1
|
Mull N, Seifert SN, Forbes KM. A framework for understanding and predicting orthohantavirus functional traits. Trends Microbiol 2023; 31:1102-1110. [PMID: 37277284 DOI: 10.1016/j.tim.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/07/2023]
Abstract
Orthohantaviruses present a global public health threat; there are 58 distinct viruses currently recognized and case fatality of pathogenic orthohantaviruses ranges from <0.1% to 50%. An Old World versus New World dichotomy is frequently applied to distinguish human diseases caused by orthohantaviruses. However, this geographic grouping masks the importance of phylogeny and virus-host ecology in shaping orthohantavirus traits, especially since related arvicoline rodents and their orthohantaviruses are found in both regions. We argue that orthohantaviruses can be separated into three phylogenetically based rodent host groups with differences in key functional traits, including human disease, transmission route, and virus-host fidelity. This framework can help understand and predict traits of under-studied and newly discovered orthohantaviruses and guide public health and biosafety policy.
Collapse
Affiliation(s)
- Nathaniel Mull
- Department of Biological Sciences, University of Arkansas, Fayetteville, AR, USA.
| | - Stephanie N Seifert
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Kristian M Forbes
- Department of Biological Sciences, University of Arkansas, Fayetteville, AR, USA
| |
Collapse
|
2
|
Abstract
Puumala virus (PUUV) is the most common hantavirus in Europe. It is known to cause nephropathia epidemica, which is considered a mild type of hemorrhagic fever with renal syndrome. However, it does not only involve the kidneys and is rarely accompanied by symptomatic hemorrhage. We review the imaging abnormalities caused by PUUV infection, from head to pelvis, emphasizing the broad spectrum of possible findings and bringing further support to a previously suggested denomination "Hantavirus disease" that would encompass all clinical manifestations. Although non-specific, knowledge of radiological appearances is useful to support clinically suspected PUUV infection, before confirmation by serology.
Collapse
Affiliation(s)
- Olivier Lebecque
- Department of Radiology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Michaël Dupont
- Department of Radiology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| |
Collapse
|
3
|
Kim SH, Park S, Choi J. Acalculous cholecystitis associated with Hantaan virus: A case report. Ann Hepatobiliary Pancreat Surg 2019; 23:278-281. [PMID: 31501818 PMCID: PMC6728245 DOI: 10.14701/ahbps.2019.23.3.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 11/17/2022] Open
Abstract
Acute acalculous cholecystitis (AAC) still remains one of the most elusive diagnoses and occurs in various conditions. Although AACs caused by viral infections are rare, various viruses have been revealed to cause AAC. Here we present a case in which a man suffered from AAC caused by a Hantaan virus infection. A 35-year-old man was referred to the emergency room for myalgia and fever that began 4 days ago. He suffered oliguria and abdominal pain for 2 days. At the time of his visit to the emergency room, he experienced a fever that spiked up to 38.3℃. An initial blood sample objectified the following pathologic results: white blood cells - 10260/µl; C-reactive protein – 6.76 mg/dl; total bilirubin – 1.7 mg/dl; AST – 90 IU/L; ALT – 233 IU/L. In the computed tomography, bilateral perirenal fluid collections and bilateral flexural effusion were shown and acute hepatopathy and cholecystopathy were also shown. Because there was no definite tenderness around the patient's right upper quadrant from physical examination and his cholecystopathy looked like it was from secondary change according to acute hepatopathy, we decided to perform conservative care without surgical treatment. The following day, in viral antibody test, Hantaan virus antibody was detected. After conservative management, the patient's condition improved and his laboratory findings were stable. The patient was discharged on the 10th day at the hospital stay without any symptoms. The Hantaan virus infection should be suspected as a causative agent of AAC, especially when there is abnormal liver function tests and abdominal pain.
