BACKGROUND: Puumala hantavirus (PUUV) causes a hemorrhagic fever with renal syndrome (HFRS) also called nephropathia epidemica (NE). Recent case reports and retrospective studies suggest that NE may damage the pituitary gland. Based on these observations, our goal was to explore the nature of this complication prospectively. METHODS: A total of 58 hospitalized patients with acute NE volunteered to participate. Central nervous system (CNS) symptoms were recorded, cerebrospinal fluid (CSF) samples were collected, human leukocyte antigen (HLA) haplotype was analyzed, brain magnetic resonance imaging (MRI) was acquired, and electroencephalography (EEG) was recorded. Patients with abnormal pituitary MRI finding were examined by an endocrinologist. RESULTS: Most patients experienced CNS symptoms, and half of the CSF samples were positive for PUUV IgM, elevated protein level, or leukocyte count. CSF of patients negative for DR15(2)-DQ6 haplotype was less frequently affected. MRI revealed pituitary hemorrhage in two patients; these two patients suffered sudden loss of vision associated with headache, and they both developed hypopituitarism. Only one patient required long-term hormonal replacement therapy. CONCLUSION: CNS-related symptoms and inflammation in the CSF are common in acute NE. Genetic properties of the host may predispose to CNS involvement. It does seem that pituitary injury and subsequent hormonal insufficiency may complicate the recovery.
BACKGROUND:Puumala hantavirus (PUUV) causes a hemorrhagic fever with renal syndrome (HFRS) also called nephropathia epidemica (NE). Recent case reports and retrospective studies suggest that NE may damage the pituitary gland. Based on these observations, our goal was to explore the nature of this complication prospectively. METHODS: A total of 58 hospitalized patients with acute NE volunteered to participate. Central nervous system (CNS) symptoms were recorded, cerebrospinal fluid (CSF) samples were collected, human leukocyte antigen (HLA) haplotype was analyzed, brain magnetic resonance imaging (MRI) was acquired, and electroencephalography (EEG) was recorded. Patients with abnormal pituitary MRI finding were examined by an endocrinologist. RESULTS: Most patients experienced CNS symptoms, and half of the CSF samples were positive for PUUV IgM, elevated protein level, or leukocyte count. CSF of patients negative for DR15(2)-DQ6 haplotype was less frequently affected. MRI revealed pituitary hemorrhage in two patients; these two patients suffered sudden loss of vision associated with headache, and they both developed hypopituitarism. Only one patient required long-term hormonal replacement therapy. CONCLUSION: CNS-related symptoms and inflammation in the CSF are common in acute NE. Genetic properties of the host may predispose to CNS involvement. It does seem that pituitary injury and subsequent hormonal insufficiency may complicate the recovery.
Authors: Timo Hautala; Nina Hautala; Saara-Mari Mähönen; Tarja Sironen; Eija Pääkkö; Ari Karttunen; Pasi I Salmela; Olli Vainio; Seppo Rytky; Alexander Plyusnin; Antti Vaheri; Olli Vapalahti; Heikki Kauma Journal: BMC Infect Dis Date: 2011-08-14 Impact factor: 3.090
Authors: Casey C Perley; Rebecca L Brocato; Steven A Kwilas; Sharon Daye; Alicia Moreau; Donald K Nichols; Kelly S Wetzel; Joshua Shamblin; Jay W Hooper Journal: PLoS One Date: 2019-05-10 Impact factor: 3.240
Authors: Timo Hautala; Terhi Partanen; Tarja Sironen; Saara-Mari Rajaniemi; Nina Hautala; Olli Vainio; Olli Vapalahti; Heikki Kauma; Antti Vaheri Journal: Clin Dev Immunol Date: 2013-07-31