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Ling J, Lundeberg EE, Wasberg A, Faria IR, Vucicevic S, Settergren B, Lundkvist Å. Nephropathia Epidemica Caused by Puumala Virus in Bank Voles, Scania, Southern Sweden. Emerg Infect Dis 2024; 30:732-737. [PMID: 38526134 PMCID: PMC10977816 DOI: 10.3201/eid3004.231414] [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] [Indexed: 03/26/2024] Open
Abstract
In 2018, a local case of nephropathia epidemica was reported in Scania, southern Sweden, more than 500 km south of the previously known presence of human hantavirus infections in Sweden. Another case emerged in the same area in 2020. To investigate the zoonotic origin of those cases, we trapped rodents in Ballingslöv, Norra Sandby, and Sörby in southern Sweden during 2020‒2021. We found Puumala virus (PUUV) in lung tissues from 9 of 74 Myodes glareolus bank voles by screening tissues using a hantavirus pan-large segment reverse transcription PCR. Genetic analysis revealed that the PUUV strains were distinct from those found in northern Sweden and Denmark and belonged to the Finnish PUUV lineage. Our findings suggest an introduction of PUUV from Finland or Karelia, causing the human PUUV infections in Scania. This discovery emphasizes the need to understand the evolution, cross-species transmission, and disease outcomes of this newly found PUUV variant.
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Zhou W, Dong Y, Si H, Yang C, Zhao J, Chen X, Ye Z. Visual analysis of global hemorrhagic fever with renal syndrome research from 1980 to 2022: Based on CiteSpace and VOSviewer. Medicine (Baltimore) 2024; 103:e37586. [PMID: 38552094 PMCID: PMC10977534 DOI: 10.1097/md.0000000000037586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/22/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE The development and current state of hemorrhagic fever with renal syndrome (HFRS) over the past 40 years are analyzed in this study, along with explored and discovered the hotspots and frontiers in the field, which serve as the foundation for future investigation. METHODS CiteSpace and VOSviewer analysis software were used to visually analyze the literature data on HFRS from 1980 to 2022, including the annual number of publications, countries and research institutions, authors, co-cited literature and keywords. RESULTS The number of pertinent papers published in the field of HFRS displayed an overall upward trend from 1980 to 2022. The United States, China, Germany, Sweden, and France are the top 5 countries in terms of publishing volume, with high intermediate centrality mainly concentrated in Europe and the United States. The top 10 co-occurring keywords were hemorrhagic fever, renal syndrome, infection, virus, epidemic, nephropathia epidemical, disease, hantavirus, outbreak, and transmission. According to keyword cluster analysis, there were 4 main research fields. In the HFRS-related study, there were mainly 21 notable keywords and "Korean hemorrhagic fever" had the highest hemorrhagic value (28.87). CONCLUSION The United States, China, Germany, Sweden and other countries attached great importance to the HFRS-related research. Moreover, the collaboration between authors and institutions in various collaborator clusters should be strengthened. In recent decades, investigations have focused on the study of viral infection and the clinical symptoms and pathophysiology of HFRS. Future research may concentrate on factors affecting host population distribution and density, such as vaccine development and meteorological factors pertaining to virus transmission.
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Affiliation(s)
- Wenfang Zhou
- Young Scientific Research and Innovation Team of Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Yonghai Dong
- Young Scientific Research and Innovation Team of Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Hongyu Si
- Young Scientific Research and Innovation Team of Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Cheng Yang
- Young Scientific Research and Innovation Team of Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Jun Zhao
- Young Scientific Research and Innovation Team of Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Xiaona Chen
- Young Scientific Research and Innovation Team of Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Zhenzhen Ye
- Young Scientific Research and Innovation Team of Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
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Plyusnin A, Kedari A, Rissanen I, Iheozor-Ejiofor RP, Lundkvist Å, Vapalahti O, Levanov L. Validation of an antigenic site targeted by monoclonal antibodies against Puumala virus. J Gen Virol 2023; 104. [PMID: 37801017 DOI: 10.1099/jgv.0.001901] [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] [Indexed: 10/07/2023] Open
Abstract
Identification of B-cell epitopes facilitates the development of vaccines, therapeutic antibodies and diagnostic tools. Previously, the binding site of the bank vole monoclonal antibody (mAb) 4G2 against Puumala virus (PUUV, an orthohantavirus in the Hantaviridae family of the Bunyavirales order) was predicted using a combination of methods, including pepscan, phage-display, and site-directed mutagenesis of vesicular stomatitis virus (VSV) particles pseudotyped with Gn and Gc glycoproteins from PUUV. These techniques led to the identification of the neutralization escape mutation F915A. To our surprise, a recent crystal structure of PUUV Gc in complex with Fab 4G2 revealed that residue F915 is distal from epitope of mAb 4G2. To clarify this issue and explore potential explanations for the inconsistency, we designed a mutagenesis experiment to probe the 4G2 epitope, with three PUUV pseudoviruses carrying amino acid changes E725A, S944F, and S946F, located within the structure-based 4G2 epitope on the Gc. These amino acid changes were able to convey neutralization escape from 4G2, and S944F and S946F also conveyed escape from neutralization by human mAb 1C9. Furthermore, our mapping of all the known neutralization evasion sites from hantaviral Gcs onto PUUV Gc revealed that over 60 % of these sites reside within or close to the epitope of mAb 4G2, indicating that this region may represent a crucial area targeted by neutralizing antibodies against PUUV, and to a lesser extent, other hantaviruses. The identification of this site of vulnerability could guide the creation of subunit vaccines against PUUV and other hantaviruses in the future.
