Abstract
In Europe, infections with Puumala hantavirus cause nephropathia epidemica. Presently the risk factors predicting severe kidney damage after Puumala virus infection are not well known. The objective of the study was to investigate environmental and individual factors predicting severe kidney damage caused by serologically established Puumala infections. In a nationwide cohort study we investigated all serologically established Puumala infections in Southern Denmark from 1996 to 2012. A total of 184 patients had serologically verified Puumala virus infection. In patients with Puumala virus infections the decrease of platelet counts preceded acute kidney failure. Multivariable logistic regression demonstrated that recent activities in the forest, platelet counts, and flu-like symptoms predicted estimated glomerular filtration rates less than 30 mL/min/1.73 m², but not age, gender, fever, nor abdominal pain. Severe kidney damage in Puumala infections in Southern Denmark is associated with the risk of recent activities in the forest.
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References
Pettersson L, Boman J, Juto P, Evander M, Ahlm C (2008) Outbreak of Puumala virus infection. Sweden Emerg Infect Dis 14:808–810. doi:10.3201/eid1405.071124
Vapalahti O, Mustonen J, Lundkvist A, Henttonen H, Plyusnin A, Vaheri A (2003) Hantavirus infections in Europe. Lancet Infect Dis 3:653–661
Bi Z, Formenty PB, Roth CE (2008) Hantavirus infection: a review and global update. J Infect Dev Ctries 2:3–23
Muranyi W, Kehm R, Bahr U, Müller S, Handermann M, Darai G, Zeier M (2004) Bovine aortic endothelial cells are susceptible to hantavirus infection; a new aspect in hantavirus ecology. Virology 318:112–122
Geimonen E, Neff S, Raymond T, Kocer SS, Gavrilovskaya IN, Mackow ER (2002) Pathogenic and nonpathogenic hantaviruses differentially regulate endothelial cell responses. Proc Natl Acad Sci USA 99:13837–13842
Libraty DH, Mäkelä S, Vlk J, Hurme M, Vaheri A, Ennis FA, Mustonen J (2012) The degree of leukocytosis and urine GATA-3 mRNA levels are risk factors for severe acute kidney injury in Puumala virus nephropathia epidemica. PLoS One 7, e35402. doi:10.1371/journal.pone.0035402
Wang M, Wang J, Wang T, Li J, Hui L, Ha X (2013) Thrombocytopenia as a predictor of severe acute kidney injury in patients with Hantaan virus infections. PLoS One 8, e53236. doi:10.1371/journal.pone.0053236
Sane J, Laine O, Mäkelä S, Paakkala A, Jarva H, Mustonen J, Vapalahti O, Meri S, Vaheri A (2012) Complement activation in Puumala hantavirus infection correlates with disease severity. Ann Med 44:468–475. doi:10.3109/07853890.2011.573500
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612
Chapman LE, Ellis BA, Koster FT, Sotir M, Ksiazek TG, Mertz GJ, Rollin PE, Baum KF, Pavia AT, Christenson JC, Rubin PJ, Jolson HM, Behrman RE, Khan AS, Bell LJ, Simpson GL, Hawk J, Holman RC, Peters CJ, Ribavirin Study Group (2002) Discriminators between hantavirus-infected and -uninfected persons enrolled in a trial of intravenous ribavirin for presumptive hantavirus pulmonary syndrome. Clin Infect Dis 34:293–304
Keyaerts E, Ghijsels E, Lemey P, Maes P, Zachée P, Daelemans R, Vervoort T, Mertens G, Van Ranst M, Clement J (2004) Plasma exchange-associated immunoglobulin M-negative hantavirus disease after a camping holiday in southern France. Clin Infect Dis 38:1350–1356
Rasche FM, Uhel B, Ulrich R, Krüger DH, Karges W, Czock D, Hampl W, Keller F, Meisel H, von Müller L (2004) Thrombocytopenia and acute renal failure in Puumala hantavirus infections. Emerg Infect Dis 10:1420–1425
Acknowledgments
We thank Jens K. Møller and Hans L Nielsen for help in data collection.
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The authors declare that they have no competing financial interests. There is no conflict of interest.
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Skarphedinsson S, Thiesson HC, and Tepel M designed the research.
Skarphedinsson S, Thiesson HC, Shakar SA and Tepel M acquired, analyzed and interpreted data.
Skarphedinsson S, Thiesson HC, and Tepel M drafted the manuscript.
Skarphedinsson S, Thiesson HC, Shakar SA and Tepel M revised the manuscript for important intellectual content.
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Skarphedinsson, S., Thiesson, H.C., Shakar, S.A. et al. Factors predicting kidney damage in Puumala virus infected patients in Southern Denmark. Eur J Clin Microbiol Infect Dis 34, 2017–2021 (2015). https://doi.org/10.1007/s10096-015-2446-2
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DOI: https://doi.org/10.1007/s10096-015-2446-2