Document Detail


Central nervous system-related symptoms and findings are common in acute Puumala hantavirus infection.
MedLine Citation:
PMID:  20545485     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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; Saara-Mari Mähönen; Tarja Sironen; Nina Hautala; Eija Pääkkö; Ari Karttunen; Pasi I Salmela; Jorma Ilonen; Olli Vainio; Virpi Glumoff; Seppo Rytky; Alexander Plyusnin; Antti Vaheri; Olli Vapalahti; Heikki Kauma
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of medicine     Volume:  42     ISSN:  1365-2060     ISO Abbreviation:  Ann. Med.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-15     Completed Date:  2010-09-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8906388     Medline TA:  Ann Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  344-51     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Oulu University Hospital, Oulu, Finland. timo.hautala@oulu.fi
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MeSH Terms
Descriptor/Qualifier:
Adult
Brain / virology
Central Nervous System Diseases / genetics,  virology*
Cerebrospinal Fluid / virology
Electroencephalography
Female
Genetic Predisposition to Disease
HLA Antigens / genetics
Haplotypes
Hemorrhagic Fever with Renal Syndrome / complications*,  genetics
Humans
Immunoglobulin M / cerebrospinal fluid
Magnetic Resonance Imaging / methods
Male
Middle Aged
Prospective Studies
Puumala virus / isolation & purification*
Chemical
Reg. No./Substance:
0/HLA Antigens; 0/Immunoglobulin M

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