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Affiliation(s)
- Alexander Plyusnin
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
| | - Ashwini Kedari
- Institute of Biotechnology, Helsinki Institute of Life Science HiLIFE, University of Helsinki, Helsinki, Finland
| | - Ilona Rissanen
- Institute of Biotechnology, Helsinki Institute of Life Science HiLIFE, University of Helsinki, Helsinki, Finland
| | | | - Åke Lundkvist
- Department of Medical Biochemistry and Microbiology, Microbiology-Immunology, Uppsala University, Uppsala, Sweden
| | - Olli Vapalahti
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
- Department of Virology and Immunology, HUSLAB, Helsinki University Hospital, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
| | - Lev Levanov
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
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Hatzl S, Posch F, Linhofer M, Aberle S, Zollner-Schwetz I, Krammer F, Krause R. Poor Prognosis for Puumala Virus Infections Predicted by Lymphopenia and Dyspnea. Emerg Infect Dis 2023; 29:1038-1041. [PMID: 37081597 PMCID: PMC10124650 DOI: 10.3201/eid2905.221625] [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] [Indexed: 04/22/2023] Open
Abstract
We investigated a prospective cohort of 23 patients who had Puumala virus infection in Austria to determine predictors of infection outcomes. We reviewed routinely available clinical and laboratory parameters collected when patients initially sought care. Low absolute lymphocyte count and dyspnea were parameters associated with a severe course of infection.
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Wang YXG, Voutilainen L, Aminikhah M, Helle H, Huitu O, Laakkonen J, Lindén A, Niemimaa J, Sane J, Sironen T, Vapalahti O, Henttonen H, Kallio ER. The impact of wildlife and environmental factors on hantavirus infection in the host and its translation into human risk. Proc Biol Sci 2023; 290:20222470. [PMID: 37040809 PMCID: PMC10089723 DOI: 10.1098/rspb.2022.2470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/13/2023] [Indexed: 04/13/2023] Open
Abstract
Identifying factors that drive infection dynamics in reservoir host populations is essential in understanding human risk from wildlife-originated zoonoses. We studied zoonotic Puumala orthohantavirus (PUUV) in the host, the bank vole (Myodes glareolus), populations in relation to the host population, rodent and predator community and environment-related factors and whether these processes are translated into human infection incidence. We used 5-year rodent trapping and bank vole PUUV serology data collected from 30 sites located in 24 municipalities in Finland. We found that PUUV seroprevalence in the host was negatively associated with the abundance of red foxes, but this process did not translate into human disease incidence, which showed no association with PUUV seroprevalence. The abundance of weasels, the proportion of juvenile bank voles in the host populations and rodent species diversity were negatively associated with the abundance index of PUUV positive bank voles, which, in turn, showed a positive association with human disease incidence. Our results suggest certain predators, a high proportion of young bank vole individuals, and a diverse rodent community, may reduce PUUV risk for humans through their negative impacts on the abundance of infected bank voles.