Collapse
Affiliation(s)
- Sung Hyun Kim
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea
| | - Sejin Park
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea
| | - Jangkyu Choi
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea
| |
Collapse
|
4
|
Clement J, Lee APK, Verpooten GA, Laenen L, Vergote V, De Samblanx H, Berneman ZN, Van Ranst M, Maes P. Acute hantavirus infection presenting as haemolytic-uraemic syndrome (HUS): the importance of early clinical diagnosis. Eur J Clin Microbiol Infect Dis 2017; 37:135-140. [PMID: 28986730 DOI: 10.1007/s10096-017-3113-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 01/30/2023]
Abstract
The European prototype of hantavirus, Puumala virus (PUUV), isolated from a common wild rodent, the bank vole (Myodes glareolus), causes nephropathia epidemica (NE). NE can perfectly mimic haemolytic-uraemic syndrome (HUS), progressing from an aspecific flu-like syndrome to acute kidney injury with thrombocytopaenia, and presenting with some signs of haemolytic anaemia and/or coagulopathy. Moreover, both NE and HUS can occur in local outbreaks. We report an isolated case of NE, initially referred for plasmapheresis for suspected HUS, although signs of overt haemolysis were lacking. Early suspicion of hantavirus infection, later confirmed by serology and reverse transcription polymerase chain reaction (RT-PCR), prevented subsequent excessive treatment modalities.
Collapse
Affiliation(s)
- J Clement
- National Reference Laboratory for Hantavirus Infections, University Hospitals Leuven, Leuven, Belgium.
- Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
| | - A P K Lee
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - G A Verpooten
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - L Laenen
- National Reference Laboratory for Hantavirus Infections, University Hospitals Leuven, Leuven, Belgium
- Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - V Vergote
- National Reference Laboratory for Hantavirus Infections, University Hospitals Leuven, Leuven, Belgium
- Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - H De Samblanx
- Department of Haematology, Antwerp University Hospital, Edegem, Belgium
| | - Z N Berneman
- Department of Haematology, Antwerp University Hospital, Edegem, Belgium
| | - M Van Ranst
- National Reference Laboratory for Hantavirus Infections, University Hospitals Leuven, Leuven, Belgium
- Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - P Maes
- National Reference Laboratory for Hantavirus Infections, University Hospitals Leuven, Leuven, Belgium
- Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| |
Collapse
|
5
|
Abstract
Hantaviruses are responsible for various types of hemorrhagic fevers depending on the involved subtype. In Europe, Puumala virus is responsible for an epidemic nephropathy. This infection can be complicated by severe abdominal pain. A rarely reported cause of this presenting symptom is acalculous cholecystitis, which must be integrated in the clinicobiological spectrum and should not lead to a surgical sanction. Its presence seems to be correlated with the severity of the disease, whose main pathophysiological phenomenon is plasma leakage induced by a microvascular endothelial dysfunction. We report the case of a young male patient who presented with severe hantavirus infection complicated by acalculous cholecystitis.
Collapse
Affiliation(s)
- J B Nicolas
- Department of General Internal Medicine, CHU Dinant Godinne UCL Namur , Yvoir, Belgium
| |
Collapse
|
6
|
Skarphedinsson S, Thiesson HC, Shakar SA, Tepel M. Factors predicting kidney damage in Puumala virus infected patients in Southern Denmark. Eur J Clin Microbiol Infect Dis 2015. [PMID: 26205664 DOI: 10.1007/s10096-015-2446-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In Europe, infections with Puumala hantavirus cause nephropathia epidemica. Presently the risk factors predicting severe kidney damage after Puumala virus infection are not well known. The objective of the study was to investigate environmental and individual factors predicting severe kidney damage caused by serologically established Puumala infections. In a nationwide cohort study we investigated all serologically established Puumala infections in Southern Denmark from 1996 to 2012. A total of 184 patients had serologically verified Puumala virus infection. In patients with Puumala virus infections the decrease of platelet counts preceded acute kidney failure. Multivariable logistic regression demonstrated that recent activities in the forest, platelet counts, and flu-like symptoms predicted estimated glomerular filtration rates less than 30 mL/min/1.73 m(²), but not age, gender, fever, nor abdominal pain. Severe kidney damage in Puumala infections in Southern Denmark is associated with the risk of recent activities in the forest.
Collapse
Affiliation(s)
- S Skarphedinsson
- Clinical Center of Emerging and Vectorborne Infections, Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - H C Thiesson
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - S A Shakar
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - M Tepel
- Department of Nephrology, Odense University Hospital, Odense, Denmark. .,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark. .,Institute for Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense University Hospital and University of Southern Denmark, Winsløwparken 21.3, 5000, Odense C, Denmark.
