Tula Virus Infection Associated with Fever and Exanthema After a Wild Rodent Bite

Schultze, D.; Lundkvist, Åke; Blauenstein, U.; Heyman, Paul

doi:10.1007/s10096-002-0705-5

Cited by 62 publications

(35 citation statements)

References 7 publications

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“…This suggests that the PUUV strain used either differed substantially from the virus causing the infection and/or that some of the tested individuals might have been infected with another hantavirus species. The presence of Tula virus, for example, has been documented in Switzerland, in a 10 year-old boy bitten by a small wild rodent in 2000 as well as in rodents trapped between 2001 and 2009 [31,32].…”

Section: Discussionmentioning

confidence: 99%

Seroprevalence of hantavirus infections in Switzerland in 2009: difficulties in determining prevalence in a country with low endemicity

et al. 2013

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In several European countries, diagnosis of nephropathia epidemica, a mild form of haemorrhagic fever with renal syndrome (HFRS) caused by Puumalavirus infection, has increased over the past 10-20 years. In Switzerland, despite its geographical proximity to regions with epidemic outbreaks in Germany and France, infections are detected only sporadically. To estimate the actual prevalence and potential risk factors of human hantavirus infections in Switzerland, a seroepidemiological study was performed in 2009 on serum samples from 4,559 blood donors and 1,810 military personnel. Sera were screened using commercial Puumala IgG and hantavirus IgG enzyme-linked immunosorbent assays indicating a seroprevalence of 1% and 9%, respectively. Subsequently, the samples were analysed by immunofluorescence assay and immunoblot assay, showing a much lower prevalence, of 0.4% and 0.3%, respectively. Two of the serum samples achieved an 80% reduction in plaque-forming units in a neutralisation test. Statistical evaluation of questionnaires only identified an association of age (above 50 years) with hantavirus seropositivity when adjusted for sex (odds ratio: 2.36; 95% confidence interval: 1.10-5.05). This study provides baseline data (0.3-0.4%) for future monitoring of hantavirus seroprevalence in Switzerland and highlights the challenges in estimating the seroprevalence of these viruses in a country with very low endemicity.

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Section: Discussionmentioning

confidence: 99%

Seroprevalence of hantavirus infections in Switzerland in 2009: difficulties in determining prevalence in a country with low endemicity

et al. 2013

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“…A single case of (anamnestic) human infection could be found by serological evidence in a healthy blood donor, thus indicating that TULV (or a TULV-like virus) can be transmitted to humans (22). In addition, one acute case of TULV infection of a patient with fever, paronychia, and exanthema but without renal or pulmonary affection has been reported (17) and recently commented upon (2).…”

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confidence: 95%

Occurrence of Renal and Pulmonary Syndrome in a Region of Northeast Germany Where Tula Hantavirus Circulates

Klempa

Meisel

Räth³

et al. 2003

J Clin Microbiol

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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...

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“…Similarly, the Eurasian hantavirus species Khabarovsk virus hosted by the reed vole Microtus fortis (23) and TULV are believed to have no or low pathogenicity for humans. However, a few human TULV infections have been reported, with two case reports about potential TULV-induced disease in humans (32,59,70,71). This low frequency in the detection of human TULV infections might be explained by its low pathogenic potential (36); however, human TULV infections might have been overlooked because their differentiation from infections with the TULVcross-reactive Puumala virus (PUUV) would require a neutralization assay (70).…”

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Extensive Host Sharing of Central European Tula Virus

Schmidt‐Chanasit

Eßbauer

Petraityte³

et al. 2010

J Virol

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To examine the host association of Tula virus (TULV), a hantavirus present in large parts of Europe, we investigated a total of 791 rodents representing 469 Microtus arvalis and 322 Microtus agrestis animals from northeast, northwest, and southeast Germany, including geographical regions with sympatric occurrence of both vole species, for the presence of TULV infections. Based on serological investigation, reverse transcriptase PCR, and subsequent sequence analysis of partial small (S) and medium (M) segments, we herein show that TULV is carried not only by its commonly known host M. arvalis but also frequently by M. agrestis in different regions of Germany for a prolonged time period. At one trapping site, TULV was exclusively detected in M. agrestis, suggesting an isolated transmission cycle in this rodent reservoir separate from spillover infections of TULV-carrying M. arvalis. Phylogenetic analysis of the S and M segment sequences demonstrated geographical clustering of the TULV sequences irrespective of the host, M. arvalis or M. agrestis. The novel TULV lineages from northeast, northwest, and southeast Germany described here are clearly separated from each other and from other German, European, or Asian lineages, suggesting their stable geographical localization and fast sequence evolution. In conclusion, these results demonstrate that TULV represents a promiscuous hantavirus with a large panel of susceptible hosts. In addition, this may suggest an alternative evolution mode, other than a strict coevolution, for this virus in its Microtus hosts, which should be proven in further large-scale investigations on sympatric Microtus hosts.Hantaviruses (genus Hantavirus, family Bunyaviridae) are characterized by a tripartite RNA genome of negative polarity. The small (S) genome segment of about 1.7 kb encodes the nucleocapsid (N) protein that is associated as a multimer with the viral RNA genome. The medium (M) segment of about 3.6 kb encodes a glycoprotein precursor that is cotranslationally cleaved at a highly conserved WAASA motif into the G1 and G2 envelope glycoproteins. These proteins form oligomers which mediate the interaction of the virus with the cellular receptor. The large (L) segment of about 6.5 kb encodes the RNA-dependent RNA polymerase that functions as transcriptase and replicase (for a review, see reference 57).In general, hantaviruses are harbored by persistently infected rodent reservoir hosts which shed the hantaviruses by urine, feces, and saliva. Therefore, the major route of transmission to humans is by inhalation of aerosols originating from virus-contaminated urine or feces (for a review, see reference 58). The high stability of hantaviruses in nature allows indirect transmission and underlines the importance of environmental factors on the frequency of transmission (31). An alternative route of virus transmission to humans is by rodent bites (10). Human-to-human transmission has exclusively been observed for the South American Andes virus (42).The congruent phylogenetic affinities of h...

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Tula Virus Infection Associated with Fever and Exanthema After a Wild Rodent Bite

Cited by 62 publications

References 7 publications

Seroprevalence of hantavirus infections in Switzerland in 2009: difficulties in determining prevalence in a country with low endemicity

Seroprevalence of hantavirus infections in Switzerland in 2009: difficulties in determining prevalence in a country with low endemicity

Occurrence of Renal and Pulmonary Syndrome in a Region of Northeast Germany Where Tula Hantavirus Circulates

Extensive Host Sharing of Central European Tula Virus

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