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Affiliation(s)
- Yingying X. G. Wang
- Department of Biological and Environmental Science, University of Jyvaskyla, 40014 Jyvaskyla, Finland
| | - Liina Voutilainen
- Department of Health Security, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Mahdi Aminikhah
- Department of Ecology and Genetics, University of Oulu, 90014 Oulu, Finland
| | - Heikki Helle
- Department of Biological and Environmental Science, University of Jyvaskyla, 40014 Jyvaskyla, Finland
| | - Otso Huitu
- Wildlife Ecology Group, Natural Resources Institute Finland, 00790 Helsinki, Finland
| | - Juha Laakkonen
- Department of Veterinary Biosciences, University of Helsinki, 00014 Helsinki, Finland
| | - Andreas Lindén
- Wildlife Ecology Group, Natural Resources Institute Finland, 00790 Helsinki, Finland
| | - Jukka Niemimaa
- Research infrastructure services, Natural Resources Institute Finland, 00790 Helsinki, Finland
| | - Jussi Sane
- Department of Health Security, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Tarja Sironen
- Department of Veterinary Biosciences, University of Helsinki, 00014 Helsinki, Finland
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland
| | - Olli Vapalahti
- Department of Veterinary Biosciences, University of Helsinki, 00014 Helsinki, Finland
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland
- Department of Virology, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland
| | - Heikki Henttonen
- Wildlife Ecology Group, Natural Resources Institute Finland, 00790 Helsinki, Finland
| | - Eva R. Kallio
- Department of Biological and Environmental Science, University of Jyvaskyla, 40014 Jyvaskyla, Finland
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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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Meteorological change and hemorrhagic fever with renal syndrome epidemic in China, 2004-2018. Sci Rep 2022; 12:20037. [PMID: 36414682 PMCID: PMC9681842 DOI: 10.1038/s41598-022-23945-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022] Open
Abstract
Hemorrhagic fever with renal syndrome (HFRS), caused by hantavirus, is a serious public health problem in China. Despite intensive countermeasures including Patriotic Health Campaign, rodent control and vaccination in affected areas, HFRS is still a potential public health threat in China, with more than 10,000 new cases per year. Previous epidemiological evidence suggested that meteorological factors could influence HFRS incidence, but the studies were mainly limited to a specific city or region in China. This study aims to evaluate the association between monthly HFRS cases and meteorological change at the country level using a multivariate distributed lag nonlinear model (DLNM) from 2004 to 2018. The results from both univariate and multivariate models showed a non-linear cumulative relative risk relationship between meteorological factors (with a lag of 0-6 months) such as mean temperature (Tmean), precipitation, relative humidity (RH), sunshine hour (SH), wind speed (WS) and HFRS incidence. The risk for HFRS cases increased steeply as the Tmean between - 23 and 14.79 °C, SH between 179.4 and 278.4 h and RH remaining above 69% with 50-95 mm precipitation and 1.70-2.00 m/s WS. In conclusion, meteorological factors such as Tmean and RH showed delayed-effects on the increased risk of HFRS in the study and the lag varies across climate factors. Temperature with a lag of 6 months (RR = 3.05) and precipitation with a lag of 0 months (RR = 2.08) had the greatest impact on the incidence of HFRS.
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Molecular Characterisation and Phylogeny of Tula Virus in Kazakhstan. Viruses 2022; 14:v14061258. [PMID: 35746729 PMCID: PMC9230364 DOI: 10.3390/v14061258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 01/18/2023] Open
Abstract
Orthohantaviruses are zoonotic pathogens that play a significant role in public health. These viruses can cause haemorrhagic fever with renal syndrome in Eurasia. In the Republic of Kazakhstan, the first human cases were registered in the year 2000 in the West Kazakhstan region. Small mammals can be reservoirs of orthohantaviruses. Previous studies showed orthohantavirus antigens in wild-living small mammals in four districts of West Kazakhstan. Clinical studies suggested that there might be further regions with human orthohantavirus infections in Kazakhstan, but genetic data of orthohantaviruses in natural foci are limited. The aim of this study was to investigate small mammals for the presence of orthohantaviruses by molecular biological methods and to provide a phylogenetic characterization of the circulating strains in Kazakhstan. Small mammals were trapped at 19 sites in West Kazakhstan, four in Almaty region and at seven sites around Almaty city during all seasons of 2018 and 2019. Lung tissues of small mammals were homogenized and RNA was extracted. Orthohantavirus RT-PCR assays were applied for detection of partial S and L segment sequences. Results were compared to published fragments. In total, 621 small mammals from 11 species were analysed. Among the collected small mammals, 2.4% tested positive for orthohantavirus RNA, one sample from West Kazakhstan and 14 samples from Almaty region. None of the rodents caught in Almaty city were infected. Sequencing parts of the small (S) and large (L) segments specified Tula virus (TULV) in these two regions. Our data show that geographical distribution of TULV is more extended as previously thought. The detected sequences were found to be split in two distinct genetic clusters of TULV in West Kazakhstan and Almaty region. TULV was detected in the common vole (Microtus arvalis) and for the first time in two individuals of the forest dormouse (Dryomys nitedula), interpreted as a spill-over infection in Kazakhstan.
