Fatal Puumala Hantavirus Infection in a Patient with Common Variable Immunodeficiency (CVID)

Area of Science:

• Infectious Diseases
• Immunology
• Virology

Background:

• Puumala hantavirus (PUUV) infections typically present with mild to moderate symptoms, but can be severe.
• Common variable immunodeficiency (CVID) is a primary immunodeficiency characterized by impaired antibody production.

Observation:

• A 60-year-old female with CVID developed a fatal PUUV infection with renal failure, thrombocytopenia, and central nervous system (CNS) involvement.
• Hantavirus-specific antibodies were undetectable due to the patient's CVID.
• PUUV RNA was detected for an extended period (one month) in blood, CSF, bronchial lavage, and urine.

Findings:

• Diagnosis and monitoring relied on quantitative PCR detection of PUUV RNA.
• Treatment with ribavirin and fresh frozen plasma (FFP) from convalescent donors was administered.
• Despite viral clearance, the patient's condition deteriorated, leading to death.

Implications:

• This case underscores the importance of the humoral immune response in controlling PUUV infections.
• PCR-based diagnostics are crucial for diagnosing and monitoring PUUV in immunocompromised patients.
• Convalescent plasma therapy warrants consideration for severe hantavirus diseases due to its potential antiviral effects.