The pathogenesis of nephropathia epidemica: New knowledge and unanswered questions

Mustonen, Jukka; Mäkelä, Satu; Outinen, Tuula; Laine, Outi; Jylhävä, Juulia; Arstila, Petteri T.; Hurme, Mikko; Vaheri, Antti

doi:10.1016/j.antiviral.2013.10.001

Cited by 80 publications

(131 citation statements)

References 182 publications

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“…The main host of PUUV is the bank vole (Myodes glareolus), and the virus is predominantly transmitted horizontally to humans via exposure to contaminated vole excreta [13,39,42]. Human infection is characterized by sudden onset of fever, head and backache, vomiting, and abdominal pain often accompanied by visual disturbances [24]. A minority of patients enter clinical shock.…”

Section: Introductionmentioning

confidence: 99%

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Lymphocytic choriomeningitis, Ljungan and orthopoxvirus seroconversions in patients hospitalized due to acute Puumala hantavirus infection

Fevola

Forbes

Mäkelä

et al. 2016

Journal of Clinical Virology

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a b s t r a c tBackground: The emergence and re-emergence of zoonotic and vector-borne diseases are increasing in Europe. Prominent rodent-borne zoonotic viruses include Puumala hantavirus (PUUV; the causative agent of nephropathia epidemica, NE), lymphocytic choriomeningitis virus (LCMV), and orthopoxviruses (OPV). In addition, Ljungan virus (LV) is considered a potentially zoonotic virus. Objective: The aim of this study was to compare clinical picture between acute PUUV patients with and without additional rodent-borne viral infections, to investigate if concurrent infections influence disease severity. Study design: We evaluated seroprevalence of and seroconversions to LCMV, LV and OPV in 116 patients hospitalized for NE. Clinical and laboratory variables were closely monitored during hospital care. Results: A total of five LCMV, 15 LV, and one OPV seroconversions occurred. NE patients with LCMV seroconversions were younger, and had lower plasma creatinine concentrations and platelet counts than patients without LCMV seroconversions. No differences occurred in clinical or laboratory findings between patients with and without seroconversions to LV and OPV. We report, for the first time, LCMV seroprevalence in Finland, with 8.5% of NE patients seropositive for this virus. Seroprevalences for LV and OPV were 47.8% and 32.4%, respectively. Conclusion: Cases with LCMV seroconversions were statistically younger, had milder acute kidney injury and more severe thrombocytopenia than patients without LCMV. However, the low number of seroconversion cases precludes firm conclusions. Concurrent LV or OPV infections do not appear to influence clinical picture for NE patients.

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Section: Introductionmentioning

confidence: 99%

“…While many studies have investigated the clinical outcomes of human disease following infection with PUUV (e.g. [24,32], LCMV and OPV, the interactive effects of sequential or co-infections remain little studied and poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Lymphocytic choriomeningitis, Ljungan and orthopoxvirus seroconversions in patients hospitalized due to acute Puumala hantavirus infection

Fevola

Forbes

Mäkelä

et al. 2016

Journal of Clinical Virology

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“…The typical features of PUUV infection are renal involvement and thrombocytopenia, the latter rarely causing serious hemorrhages [12,13,14,15,16]. The patients commonly suffer from sudden high fever, headache, abdominal pain, nausea, backache, and visual disturbances [12,13,14,15,16].…”

Section: Introductionmentioning

confidence: 99%

“…Renal involvement of PUUV infection causes a temporary decrease in glomerular filtration, transient, but often massive, proteinuria, microscopic hematuria, and oliguria [12,13,14,15]. The renal symptoms begin around the 3rd day of illness, and the peak plasma creatinine level is reached around the end of the 1st week [2].…”

Section: Introductionmentioning

confidence: 99%

“…During the oliguric phase, maximum 6% of the hospitalized patients require transient renal replacement therapy (RRT) [12,13,16,20]. Within 2-3 weeks, oliguria is followed by polyuria and spontaneous recovery is the rule [12,13,14,15]. The characteristic histopathological renal finding is acute tubulointerstitial nephritis (ATIN) without specific glomerular changes [21,22].…”

Section: Introductionmentioning

confidence: 99%

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Community Acquired Severe Acute Kidney Injury Caused by Hantavirus-Induced Hemorrhagic Fever with Renal Syndrome Has a Favorable Outcome

Outinen¹,

Mäkelä²,

Clément³

et al. 2015

Nephron

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Background: Puumala hantavirus (PUUV) induces an acute tubulointerstitial nephritis and acute kidney injury (AKI). Our aim was to evaluate the prognosis of severe AKI associated with PUUV infection. Methods: We examined 556 patients who were treated at Tampere University Hospital during 1982-2013 for acute, serologically confirmed PUUV infection. Plasma creatinine was measured during hospitalization, convalescence, and 1, 2, and 5 years after the acute infection. Results: Plasma creatinine concentration was elevated (>100 μmol/l) in 459 (83%) patients, while altogether 189 patients (34%) had severe AKI defined as Kidney Disease: Improving Global Outcomes (KDIGO) stage 3, that is, plasma creatinine ≥353.6 μmol/l (4.0 mg/dl) or need of dialysis. There were no fatal cases during the hospitalization or the following 3 months. Fatality rate during the years following PUUV infection did not differ between patients who had suffered from severe AKI versus those without severe AKI. Post-hospitalization plasma creatinine values were available for 188 (34%) patients. One month after the acute infection, patients with prior severe AKI had higher median plasma creatinine concentration (82 µmol/l, range 54-184) than patients without severe AKI (74 µmol/l, range 55-109, p = 0.005). After 1 year, no significant difference existed in median plasma creatinine concentrations between patients with (71 µmol/l, range 36-123) and without prior severe AKI (72 µmol/l, range 34-116, p = 0.711). After 5 years all but 1 patient had normal creatinine levels. Conclusions: In contrast to the worldwide well-accepted KDIGO criteria, severe AKI associated with PUUV infection is not associated with excess fatality but has a very good prognosis, both in the short and long terms.

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Pathogenesis of Hantavirus Infections

Sironen

Vapalahti

Plyusnin

2015

Human Emerging and Re‐emerging Infections

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The pathogenesis of nephropathia epidemica: New knowledge and unanswered questions

Cited by 80 publications

References 182 publications

Lymphocytic choriomeningitis, Ljungan and orthopoxvirus seroconversions in patients hospitalized due to acute Puumala hantavirus infection

Lymphocytic choriomeningitis, Ljungan and orthopoxvirus seroconversions in patients hospitalized due to acute Puumala hantavirus infection

Community Acquired Severe Acute Kidney Injury Caused by Hantavirus-Induced Hemorrhagic Fever with Renal Syndrome Has a Favorable Outcome

Pathogenesis of Hantavirus Infections

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