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Alcohol Consumption and Its Influence on the Clinical Picture of Puumala Hantavirus Infection. Viruses 2022; 14:v14030500. [PMID: 35336910 PMCID: PMC8948946 DOI: 10.3390/v14030500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 01/18/2023] Open
Abstract
Puumala hantavirus (PUUV) causes hemorrhagic fever with renal syndrome. Characteristic clinical findings include acute kidney injury (AKI), thrombocytopenia, and capillary leakage. Smoking increases the risk of severe AKI, but it is not known whether alcohol consumption predisposes patients to a more severe infection. Liver and pancreatic enzymes, as well as biomarkers of alcohol consumption (gamma-glutamyl transferase, GGT; carbohydrate-deficient transferrin, CDT; GGT-CDT combination; and ethyl glucuronide, EtG), were measured from 66 patients with acute PUUV infection during hospitalization and at the convalescence phase. Alcohol consumption was present in 41% of the study population, 15% showing signs of heavy drinking. Alcohol use did not affect the severity of PUUV induced AKI nor the overall clinical picture of the infection. Liver enzyme levels (GGT or alanine aminotransferase, ALT) were elevated in 64% of the patients, but the levels did not associate with the markers reflecting the severity of the disease. Serum amylase activities at the convalescent stage were higher than those at the acute phase (p < 0.001). No cases with acute pancreatitis were found. In conclusion, our findings indicate that alcohol consumption does not seem to affect the clinical course of an acute PUUV infection.
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Severity Biomarkers in Puumala Hantavirus Infection. Viruses 2021; 14:v14010045. [PMID: 35062248 PMCID: PMC8778356 DOI: 10.3390/v14010045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/16/2021] [Accepted: 12/23/2021] [Indexed: 12/12/2022] Open
Abstract
Annually, over 10,000 cases of hemorrhagic fever with renal syndrome (HFRS) are diagnosed in Europe. Puumala hantavirus (PUUV) causes most of the European HFRS cases. PUUV causes usually a relatively mild disease, which is rarely fatal. However, the severity of the infection varies greatly, and factors affecting the severity are mostly unrevealed. Host genes are known to have an effect. The typical clinical features in PUUV infection include acute kidney injury, thrombocytopenia, and increased vascular permeability. The primary target of hantavirus is the endothelium of the vessels of different organs. Although PUUV does not cause direct cytopathology of the endothelial cells, remarkable changes in both the barrier function of the endothelium and the function of the infected endothelial cells occur. Host immune or inflammatory mechanisms are probably important in the development of the capillary leakage. Several immunoinflammatory biomarkers have been studied in the context of assessing the severity of HFRS caused by PUUV. Most of them are not used in clinical practice, but the increasing knowledge about the biomarkers has elucidated the pathogenesis of PUUV infection.
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Bermejo M, Mestrallet S, Servettaz A, Pannet LA, Lebrun D, N'Guyen Y, Andreoletti L, Reynes JM, Hentzien M, Bani-Sadr F. Eosinophilia during Hantavirus infection: a cohort study. Infect Dis (Lond) 2021; 54:277-282. [PMID: 34846983 DOI: 10.1080/23744235.2021.2009129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND There are emerging eosinophil-related considerations concerning viral infections. The role of eosinophils has poorly been evaluated during Hantavirus infection. METHODS The aim of this study was to determine the prevalence of eosinophilia (defined as an eosinophil count above 500 cells/mm3) during haemorrhagic fever with renal syndrome (HFRS) in a large cohort of patients, and to identify factors associated with eosinophilia. RESULTS Among 387 patients hospitalized for HFRS, 98 (25.3%) had eosinophilia. By univariate analysis, eosinophilia was significantly associated with more severe thrombocytopenia, high C-reactive protein level, white blood cell count and neutrophil count and lower nephrotoxic drug intake. As there was a collinearity between white blood cell count and C-reactive protein level, only C-reactive protein level with platelet count and nephrotoxic drug intake were entered in the multivariable analysis. Elevated C-reactive protein concentrations remained independently associated with eosinophilia. CONCLUSION Eosinophilia during HFRS affects one quarter of patients, and supports the role of eosinophils in antiviral immunity against hantavirus infection.
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Affiliation(s)
- Messaline Bermejo
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Reims, France
| | - Stéphanie Mestrallet
- Department of Internal Medicine and Infectious Diseases, Manchester Hospital, Charleville-Mézières, France
| | - Amélie Servettaz
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Reims, France
| | - Laure-Anne Pannet
- Department of Internal Medicine and Infectious Diseases, Manchester Hospital, Charleville-Mézières, France
| | - Delphine Lebrun
- Department of Internal Medicine and Infectious Diseases, Manchester Hospital, Charleville-Mézières, France
| | - Yohan N'Guyen
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Reims, France
| | - Laurent Andreoletti
- Department of Virology, Reims Teaching Hospitals, Reims, France.,Reims Champagne-Ardenne University, EA-4684/SFR CAP-SANTE, Reims, France
| | - Jean-Marc Reynes
- Centre national de référence des Hantavirus, Unité Environnement et Risques Infectieux, Institut Pasteur, Paris, France
| | - Maxime Hentzien
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Reims, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Reims, France.,Reims Champagne-Ardenne University, EA-4684/SFR CAP-SANTE, Reims, France
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