) is an important part of the pathogenesis. The study objectives were to study the variability of DIC in consecutive patients with acute hemorrhagic fever with renal syndrome (HFRS), and to evaluate if different established DIC-scores can be used as a prognostic marker for a more severe illness. METHOD AND FINDINGS In a prospective study 2006-2008, data from 106 patients with confirmed HFRS were analyzed and scored for the presence of DIC according to six different templates based on criteria from the International Society on Thrombosis and Haemostasis (ISTH). The DIC-scoring templates with a fibrinogen/CRP-ratio were most predictive, with predictions for moderate/severe illness (p<0.01) and bleeding of moderate/major importance (p<0.05). With these templates, 18.9-28.3% of the patients were diagnosed with DIC. CONCLUSIONS DIC was found in about one fourth of the patients and correlated with a more severe disease. This supports that DIC is an important part of the pathogenesis in HFRS. ISTH-scores including fibrinogen/CRP-ratio outperform models without. The high negative predictive value could be a valuable tool for the clinician. We also believe that our findings could be relevant for other VHFs.
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Affiliation(s)
- Erik Sundberg
- Department of Clinical Microbiology/Infectious Diseases, Umeå University, Umeå, Sweden.
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