Central nervous system and ophthalmic involvement in nephropathia epidemica (European type of haemorrhagic fever with renal syndrome)

Hemorrhagic fever with renal syndrome in the Pomurje region of Slovenia – An 18-year survey

“…Tsai reported the presence of elevated protein levels in CFS in approximately one-third to one-half of HFRS cases, and the elevation of leucocytes in CSF in 20-30% [28]. In the study by Ahlm et al two out of ten patients with PUUV infection had marginally elevated protein levels in CSF [29]. In our study elevated protein concentration in CSF was found in nearly one-half of the PUUV patients who underwent lumbar puncture.…”

Case report: Severe neurological manifestation of dobrava hantavirus infection

“…Intrathecal production of specific antibodies was also reported in a patient with encephalitis during the course of HFRS due to Puumala virus [Bergman et al, 2002]. However, in another study on Puumala virus infected HFRS patients with neurological manifestations, no evidence for the presence of Puumala virus in the CNS was found [Ahlm et al, 1998]. On the basis of increased levels of neopterin, IL-6 and IFN-g in CSF the authors hypothesized that immune mediated mechanisms, rather than the virus infection per se, caused the CNS related symptoms in patients with HFRS.…”

“…In contrast, in a review of 811 patients with Puumala virus infection in Western Russia only two patients exhibited epileptic seizures and one patient had cerebral hemorrhage [Alexeyev and Morozov, 1995]. There have been also case reports on encephalitis, cerebral hemorrhage, Guillian-Barré syndrome, panhypopituitarism, and acute disseminated encephalomyelitis in patients with Puumala virus associated HFRS [Esselink et al, 1994;Alexeyev and Morozov, 1995;Ahlm et al, 1998;Bergman et al, 2002;Markotić et al, 2002;Toivanen et al, 2002]. Information on the clinical course of HFRS due to infection with Dobrava virus is much more limited and only a few cases with pronounced neurological manifestation have been documented [Avšič-Ž upanc et al, 1999;Markotić et al, 2002].…”

Puumala virus RNA in cerebrospinal fluid in a patient with uncomplicated nephropathia epidemica

“…CNS involvement or even death due to CNS complications during acute NE have been described (Ahlm et al, 1998;Alexeyev and Morozov, 1995;Forslund et al, 1992;Hautala et al, 2002;Settergren et al, 1992;Valtonen et al, 1995). CNS infection or complications caused by other hantaviruses are not equally well understood (Mertz et al, 2006;Vapalahti et al, 2003).…”

“…Involvement of central nervous system (CNS) during acute NE has been demonstrated (Alexeyev and Morozov, 1995;Toivanen et al, 2002) and direct viral invasion of hypophysis has been described (Hautala et al, 2002). A prospective study of 26 patients showed that CNS-related symptoms and possible inflammatory reaction in cerebrospinal fluid (CSF) may be common in NE (Ahlm et al, 1998). Presence of PUUV in CSF in a patient with acute NE, however, has not been previously confirmed.…”