| |
Collapse
|
7
|
Clement J, Maes P, Van Ranst M. Hemorrhagic Fever with Renal Syndrome in the New, and Hantavirus Pulmonary Syndrome in the Old World: paradi(se)gm lost or regained? Virus Res 2014; 187:55-8. [PMID: 24440318 DOI: 10.1016/j.virusres.2013.12.036] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/17/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
Abstract
Since the first clinical description in 1994 of the so-called "Hantavirus Pulmonary Syndrome" (HPS) as a "newly recognized disease", hantavirus infections have always been characterized as presenting in two distinct syndromes, the so-called "Hemorrhagic Fever with Renal Syndrome" (HFRS) in the Old World, with the kidney as main target organ, in contrast to HPS in the New World, with the lung as main target organ. However, European literature mentions already since 1934 a mostly milder local HFRS form, aptly named "nephropathia epidemica" (NE), and caused by the prototype European hantavirus species Puumala virus (PUUV). Several NE reports dating from the 1980s and early 1990s described already non-cardiogenic HPS-like lung involvement, prior to any kidney involvement, and increasing evidence is now mounting that a considerable clinical overlap exists between HPS and HFRS. Moreover, growing immunologic insights point to common pathologic mechanisms, leading to capillary hyperpermeability, the cardinal feature of all hantavirus infections, both of the New and Old World. It is now perhaps time to reconsider the paradigm of two "different" syndromes caused by viruses of the same Hantavirus genus in the same Bunyaviridae family, and to agree on a common, more logical disease denomination, such as simply and briefly "Hantavirus fever".
Collapse
Affiliation(s)
- Jan Clement
- Belgian National Reference Laboratory for Hantavirus Infections, Clinical Virology Laboratory, University Hospital Gasthuisberg, Catholic University of Leuven, Herestraat, 49, B-3000 Leuven, Belgium.
| | - Piet Maes
- Belgian National Reference Laboratory for Hantavirus Infections, Clinical Virology Laboratory, University Hospital Gasthuisberg, Catholic University of Leuven, Herestraat, 49, B-3000 Leuven, Belgium
| | - Marc Van Ranst
- Belgian National Reference Laboratory for Hantavirus Infections, Clinical Virology Laboratory, University Hospital Gasthuisberg, Catholic University of Leuven, Herestraat, 49, B-3000 Leuven, Belgium
| |
Collapse
|
8
|
Gizzi M, Delaere B, Weynand B, Clement J, Maes P, Vergote V, Laenen L, Hjelle B, Verroken A, Dive A, Michaux I, Evrard P, Creytens D, Bulpa P. Another case of "European hantavirus pulmonary syndrome" with severe lung, prior to kidney, involvement, and diagnosed by viral inclusions in lung macrophages. Eur J Clin Microbiol Infect Dis 2013; 32:1341-5. [PMID: 23670277 PMCID: PMC7102061 DOI: 10.1007/s10096-013-1885-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/17/2013] [Indexed: 12/24/2022]
Abstract
Puumala virus (PUUV) is considered a classic Old World etiologic agent of nephropathia epidemica (NE), or hemorrhagic fever with renal syndrome (HFRS). HFRS is considered to be distinct from hantavirus (cardio-)pulmonary syndrome (HPS or HCPS), described in the New World. Here, we report a severe case, which fulfilled most, if not all, Centers for Disease Control and Prevention (CDC) criteria for HPS, needing non-invasive ventilation and subsequent acute hemodialysis. However, the etiological agent was PUUV, as proved by serological testing, real-time polymerase chain reaction (PCR), and sequencing. Viral antigen was detected by specific anti-PUUV immunostaining, showing, for the first time, greenish intracytoplasmic inclusions in bronchoalveolar lavage (BAL) macrophages. This case definitely confirms that HPS can be encountered during PUUV infections. Interestingly, special findings could render the diagnosis easier, such as greenish homogeneous cytoplasmic inclusions, surrounded by a fine clear halo in BAL macrophages. Therefore, although the diagnosis remains difficult before the onset of renal involvement, the occurrence of severe respiratory failure mimicking community-acquired pneumonia must alert the clinician for possible HPS, especially in endemic areas.
