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Fatal Puumala Hantavirus Infection in a Patient with Common Variable Immunodeficiency (CVID)

Puumala hantavirus (PUUV) infections usually show a mild or moderate clinical course, but may sometimes also lead to life-threatening disease. Here, we report on a 60-year-old female patient with common variable immunodeficiency (CVID) who developed a fatal PUUV infection with persistent renal failu...

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Autores principales: Steininger, Philipp, Herbst, Larissa, Bihlmaier, Karl, Willam, Carsten, Körper, Sixten, Schrezenmeier, Hubert, Klüter, Harald, Pfister, Frederick, Amann, Kerstin, Weiss, Sabrina, Krüger, Detlev H., Zimmermann, Robert, Korn, Klaus, Hofmann, Jörg, Harrer, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9966676/
https://www.ncbi.nlm.nih.gov/pubmed/36838248
http://dx.doi.org/10.3390/microorganisms11020283
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author Steininger, Philipp
Herbst, Larissa
Bihlmaier, Karl
Willam, Carsten
Körper, Sixten
Schrezenmeier, Hubert
Klüter, Harald
Pfister, Frederick
Amann, Kerstin
Weiss, Sabrina
Krüger, Detlev H.
Zimmermann, Robert
Korn, Klaus
Hofmann, Jörg
Harrer, Thomas
author_facet Steininger, Philipp
Herbst, Larissa
Bihlmaier, Karl
Willam, Carsten
Körper, Sixten
Schrezenmeier, Hubert
Klüter, Harald
Pfister, Frederick
Amann, Kerstin
Weiss, Sabrina
Krüger, Detlev H.
Zimmermann, Robert
Korn, Klaus
Hofmann, Jörg
Harrer, Thomas
author_sort Steininger, Philipp
collection PubMed
description Puumala hantavirus (PUUV) infections usually show a mild or moderate clinical course, but may sometimes also lead to life-threatening disease. Here, we report on a 60-year-old female patient with common variable immunodeficiency (CVID) who developed a fatal PUUV infection with persistent renal failure, thrombocytopenia, and CNS infection with impaired consciousness and tetraparesis. Hantavirus-specific antibodies could not be detected due to the humoral immunodeficiency. Diagnosis and virological monitoring were based on the quantitative detection of PUUV RNA in blood, cerebrospinal fluid, bronchial lavage, and urine, where viral RNA was found over an unusually extended period of one month. Due to clinical deterioration and virus persistence, treatment with ribavirin was initiated. Additionally, fresh frozen plasma (FFP) from convalescent donors with a history of PUUV infection was administered. Despite viral clearance, the clinical condition of the patient did not improve and the patient died on day 81 of hospitalization. This case underlines the importance of the humoral immune response for the course of PUUV disease and illustrates the need for PCR-based virus diagnostics in those patients. Due to its potential antiviral activity, convalescent plasma should be considered in the therapy of severe hantavirus diseases.
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spelling pubmed-99666762023-02-26 Fatal Puumala Hantavirus Infection in a Patient with Common Variable Immunodeficiency (CVID) Steininger, Philipp Herbst, Larissa Bihlmaier, Karl Willam, Carsten Körper, Sixten Schrezenmeier, Hubert Klüter, Harald Pfister, Frederick Amann, Kerstin Weiss, Sabrina Krüger, Detlev H. Zimmermann, Robert Korn, Klaus Hofmann, Jörg Harrer, Thomas Microorganisms Case Report Puumala hantavirus (PUUV) infections usually show a mild or moderate clinical course, but may sometimes also lead to life-threatening disease. Here, we report on a 60-year-old female patient with common variable immunodeficiency (CVID) who developed a fatal PUUV infection with persistent renal failure, thrombocytopenia, and CNS infection with impaired consciousness and tetraparesis. Hantavirus-specific antibodies could not be detected due to the humoral immunodeficiency. Diagnosis and virological monitoring were based on the quantitative detection of PUUV RNA in blood, cerebrospinal fluid, bronchial lavage, and urine, where viral RNA was found over an unusually extended period of one month. Due to clinical deterioration and virus persistence, treatment with ribavirin was initiated. Additionally, fresh frozen plasma (FFP) from convalescent donors with a history of PUUV infection was administered. Despite viral clearance, the clinical condition of the patient did not improve and the patient died on day 81 of hospitalization. This case underlines the importance of the humoral immune response for the course of PUUV disease and illustrates the need for PCR-based virus diagnostics in those patients. Due to its potential antiviral activity, convalescent plasma should be considered in the therapy of severe hantavirus diseases. MDPI 2023-01-21 /pmc/articles/PMC9966676/ /pubmed/36838248 http://dx.doi.org/10.3390/microorganisms11020283 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Steininger, Philipp
Herbst, Larissa
Bihlmaier, Karl
Willam, Carsten
Körper, Sixten
Schrezenmeier, Hubert
Klüter, Harald
Pfister, Frederick
Amann, Kerstin
Weiss, Sabrina
Krüger, Detlev H.
Zimmermann, Robert
Korn, Klaus
Hofmann, Jörg
Harrer, Thomas
Fatal Puumala Hantavirus Infection in a Patient with Common Variable Immunodeficiency (CVID)
title Fatal Puumala Hantavirus Infection in a Patient with Common Variable Immunodeficiency (CVID)
title_full Fatal Puumala Hantavirus Infection in a Patient with Common Variable Immunodeficiency (CVID)
title_fullStr Fatal Puumala Hantavirus Infection in a Patient with Common Variable Immunodeficiency (CVID)
title_full_unstemmed Fatal Puumala Hantavirus Infection in a Patient with Common Variable Immunodeficiency (CVID)
title_short Fatal Puumala Hantavirus Infection in a Patient with Common Variable Immunodeficiency (CVID)
title_sort fatal puumala hantavirus infection in a patient with common variable immunodeficiency (cvid)
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9966676/
https://www.ncbi.nlm.nih.gov/pubmed/36838248
http://dx.doi.org/10.3390/microorganisms11020283
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