Case report: Severe neurological manifestation of dobrava hantavirus infection

Abstract

In Europe infection with Puumala or Dobrava viruses causes hemorrhagic fever with renal syndrome (HFRS). In the course of HFRS, mild neurological symptoms such as headache, vertigo, and nausea are common. However, the data about the occurrence of severe, potentially life-threatening neurological manifestations are rather scarce. Here, we present a case of HFRS with serologically proven Dobrava virus infection complicated by epileptic seizures and hemiparesis due to focal encephalitis.

Hantavirus pulmonary syndrome: encephalitis caused by virus Andes

“…This case could be an ADEM-like syndrome. None of the available similar communications of encephalitis on other hantaviruses could demonstrate the presence of RNA on CSF, although they showed intrathecal production of specific antibodies (Huisa et al 2009;Cerar et al 2007). The viral amplification in CSF of the case reported here was also negative but the sample was taken 15 days post-onset of symptoms, so the virus could have been cleared from the CNS at that time.…”

“…There were described cases of encephalitis in the Old World hantaviruses (Puumala, Dobrava, and Hantaan virus) (Bergmann et al 2002;Cerar et al 2007). …”

Lethal disease in infant and juvenile Syrian hamsters experimentally infected with Imjin virus, a newfound crocidurine shrew-borne hantavirus

“…Nevertheless, the findings reported here suggest that hamsters provide an acute MJNV disease model, and may be a convenient experimental host for ascertaining the infectivity and pathogenicity of newfound non-rodent-borne hantaviruses, as well as provide helpful clues about the type(s) of disease MJNV might cause in humans. That is, while neurological manifestations have only rarely been a feature of rodent-borne hantavirus infection in humans (Cerar et al, 2007; Chan et al, 1996), the neurotropism and neuropathology, with high viral load in brains of MJNV-infected hamsters, warrant targeted investigations for disease correlates in humans.…”

Hantavirus protein interactions regulate cellular functions and signaling responses

“…Brain MRI also revealed pituitary hemorrhage in two HFRS patients who developed hypopituitarism [48]. Patients with acute HFRS are sometimes misdiagnosed with viral encephalitis at admission [49].…”