Collapse
Affiliation(s)
- M. Gizzi
- Intensive Care Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, 5530 Yvoir, Belgium
| | - B. Delaere
- Infectious Diseases Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - B. Weynand
- Pathology Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - J. Clement
- National Reference Centre for Hantaviruses, University Hospitals Leuven, Gasthuisberg, University of Leuven, Leuven, KU Belgium
- Zoonotic Infectious Diseases unit, Clinical Virology, Rega Institute for Medical Research, Leuven, KU Belgium
| | - P. Maes
- National Reference Centre for Hantaviruses, University Hospitals Leuven, Gasthuisberg, University of Leuven, Leuven, KU Belgium
- Zoonotic Infectious Diseases unit, Clinical Virology, Rega Institute for Medical Research, Leuven, KU Belgium
| | - V. Vergote
- National Reference Centre for Hantaviruses, University Hospitals Leuven, Gasthuisberg, University of Leuven, Leuven, KU Belgium
- Zoonotic Infectious Diseases unit, Clinical Virology, Rega Institute for Medical Research, Leuven, KU Belgium
| | - L. Laenen
- National Reference Centre for Hantaviruses, University Hospitals Leuven, Gasthuisberg, University of Leuven, Leuven, KU Belgium
- Zoonotic Infectious Diseases unit, Clinical Virology, Rega Institute for Medical Research, Leuven, KU Belgium
| | - B. Hjelle
- Departments of Pathology, Biology, Molecular Genetics and Microbiology, Center for Infectious Diseases and Immunity, University of New Mexico, Albuquerque, NM USA
| | - A. Verroken
- Microbiology Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - A. Dive
- Intensive Care Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, 5530 Yvoir, Belgium
| | - I. Michaux
- Intensive Care Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, 5530 Yvoir, Belgium
| | - P. Evrard
- Intensive Care Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, 5530 Yvoir, Belgium
| | - D. Creytens
- Pathology Department, University Hospital Ghent, Ghent, Belgium
| | - P. Bulpa
- Intensive Care Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, 5530 Yvoir, Belgium
| |
Collapse
|
9
|
Heyman P, Thoma BR, Marié JL, Cochez C, Essbauer SS. In Search for Factors that Drive Hantavirus Epidemics. Front Physiol 2012; 3:237. [PMID: 22934002 PMCID: PMC3429022 DOI: 10.3389/fphys.2012.00237] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 06/11/2012] [Indexed: 12/23/2022] Open
Abstract
In Europe, hantaviruses (Bunyaviridae) are small mammal-associated zoonotic and emerging pathogens that can cause hemorrhagic fever with renal syndrome (HFRS). Puumala virus, the main etiological agent carried by the bank vole Myodes glareolus is responsible for a mild form of HFRS while Dobrava virus induces less frequent but more severe cases of HFRS. Since 2000 in Europe, more than 3000 cases of HFRS have been recorded, in average, each year, which is nearly double compared to the previous decade. In addition to this upside long-term trend, significant oscillations occur. Epidemic years appear, usually every 2-4 years, with an increased incidence, generally in localized hot spots. Moreover, the virus has been identified in new areas in the recent years. A great number of surveys have been carried out in order to assess the prevalence of the infection in the reservoir host and to identify links with different biotic and abiotic factors. The factors that drive the infections are related to the density and diversity of bank vole populations, prevalence of infection in the reservoir host, viral excretion in the environment, survival of the virus outside its host, and human behavior, which affect the main transmission virus route through inhalation of infected rodent excreta. At the scale of a rodent population, the prevalence of the infection increases with the age of the individuals but also other parameters, such as sex and genetic variability, interfere. The contamination of the environment may be correlated to the number of newly infected rodents, which heavily excrete the virus. The interactions between these different parameters add to the complexity of the situation and explain the absence of reliable tools to predict epidemics. In this review, the factors that drive the epidemics of hantaviruses in Middle Europe are discussed through a panorama of the epidemiological situation in Belgium, France, and Germany.
Collapse
Affiliation(s)
- Paul Heyman
- Epidemiology and Biostatistics, Research Laboratory for Vector-Borne Diseases, Queen Astrid Military Hospital Brussels, Belgium
| | | | | | | | | |
Collapse
|
10
|
Beeching NJ, Fletcher TE, Hill DR, Thomson GL. Travellers and viral haemorrhagic fevers: what are the risks? Int J Antimicrob Agents 2010; 36 Suppl 1:S26-35. [PMID: 20705436 DOI: 10.1016/j.ijantimicag.2010.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Viral haemorrhagic fevers (VHF) are caused by zoonotic viral infections transmitted to humans directly or by ticks or mosquitoes. The overall risk to travellers is conservatively estimated at <1 in 1 million travel episodes to African countries where infection is present, and febrile patients returning from these countries are at least 1000 times more likely to have malaria than Lassa fever or another VHF. No cases have been reported in fellow travellers exposed to a travelling case and only one asymptomatic seroconversion (to Lassa) has been reported in over 2000 contacts following care of VHF cases in modern Western hospital settings. However, healthcare-associated transmission of infection has been a major problem in some endemic settings. The potential for healthcare-associated infection and the threats posed by unrecognised or new agents necessitate a high index of suspicion and a standardised risk assessment approach to febrile travellers. Travel-related hantavirus infections are increasingly being reported from Europe and the Americas. This article summarises the epidemiology and reports of travel-related VHF cases in the past 40 years, together with strategies for their recognition, management and prevention.
