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Santini M, Ljubić J, Šoštar N, Vilibić-Čavlek T, Bogdanić M, Zakotnik S, Avšič-Županc T, Korva M, Kurolt IC, Radmanić L, Šimičić P, Krznarić J, Gjurašin B, Kutleša M, Višković K, Balent NC, Žunec R, Margeta Marić I, Ribarović A, Židovec-Lepej S. Hantavirus Pulmonary Syndrome Caused by Puumala Orthohantavirus-A Case Report and Literature Review. Microorganisms 2023; 11:2963. [PMID: 38138107 PMCID: PMC10745754 DOI: 10.3390/microorganisms11122963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
In this article, we report on a rare case of acute respiratory distress syndrome (ARDS) caused by the Puumala orthohantavirus (PUUV), which is typically associated with hemorrhagic fever with renal syndrome (HFRS). This is the first documented case of PUUV-associated ARDS in Southeast Europe. The diagnosis was confirmed by serum RT-PCR and serology and corroborated by phylogenetic analysis and chemokine profiling. The patient was a 23-year-old male from Zagreb, Croatia, who had recently traveled throughout Europe. He presented with fever, headache, abdominal pain, and sudden onset of ARDS. Treatment involved high-flow nasal cannula oxygen therapy and glucocorticoids, which resulted in a full recovery. A systematic literature review identified 10 cases of hantavirus pulmonary syndrome (HPS) caused by PUUV in various European countries and Turkey between 2002 and 2023. The median age of patients was 53 years (range 24-73), and six of the patients were male. Most patients were treated in intensive care units, but none received antiviral therapy targeting PUUV. Eight patients survived hospitalization. The presented case highlights the importance of considering HPS in the differential diagnosis of ARDS, even in areas where HFRS is the dominant form of hantavirus infection.
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Affiliation(s)
- Marija Santini
- Department for Infections in Immunocompromised Patients, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (T.V.-Č.); (J.K.); (M.K.)
| | - Jelena Ljubić
- Infectious Diseases Department, County Hospital Čakovec, 40000 Čakovec, Croatia;
| | - Nikola Šoštar
- Emergency Department, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia;
| | - Tatjana Vilibić-Čavlek
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (T.V.-Č.); (J.K.); (M.K.)
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
| | - Maja Bogdanić
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
| | - Samo Zakotnik
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (S.Z.); (T.A.-Ž.); (M.K.)
| | - Tatjana Avšič-Županc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (S.Z.); (T.A.-Ž.); (M.K.)
| | - Miša Korva
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (S.Z.); (T.A.-Ž.); (M.K.)
| | - Ivan Christian Kurolt
- Research Department, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia;
| | - Leona Radmanić
- Department for Molecular Diagnostics and Flow Cytometry, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia; (L.R.); (P.Š.); (S.Ž.-L.)
| | - Petra Šimičić
- Department for Molecular Diagnostics and Flow Cytometry, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia; (L.R.); (P.Š.); (S.Ž.-L.)
| | - Juraj Krznarić
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (T.V.-Č.); (J.K.); (M.K.)
- Department of Intensive Care Medicine and Neuroinfectology, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia;
| | - Branimir Gjurašin
- Department of Intensive Care Medicine and Neuroinfectology, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia;
| | - Marko Kutleša
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (T.V.-Č.); (J.K.); (M.K.)
- Department of Intensive Care Medicine and Neuroinfectology, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia;
| | - Klaudija Višković
- Department of Radiology and Ultrasound, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia;
| | - Nataša Cetinić Balent
- Department of Clinical Microbiology, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia;
| | - Renata Žunec
- Tissue Typing Laboratory, University Hospital Zagreb, 10000 Zagreb, Croatia;
| | | | | | - Snjezana Židovec-Lepej
- Department for Molecular Diagnostics and Flow Cytometry, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia; (L.R.); (P.Š.); (S.Ž.-L.)
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