Hantavirus species Tula (TULV) is carried by European common voles (Microtus spp.). Its pathogenic potential for humans is unknown. In a rural region of northeast Germany, a 43-year-old man became ill with fever, renal syndrome, and pneumonia. Typing of late acute-and convalescent-phase sera by focus reduction neutralization assay revealed the presence of neutralizing antibodies against TULV. Moreover, we detected TULV genetic material in Microtus arvalis animals that were trapped at places only a few kilometers from the home village of the patient. Phylogenetic analysis of completely sequenced genomic S segments from three virus strains grouped them within a third genetic lineage of the TULV species. This is the first case of hemorrhagic fever with renal syndrome and pulmonary involvement which can be associated with TULV infection.
CASE REPORTA 43-year-old male patient from a rural region near Cottbus (on the Northern German Plain) was admitted to the hospital. Since the previous day, he had suffered from fever (40.0°C), chills, headache, and left-thoracic, breathing-associated pain. The X-ray examination showed an infiltration within the left pulmonary midzone. The laboratory tests detected elevated levels of serum creatinine (116 mol/liter Ϸ 1.3 mg/dl), C-reactive protein (91.55 mg/liter), and a left shift in the differential blood count. Platelet count, serum bilirubin, and transaminase values were found to be normal. However, proteinuria, erythrocyturia, urobilinogenuria, and bilirubinuria were detected in urine. During the clinical course, the level of proteinuria reached a value of 4.55 g/day. No oliguria was observed, but a moderate polyuria did occur at day 7 and on the following days. With routine diagnostic methods, no evidence for acute bacterial, fungal, or viral infections (with the exception of elevated hantavirus antibody titers; see below) was found to explain the nephritis and pneumonia. A spontaneous remission of clinical symptoms and laboratory values was observed during supportive treatment of the patient. The man had not visited other countries in previous years. However, he reported that he had frequently seen and trapped rodents in a barn near his house.At day 15, the patient was discharged from the clinic; however, at day 21 he was hospitalized again with symptoms of fever (up to 40°C), unproductive cough, and pain in the left thorax. Diagnostic radiology then demonstrated an infiltration in the basolateral segment of the lower-left lobe, whereas the primary infiltration in the left pulmonary midzone was no longer detectable. Again, elevated levels of serum creatinine and C-reactive protein were found, but this time no proteinuria occurred. Ribavirin treatment (1 g/day; Rebetol) was started and maintained over 2 weeks. Within 1 week after the second admission (day 28 after the onset of illness), the patient was free of fever and biochemical values gradually returned to normal. At day 36 after onset, the patient was finally discharged from the clinic. In the follow-up period, no clinical...