Collapse
Affiliation(s)
- Nick J Beeching
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK.
| | | | | | | |
Collapse
|
11
|
Hantavirus nephropathy as a pseudo-import pathology from Ecuador. Eur J Clin Microbiol Infect Dis 2009; 29:59-62. [PMID: 19821128 DOI: 10.1007/s10096-009-0820-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 09/15/2009] [Indexed: 10/20/2022]
Abstract
We report a case of hantavirus infection (nephropathia epidemica) diagnosed in a Belgian backpacker returning from a trekking expedition in Ecuador, after likely heavy exposure to rodents. Because of epidemiological inconsistency, molecular investigation was performed and revealed a Puumala infection acquired during very limited exposure in Belgium upon return.
Collapse
|
12
|
Environmental and ecological potential for enzootic cycles of Puumala hantavirus in Great Britain. Epidemiol Infect 2009; 138:91-8. [PMID: 19563697 DOI: 10.1017/s095026880999029x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Puumala virus (PUUV) is a zoonotic rodent-borne hantavirus in continental Europe. Its reservoir host, the bank vole (Myodes glareolus), is ubiquitous in Great Britain (GB); however, there has been no reported incidence of virus in either animals or humans. In northwest Europe, increases in bank vole numbers, stimulated by increases in production of beech/oak crops (mast), are associated with outbreaks of nephropathia epidemica (NE) in humans. These so-called 'mast years' are determined by sequential climatic events. This paper investigates the contribution of a number of ecological and environmental factors driving outbreaks of PUUV in northwest Europe and assesses whether such factors might also permit enzootic PUUV circulation in GB. Analysis of GB climate data, using regression models, confirms that mast years in GB are stimulated, and can be predicted, by the same climatic events as mast years in PUUV-endemic regions of northwest Europe. A number of other possible non-climatic constraints on enzootic cycles are discussed.
Collapse
|
13
|
Maes P, Clement J, Van Ranst M. Recent approaches in hantavirus vaccine development. Expert Rev Vaccines 2009; 8:67-76. [PMID: 19093774 DOI: 10.1586/14760584.8.1.67] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Rodent-borne hantaviruses are associated with two main clinical disorders in humans: hemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome. Although hantavirus diseases can be life threatening and numerous research efforts are focused on the development of hantavirus prevention, no specific antiviral therapy is yet available and, at this time, no WHO-approved vaccine has gained widespread acceptance. This review will summarize the current knowledge and recent progress as well as new speculative approaches in the development of hantavirus vaccines.
Collapse
Affiliation(s)
- Piet Maes
- Clinical Virology, Rega Institute for Medical Research, Katholieke Universiteit Leuven, Minderbroedersstraat 10, B3000 Leuven, Belgium.
| | | | | |
Collapse
|
14
|
Clement J, Vercauteren J, Verstraeten WW, Ducoffre G, Barrios JM, Vandamme AM, Maes P, Van Ranst M. Relating increasing hantavirus incidences to the changing climate: the mast connection. Int J Health Geogr 2009; 8:1. [PMID: 19149870 PMCID: PMC2642778 DOI: 10.1186/1476-072x-8-1] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 01/16/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nephropathia epidemica (NE), an emerging rodent-borne viral disease, has become the most important cause of infectious acute renal failure in Belgium, with sharp increases in incidence occurring for more than a decade. Bank voles are the rodent reservoir of the responsible hantavirus and are known to display cyclic population peaks. We tried to relate these peaks to the cyclic NE outbreaks observed since 1993. Our hypothesis was that the ecological causal connection was the staple food source for voles, being seeds of deciduous broad-leaf trees, commonly called "mast". We also examined whether past temperature and precipitation preceding "mast years" were statistically linked to these NE outbreaks. RESULTS Since 1993, each NE peak is immediately preceded by a mast year, resulting in significantly higher NE case numbers during these peaks (Spearman R = -0.82; P = 0.034). NE peaks are significantly related to warmer autumns the year before (R = 0.51; P < 0.001), hotter summers two years before (R = 0.32; P < 0.001), but also to colder (R = -0.25; P < 0.01) and more moist summers (R = 0.39; P < 0.001) three years before. Summer correlations were even more pronounced, when only July was singled out as the most representative summer month. CONCLUSION NE peaks in year 0 are induced by abundant mast formation in year-1, facilitating bank vole survival during winter, thus putting the local human population at risk from the spring onwards of year 0. This bank vole survival is further promoted by higher autumn temperatures in year-1, whereas mast formation itself is primed by higher summer temperatures in year-2. Both summer and autumn temperatures have been rising to significantly higher levels during recent years, explaining the virtually continuous epidemic state since 2005 of a zoonosis, considered rare until recently. Moreover, in 2007 a NE peak and an abundant mast formation occurred for the first time within the same year, thus forecasting yet another record NE incidence for 2008. We therefore predict that with the anticipated climate changes due to global warming, NE might become a highly endemic disease in Belgium and surrounding countries.
