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Hantavirus cardiopulmonary syndrome due to Puumala virus in Germany
Patrick Vollmar1, Matthias Lubnow2, Michaela Simon3
1Bundeswehr Institute of Microbiology, Neuherbergstr. 11, D- 80937 München, Germany.
Abstract:
In Germany Puumala virus (PUUV), known to cause mild forms of hemorrhagic fever with renal syndrome (HFRS), is the predominating endemic hantavirus. We herein describe an unusually severe case of a PUUV infection that occurred in summer 2015 in South Eastern Germany in a region known to be endemic for PUUV since over ten years. A 54-year-old female gardener was admitted to hospital with fever, cough and dyspnea. Within 48hours the patient developed a rapid progressive adult respiratory distress syndrome (ARDS) with circulatory failure and required ECMO (extracorporeal membrane oxygenation) treatment. Serological and molecular biological examinations of serum samples confirmed an infection with PUUV. Partial sequences of the S- and M-segment clustered to a strain previously described in South Eastern Germany. Our reported case highlights, that in rare incidents PUUV can cause hantavirus cardiopulmonary syndrome, a syndrome that is usually found after infections with New World hantaviruses, and neurological symptoms.
Insights
Puumala virus (PUUV) typically causes mild illness, but this case shows it can lead to severe hantavirus cardiopulmonary syndrome and neurological symptoms, even in endemic areas. This highlights the potential for severe PUUV infections.
Area of Science:
- Infectious Diseases
- Virology
- Public Health
Background:
- Puumala virus (PUUV) is the predominant hantavirus in Germany, usually causing mild hemorrhagic fever with renal syndrome (HFRS).
- Hantavirus cardiopulmonary syndrome (HCPS) is typically associated with New World hantaviruses.
Observation:
- A severe case of PUUV infection occurred in a 54-year-old female gardener in South Eastern Germany in 2015.
- The patient presented with fever, cough, and dyspnea, rapidly progressing to adult respiratory distress syndrome (ARDS) and circulatory failure requiring ECMO.
- Neurological symptoms were also noted during the illness.
Findings:
- Serological and molecular tests confirmed PUUV infection.
- Genetic sequencing of viral segments indicated a strain previously identified in South Eastern Germany.
- This case demonstrates an unusually severe presentation of PUUV infection.
Implications:
- Puumala virus can, in rare instances, cause hantavirus cardiopulmonary syndrome, a condition usually seen with New World hantaviruses.
- This case underscores the importance of considering severe hantavirus infections, including HCPS, in differential diagnoses, even with endemic strains.
- Enhanced surveillance and awareness are crucial in PUUV-endemic regions to manage potentially severe outcomes.
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