Another case of “European hantavirus pulmonary syndrome” with severe lung, prior to kidney, involvement, and diagnosed by viral inclusions in lung macrophages

  • M. Gizzi
  • B. Delaere
  • B. Weynand
  • J. Clement
  • P. Maes
  • V. Vergote
  • L. Laenen
  • B. Hjelle
  • A. Verroken
  • A. Dive
  • I. Michaux
  • P. Evrard
  • D. Creytens
  • P. Bulpa
Article

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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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • M. Gizzi
    • 1
  • B. Delaere
    • 2
  • B. Weynand
    • 3
  • J. Clement
    • 4
    • 5
  • P. Maes
    • 4
    • 5
  • V. Vergote
    • 4
    • 5
  • L. Laenen
    • 4
    • 5
  • B. Hjelle
    • 6
  • A. Verroken
    • 7
  • A. Dive
    • 1
  • I. Michaux
    • 1
  • P. Evrard
    • 1
  • D. Creytens
    • 8
  • P. Bulpa
    • 1
  1. 1.Intensive Care UnitCentre Hospitalier Universitaire de Mont-Godinne, Université Catholique de LouvainYvoirBelgium
  2. 2.Infectious Diseases UnitCentre Hospitalier Universitaire de Mont-Godinne, Université Catholique de LouvainYvoirBelgium
  3. 3.Pathology UnitCentre Hospitalier Universitaire de Mont-Godinne, Université Catholique de LouvainYvoirBelgium
  4. 4.National Reference Centre for Hantaviruses, University Hospitals Leuven, GasthuisbergUniversity of LeuvenLeuvenBelgium
  5. 5.Zoonotic Infectious Diseases unit, Clinical VirologyRega Institute for Medical ResearchLeuvenBelgium
  6. 6.Departments of Pathology, Biology, Molecular Genetics and Microbiology, Center for Infectious Diseases and ImmunityUniversity of New MexicoAlbuquerqueUSA
  7. 7.Microbiology UnitCentre Hospitalier Universitaire de Mont-Godinne, Université Catholique de LouvainYvoirBelgium
  8. 8.Pathology DepartmentUniversity Hospital GhentGhentBelgium

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