Collapse
Affiliation(s)
- Jan Clement
- Hantavirus Reference Center, Laboratory of Clinical Virology, Department of Microbiology & Immunology, Rega Institute, Minderbroedersstraat 10, B3000 Leuven, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Clement J, Maes P, Van Ranst M. Acute kidney injury in emerging, non-tropical infections. Acta Clin Belg 2007; 62:387-95. [PMID: 18351183 DOI: 10.1179/acb.2007.058] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- J Clement
- Hantavirus Reference Centre K.U. Leuven, Laboratory of Clinical and Epidemiological Virology & Rega Institute for Medical Research, University of Leuven, Belgium.
| | | | | |
Collapse
|
16
|
Plyusnina A, Deter J, Charbonnel N, Cosson JF, Plyusnin A. Puumala and Tula hantaviruses in France. Virus Res 2007; 129:58-63. [PMID: 17532080 DOI: 10.1016/j.virusres.2007.04.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 04/19/2007] [Accepted: 04/19/2007] [Indexed: 11/23/2022]
Abstract
The first genome sequences of Tula (TULV) and Puumala (PUUV) hantaviruses undoubtedly originated from France were recovered from tissue samples of European common voles and bank voles captured in Jura region. Genetic analysis of S and M segments of French PUUV strain revealed its highest similarity to strains from neighboring Belgium and Germany and also from Slovakia. On phylogenetic trees, French PUUV strain was placed within the central European lineage formed by strains from these three countries. Both of our French TULV strains clustered together and formed a distinct, well-supported genetic lineage.
Collapse
Affiliation(s)
- Angelina Plyusnina
- Department of Virology, Haartman Institute, University of Helsinki, P.O. Box 21 (Haartmaninkatu 3), FI-00014 Helsinki, Finland
| | | | | | | | | |
Collapse
|
17
|
Maes P, Clement J, Groeneveld PHP, Colson P, Huizinga TWJ, Van Ranst M. Tumor necrosis factor-alpha genetic predisposing factors can influence clinical severity in nephropathia epidemica. Viral Immunol 2006; 19:558-64. [PMID: 16987073 DOI: 10.1089/vim.2006.19.558] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Severe human infection with Hantavirus is characterized by high fever, cold chills, thrombocytopenia, arterial hypotension, acute renal failure, and/or adult respiratory distress syndrome (ARDS)-like pulmonary involvement, but the clinical course varies greatly between individuals. We investigated whether genetically determined differences in tumor necrosis factor (TNF)-alpha production can influence the severity of Hantavirus disease. We studied a TNF-alpha single-nucleotide promoter polymorphism (SNP) at position -238 (a guanine [G]-to-adenine [A] transition) and ex vivo TNF-alpha production in a recall study of 36 Belgian patients who had a serologically proven form of Puumala virus-induced Hantavirus infection with the kidney as main target organ. In our study, the highest creatinine levels were found in patients with the lowest ex vivo TNF-alpha production. Creatinine levels correlated inversely with TNF-alpha production (R = -0.35, p < 0.05). The number of thrombocytes was significantly lower in patients with the GA-238 genotype (low TNF-alpha producers) compared with patients with the GG-238 genotype. In our study, genetically determined low production of TNF-alpha was associated with some parameters indicating a more severe clinical course of Puumala Hantavirus infection in humans, possibly by impaired activation of TNF-alpha-dependent antiviral mechanisms, which could in turn result in decreased clearance of Hantavirus.
