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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Clement J, Vergote V, Laenen L, Van Ranst M. Letter to the editor: Distinguishing between hantavirus-induced haemorrhagic fever with renal syndrome and pregnancy-induced liver pathologies (AFLP and HELLP syndromes). Euro Surveill 2013. [DOI: 10.2807/ese.18.22.20493-en] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J Clement
- National Reference Laboratory for Hantavirus Infections, Laboratory of Clinical Virology, University Hospital Gasthuisberg, Leuven, Belgium
| | - V Vergote
- National Reference Laboratory for Hantavirus Infections, Laboratory of Clinical Virology, University Hospital Gasthuisberg, Leuven, Belgium
| | - L Laenen
- National Reference Laboratory for Hantavirus Infections, Laboratory of Clinical Virology, University Hospital Gasthuisberg, Leuven, Belgium
| | - M Van Ranst
- National Reference Laboratory for Hantavirus Infections, Laboratory of Clinical Virology, University Hospital Gasthuisberg, Leuven, Belgium
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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