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Case Reports
. 2011 May;30(5):685-90.
doi: 10.1007/s10096-010-1141-6. Epub 2011 Jan 15.

Time to revise the paradigm of hantavirus syndromes? Hantavirus pulmonary syndrome caused by European hantavirus

Affiliations
Case Reports

Time to revise the paradigm of hantavirus syndromes? Hantavirus pulmonary syndrome caused by European hantavirus

J Rasmuson et al. Eur J Clin Microbiol Infect Dis. 2011 May.

Abstract

Hantaviruses have previously been recognised to cause two separate syndromes: hemorrhagic fever with renal syndrome in Eurasia, and hantavirus pulmonary syndrome (HPS) in the Americas. However, increasing evidence suggests that this dichotomy is no longer fruitful when recognising human hantavirus disease and understanding the pathogenesis. Herein are presented three cases of severe European Puumala hantavirus infection that meet the HPS case definition. The clinical and pathological findings were similar to those found in American hantavirus patients. Consequently, hantavirus infection should be considered as a cause of acute respiratory distress in all endemic areas worldwide.

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Figures

Fig. 1
Fig. 1
Chest CT-scans of two European patients with hantavirus pulmonary syndrome. The examination showed pronounced diffuse bilateral interstitial infiltrates with pulmonary oedema, together with bilateral dependent atelectasis and moderate pleural effusions in patient 1 (a) and diffuse bilateral alveolar and interstitial infiltrates with dependent consolidation in patient 2 (b)
Fig. 2
Fig. 2
Immunohistochemistry results in lung sections from two fatal cases of hantavirus pulmonary syndrome. The findings were condensed oedematous pulmonary parenchyma with alveolar fibrinous exudate and infiltrates of mononuclear cells (a), whereof a vast majority were CD8+ T lymphocytes (b), and many were holding granules containing granzyme B (c) and T cell restricted antigen-1, TIA-1 (d); this immunophenotype is characteristic of activated cytotoxic T lymphocytes. In contrast, CD4+ helper T lymphocytes (e) were uncommon. Viral antigen was detected in capillary vascular endothelium (f) and in mononuclear cells, here represented by a monocyte (f; inset), using Puumala hantavirus nucleocapsid protein monoclonal antibody (A1C5, Progen Biotechnik GmbH, Heidelberg, Germany). For viral antigen, lung samples from two non-hantavirus patients were used as negative controls (data not shown). Panels (Patient 1 in a–e; original magnification, x 400; and Patient 3 in f; original magnification, x 600) display lung sections from paraffin embedded material. Staining was performed using hematoxylin and eosin (a), and immunoperoxidase technique (b–f)

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