Collapse
Affiliation(s)
- Piet Maes
- Laboratory of Clinical and Epidemiological Virology, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
18
|
Ardalan MR, Tubbs RS, Chinikar S, Shoja MM. Crimean–Congo haemorrhagic fever presenting as thrombotic microangiopathy and acute renal failure. Nephrol Dial Transplant 2006; 21:2304-7. [PMID: 16735392 DOI: 10.1093/ndt/gfl248] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mohammed Reza Ardalan
- Department of Nephrology, Tabriz University of Medical Sciences (TUMS), Tabriz, Iran.
| | | | | | | |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW The hemolytic uremic syndrome (HUS) is the most common cause of acute renal failure in infants and young children, and is a substantial cause of acute mortality and chronic morbidity. It is therefore relevant and appropriate that pediatricians remain familiar with the various subsets of the disease including its classification, management, and outcome. RECENT FINDINGS This review will focus on recent information relative to epidemiology, pathogenesis, treatment, and outcome. It will include some of the newer associations between HUS and a variety of infections, including, but not limited to E. coli 0157:H7 (Shiga toxin-mediated) HUS, as well as the ever-increasing number of associations between HUS and a variety of drugs. It will review some of the newer therapies for the more common subsets, but will acknowledge that choosing evidence-based therapies is often limited by our incomplete understanding of the various pathogenic cascades, and that with the possible exception of Shiga toxin-mediated HUS(D+HUS), long-term outcome information is often limited by small numbers and limited follow-up. SUMMARY This review should provide a framework for making the proper diagnosis, implementing appropriate treatment, and advising the family about anticipated outcome.
Collapse
Affiliation(s)
- Richard Siegler
- Department of Pediatrics, Division of Nephrology, University of Utah School of Medicine, East Salt Lake City, Utah, USA.
| | | |
Collapse
|
20
|
Maes P, Clement J, Gavrilovskaya I, Van Ranst M. Hantaviruses: Immunology, Treatment, and Prevention. Viral Immunol 2004; 17:481-97. [PMID: 15671746 DOI: 10.1089/vim.2004.17.481] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Hantaviruses are rodent-borne bunyaviruses that are associated with two main clinical diseases in humans: hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome. It has been suggested that host-related immune mechanisms rather than direct viral cytopathology may be responsible for the principal abnormality (vascular dysfunction) in these syndromes. This review summarizes the current knowledge on hantaviral host immune responses, immune abnormalities, laboratory diagnosis, and antiviral therapy as well as the current approaches in vaccine development.
Collapse
Affiliation(s)
- Piet Maes
- Laboratory of Clinical Virology, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | | | | | | |
Collapse
|
21
|
Maes P, Keyaerts E, Clement J, Bonnet V, Robert A, Van Ranst M. Detection of Puumala Hantavirus Antibody with ELISA Using a Recombinant Truncated Nucleocapsid Protein Expressed inEscherichia coli. Viral Immunol 2004; 17:315-21. [PMID: 15279709 DOI: 10.1089/0882824041310540] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A truncated recombinant nucleocapsid protein (rNp118) consisting of the first 118 amino-terminal amino acids (AA) of the Puumala hantavirus (PUUV) nucleocapsid protein expressed in Escherichia coli, was evaluated for its antigenicity and reliability as serodiagnostic antigen in an enzyme-linked immunosorbent assay (ELISA) for detection of PUUV antibodies in human sera. The PUUV nucleocapsid protein has been shown to contain several B-cell epitopes, mapped within the first 118 amino-terminal AA. This finding makes the rNp118 an interesting recombinant protein to use as serodiagnostic antigen. The sensitivity of this new PUUV-rNp118 ELISA, was compared with those of a commercially available PUUV ELISA assay and an home-made ELISA based on a recombinant whole nucleocapsid protein of PUUV. Eighty-six human serum samples clinically suspected for PUUV-induced nephropathia epidemica, and previously screened with the reference assays, were tested. The sensitivity of the new assay was compared with that of the reference assays and an excellent correlation between the assays was found. Sera found to be negative by other methods were also negative in our assay. The ELISA based on rNp118 represents an alternative and valid test for detection of antibodies to PUUV in human sera.
Collapse
Affiliation(s)
- Piet Maes
- Laboratory of Clinical and Epidemiological Virology, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | | | | | | | | | | |
Collapse
|