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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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Đaković Rode O, Bodulić K, Zember S, Cetinić Balent N, Novokmet A, Čulo M, Rašić Ž, Mikulić R, Markotić A. Decline of Anti-SARS-CoV-2 IgG Antibody Levels 6 Months after Complete BNT162b2 Vaccination in Healthcare Workers to Levels Observed Following the First Vaccine Dose. Vaccines (Basel) 2022; 10:vaccines10020153. [PMID: 35214612 PMCID: PMC8876023 DOI: 10.3390/vaccines10020153] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/10/2022] Open
Abstract
Research on post-vaccination antibody dynamics has become pivotal in estimating COVID-19 vaccine efficacy. We studied anti-SARS-CoV-2 Spike RBD IgG levels in 587 healthcare workers (2038 sera) who completed BNT162b2 vaccination. Average antibody titer 3 weeks after the first dose in COVID-19-naïve participants (median 873.5 AU/mL) was 18-fold higher than the test threshold, with a significant increase 1 month (median 9927.2 AU/mL) and an exponential decrease 3 (median 2976.7 AU/mL) and 6 (median 966.0 AU/mL) months after complete vaccination. Participants with a history of COVID-19 prior to vaccination showed significantly higher antibody levels, particularly after the first dose (median 14,280.2 AU/mL), with a slight decline 1 month (median 12,700.0 AU/mL) and an exponential decline in antibody titers 3 (median 4831.0 AU/mL) and 6 (median 1465.2 AU/mL) months after vaccination. Antibody levels of COVID-19-naïve subjects after the first dose were moderately correlated with age (r = −0.4). Multivariate analysis showed a strong independent correlation between IgG levels 6 months after vaccination and both IgG titers after the first dose and 1 month after vaccination (R2 = 0.709). Regardless of pre-vaccination COVID-19 history, IgG levels 6 months after vaccination were comparable to antibody levels reached by COVID-19-naïve participants after the first vaccine dose.
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Affiliation(s)
- Oktavija Đaković Rode
- Department for Clinical Microbiology, Division for Virology, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia; (N.C.B.); (R.M.)
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence: ; Tel.: +385-914-012-553
| | - Kristian Bodulić
- Research Department, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia; (K.B.); (A.M.)
| | - Sanja Zember
- Health Care Quality Unit, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia; (S.Z.); (Ž.R.)
| | - Nataša Cetinić Balent
- Department for Clinical Microbiology, Division for Virology, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia; (N.C.B.); (R.M.)
| | - Anđa Novokmet
- Department for Adult Intensive Care and Neuroinfections, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia;
| | - Marija Čulo
- Department for Clinical Microbiology, Division for Bacteriology, Hospital Infections and Sterilization, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia;
| | - Željka Rašić
- Health Care Quality Unit, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia; (S.Z.); (Ž.R.)
| | - Radojka Mikulić
- Department for Clinical Microbiology, Division for Virology, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia; (N.C.B.); (R.M.)
| | - Alemka Markotić
- Research Department, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia; (K.B.); (A.M.)
- School of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
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Rode OĐ, Kurolt IC, Puljiz I, Čivljak R, Balent NC, Laškaj R, Tiljak MK, Mikulić R, Markotić A. Antibody response and the clinical presentation of patients with COVID-19 in Croatia: the importance of a two-step testing approach. Eur J Clin Microbiol Infect Dis 2021; 40:261-268. [PMID: 32886230 PMCID: PMC7472404 DOI: 10.1007/s10096-020-04019-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/24/2020] [Indexed: 12/23/2022]
Abstract
According to anti-SARS-CoV-2 seroresponse in patients with COVID-19 from Croatia, we emphasised the issue of different serological tests and need for combining diagnostic methods for COVID-19 diagnosis. Anti-SARS-CoV-2 IgA and IgG ELISA and IgM/IgG immunochromatographic assay (ICA) were used for testing 60 sera from 21 patients (6 with severe, 10 moderate, and 5 with mild disease). The main clinical, demographic, and haemato-biochemical data were analysed. The most common symptoms were cough (95.2%), fever (90.5%), and fatigue and shortness of breath (42.9%). Pulmonary opacities showed 76.2% of patients. Within the first 7 days of illness, seropositivity for ELISA IgA and IgG was 42.9% and 7.1%, and for ICA IgM and IgG 25% and 10.7%, respectively. From day 8 after onset, ELISA IgA and IgG seropositivity was 90.6% and 68.8%, and for ICA IgM and IgG 84.4% and 75%, respectively. In general, sensitivity for ELISA IgA and IgG was 68.3% and 40%, and for ICA IgM and IgG 56.7% and 45.0%, respectively. The anti-SARS-CoV-2 antibody distributions by each method were statistically different (ICA IgM vs. IgG, p = 0.016; ELISA IgG vs. IgA, p < 0.001). Antibody response in COVID-19 varies and depends on the time the serum is taken, on the severity of disease, and on the type of test used. IgM and IgA antibodies as early-stage disease markers are comparable, although they cannot replace each other. Simultaneous IgM/IgG/IgA anti-SARS-CoV-2 antibody testing followed by the confirmation of positive findings with another test in a two-tier testing is recommended.
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Affiliation(s)
- Oktavija Đaković Rode
- University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Mirogojska 8, 10000, Zagreb, Croatia.
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia.
| | - Ivan-Christian Kurolt
- University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Mirogojska 8, 10000, Zagreb, Croatia
| | - Ivan Puljiz
- University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Mirogojska 8, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Rok Čivljak
- University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Mirogojska 8, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Nataša Cetinić Balent
- University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Mirogojska 8, 10000, Zagreb, Croatia
| | - Renata Laškaj
- University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Mirogojska 8, 10000, Zagreb, Croatia
| | - Mirjana Kujundžić Tiljak
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Andrija Štampar School of Public Health, Zagreb, Croatia
| | - Radojka Mikulić
- University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Mirogojska 8, 10000, Zagreb, Croatia
| | - Alemka Markotić
- University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Mirogojska 8, 10000, Zagreb, Croatia
- Catholic University of Croatia, Zagreb, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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