PMID- 20545485
OWN - NLM
STAT- MEDLINE
DCOM- 20100913
LR  - 20100615
IS  - 1365-2060 (Electronic)
IS  - 0785-3890 (Linking)
VI  - 42
IP  - 5
DP  - 2010 Jul
TI  - Central nervous system-related symptoms and findings are common in acute Puumala 
      hantavirus infection.
PG  - 344-51
LID - 10.3109/07853890.2010.480979 [doi]
AB  - 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.
FAU - Hautala, Timo
AU  - Hautala T
AD  - Department of Internal Medicine, Oulu University Hospital, Oulu, Finland. 
      timo.hautala@oulu.fi
FAU - Mahonen, Saara-Mari
AU  - Mahonen SM
FAU - Sironen, Tarja
AU  - Sironen T
FAU - Hautala, Nina
AU  - Hautala N
FAU - Paakko, Eija
AU  - Paakko E
FAU - Karttunen, Ari
AU  - Karttunen A
FAU - Salmela, Pasi I
AU  - Salmela PI
FAU - Ilonen, Jorma
AU  - Ilonen J
FAU - Vainio, Olli
AU  - Vainio O
FAU - Glumoff, Virpi
AU  - Glumoff V
FAU - Rytky, Seppo
AU  - Rytky S
FAU - Plyusnin, Alexander
AU  - Plyusnin A
FAU - Vaheri, Antti
AU  - Vaheri A
FAU - Vapalahti, Olli
AU  - Vapalahti O
FAU - Kauma, Heikki
AU  - Kauma H
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Ann Med
JT  - Annals of medicine
JID - 8906388
RN  - 0 (HLA Antigens)
RN  - 0 (Immunoglobulin M)
SB  - IM
MH  - Adult
MH  - Brain/virology
MH  - Central Nervous System Diseases/genetics/*virology
MH  - Cerebrospinal Fluid/virology
MH  - Electroencephalography
MH  - Female
MH  - Genetic Predisposition to Disease
MH  - HLA Antigens/genetics
MH  - Haplotypes
MH  - Hemorrhagic Fever with Renal Syndrome/*complications/genetics
MH  - Humans
MH  - Immunoglobulin M/cerebrospinal fluid
MH  - Magnetic Resonance Imaging/methods
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Puumala virus/*isolation & purification
EDAT- 2010/06/16 06:00
MHDA- 2010/09/14 06:00
CRDT- 2010/06/16 06:00
PHST- 2010/06/16 06:00 [entrez]
PHST- 2010/06/16 06:00 [pubmed]
PHST- 2010/09/14 06:00 [medline]
AID - 10.3109/07853890.2010.480979 [doi]
PST - ppublish
SO  - Ann Med. 2010 Jul;42(5):344-51. doi: 10.3109/07853890.2010.480979.