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Clinical characterization of two severe cases of hemorrhagic fever with renal syndrome (HFRS) caused by hantaviruses Puumala and Dobrava-Belgrade genotype Sochi.
BMC Infect Dis. 2016 Nov 14; 16(1):675.BI

Abstract

BACKGROUND

Hantavirus disease belongs to the emerging infections. The clinical picture and severity of infections differ between hantavirus species and may even vary between hantavirus genotypes. The mechanisms that lead to the broad variance of severity in infected patients are not completely understood. Host- and virus-specific factors are considered.

CASE PRESENTATION

We analyzed severe cases of hantavirus disease in two young women. The first case was caused by Puumala virus (PUUV) infection in Germany; the second case describes the infection with Dobrava-Belgrade virus (DOBV) in Russia. Symptoms, laboratory parameters and cytokine levels were analyzed and compared between the two patients. Serological and sequence analysis revealed that PUUV was the infecting agent for the German patient and the infection of the Russian patient was caused by Dobrava-Belgrade virus genotype Sochi (DOBV-Sochi). The symptoms in the initial phase of the diseases did not differ noticeably between both patients. However, deterioration of laboratory parameter values was prolonged and stronger in DOBV-Sochi than in PUUV infection. Circulating endothelial progenitor cells (cEPCs), known to be responsible for endothelial repair, were mobilized in both infections. Striking differences were observed in the temporal course and level of cytokine upregulation. Levels of angiopoietin-2 (Ang-2), vascular endothelial growth factor (VEGF), and stromal derived factor-1 (SDF-1α) were increased in both infections; but, sustained and more pronounced elevation was observed in DOBV-Sochi infection.

CONCLUSIONS

Severe hantavirus disease caused by different hantavirus species did not differ in the general symptoms and clinical characteristics. However, we observed a prolonged clinical course and a late and enhanced mobilization of cytokines in DOBV-Sochi infection. The differences in cytokine deregulation may contribute to the observed variation in the clinical course.

Authors+Show Affiliations

Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg, 69120, Germany. ellen.krautkraemer@med.uni-heidelberg.de.Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg, 69120, Germany.Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg, 69120, Germany.Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg, 69120, Germany.Institute of Medical Virology, Charité Medical School, Berlin, Germany.Department of Virology, University of Heidelberg, Heidelberg, Germany.Institute of Medical Virology, Charité Medical School, Berlin, Germany. Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.Institute of Medical Virology, Charité Medical School, Berlin, Germany.Institute of Medical Virology, Charité Medical School, Berlin, Germany.Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg, 69120, Germany.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

27842513

Citation

Krautkrämer, Ellen, et al. "Clinical Characterization of Two Severe Cases of Hemorrhagic Fever With Renal Syndrome (HFRS) Caused By Hantaviruses Puumala and Dobrava-Belgrade Genotype Sochi." BMC Infectious Diseases, vol. 16, no. 1, 2016, p. 675.
Krautkrämer E, Nusshag C, Baumann A, et al. Clinical characterization of two severe cases of hemorrhagic fever with renal syndrome (HFRS) caused by hantaviruses Puumala and Dobrava-Belgrade genotype Sochi. BMC Infect Dis. 2016;16(1):675.
Krautkrämer, E., Nusshag, C., Baumann, A., Schäfer, J., Hofmann, J., Schnitzler, P., Klempa, B., Witkowski, P. T., Krüger, D. H., & Zeier, M. (2016). Clinical characterization of two severe cases of hemorrhagic fever with renal syndrome (HFRS) caused by hantaviruses Puumala and Dobrava-Belgrade genotype Sochi. BMC Infectious Diseases, 16(1), 675.
Krautkrämer E, et al. Clinical Characterization of Two Severe Cases of Hemorrhagic Fever With Renal Syndrome (HFRS) Caused By Hantaviruses Puumala and Dobrava-Belgrade Genotype Sochi. BMC Infect Dis. 2016 Nov 14;16(1):675. PubMed PMID: 27842513.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characterization of two severe cases of hemorrhagic fever with renal syndrome (HFRS) caused by hantaviruses Puumala and Dobrava-Belgrade genotype Sochi. AU - Krautkrämer,Ellen, AU - Nusshag,Christian, AU - Baumann,Alexandra, AU - Schäfer,Julia, AU - Hofmann,Jörg, AU - Schnitzler,Paul, AU - Klempa,Boris, AU - Witkowski,Peter T, AU - Krüger,Detlev H, AU - Zeier,Martin, Y1 - 2016/11/14/ PY - 2016/07/22/received PY - 2016/11/07/accepted PY - 2016/11/16/entrez PY - 2016/11/16/pubmed PY - 2017/5/13/medline KW - Dobrava-Belgrade virus genotype Sochi KW - Hantavirus KW - Puumala virus KW - clinical severity KW - cytokines SP - 675 EP - 675 JF - BMC infectious diseases JO - BMC Infect. Dis. VL - 16 IS - 1 N2 - BACKGROUND: Hantavirus disease belongs to the emerging infections. The clinical picture and severity of infections differ between hantavirus species and may even vary between hantavirus genotypes. The mechanisms that lead to the broad variance of severity in infected patients are not completely understood. Host- and virus-specific factors are considered. CASE PRESENTATION: We analyzed severe cases of hantavirus disease in two young women. The first case was caused by Puumala virus (PUUV) infection in Germany; the second case describes the infection with Dobrava-Belgrade virus (DOBV) in Russia. Symptoms, laboratory parameters and cytokine levels were analyzed and compared between the two patients. Serological and sequence analysis revealed that PUUV was the infecting agent for the German patient and the infection of the Russian patient was caused by Dobrava-Belgrade virus genotype Sochi (DOBV-Sochi). The symptoms in the initial phase of the diseases did not differ noticeably between both patients. However, deterioration of laboratory parameter values was prolonged and stronger in DOBV-Sochi than in PUUV infection. Circulating endothelial progenitor cells (cEPCs), known to be responsible for endothelial repair, were mobilized in both infections. Striking differences were observed in the temporal course and level of cytokine upregulation. Levels of angiopoietin-2 (Ang-2), vascular endothelial growth factor (VEGF), and stromal derived factor-1 (SDF-1α) were increased in both infections; but, sustained and more pronounced elevation was observed in DOBV-Sochi infection. CONCLUSIONS: Severe hantavirus disease caused by different hantavirus species did not differ in the general symptoms and clinical characteristics. However, we observed a prolonged clinical course and a late and enhanced mobilization of cytokines in DOBV-Sochi infection. The differences in cytokine deregulation may contribute to the observed variation in the clinical course. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/27842513/Clinical_characterization_of_two_severe_cases_of_hemorrhagic_fever_with_renal_syndrome__HFRS__caused_by_hantaviruses_Puumala_and_Dobrava_Belgrade_genotype_Sochi_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-2012-2 DB - PRIME DP - Unbound Medicine ER -