Hantavirus‐specific IgA in saliva and viral antigen in the parotid gland in patients with hemorrhagic fever with renal syndrome

Abstract

The Hantavirus genus comprises rodent borne, zoonotic viruses of the Bunyaviridae family that cause hemorrhagic fever with renal syndrome (HFRS) in Eurasia and hantavirus cardiopulmonary syndrome (HCPS) in the Americas. Rodent saliva contains infectious hantavirus and evidence suggests that hantavirus is also shed in human saliva, but person-to-person transmission is rare. In saliva, immunoglobulin (Ig) A is the predominant immunoglobulin class. Secretory IgA serves as an important first line of defence on epithelial surfaces and the binding of secretory IgA to pathogens can inhibit adherence of microorganisms to mucosal cells and neutralize viruses. This study investigated the presence and importance of salivary IgA in relation to viral antigen in the saliva by testing Puumala hantavirus (PUUV) specific IgA, and RNA in saliva in acutely ill patients with HFRS. In saliva samples, PUUV specific IgA was detected in 12 of 33 (36%) patients with HFRS and 20 (61%) were PUUV RNA positive. There was a statistically significant inverse association between the presence of salivary IgA antibodies and PUUV RNA in the saliva. PUUV-specific IgA in saliva was not found in a long-term follow-up, while PUUV IgA in serum was detected in three patients, 28-32 months after the initial study. Notably, both PUUV RNA and PUUV nucleocapsid antigen were detected in endothelial cells within the parotid gland of a deceased patient with HFRS.

Viral load and humoral immune response in association with disease severity in Puumala hantavirus-infected patients—implications for treatment

“…In our study, one limitation was that neutralizing antibodies were not analysed. We detected an inverse association between hantavirus-specific IgG and IgA antibody titres and viral load, as previously indicated for IgG 13 , 24 and salivary IgA 25 . However, in contrast to IgG titres, we did not observe any association with disease severity for IgA and IgM titres.…”

Find the right sample: A study on the versatility of saliva and urine samples for the diagnosis of emerging viruses

“…Petterson et al could demonstrate that hantavirus RNA was found in saliva few days after disease onset [ 41 ]. The association between the anti-Hantavirus IgA and Hantavirus RNA in saliva was inverse, the same is true for detecting RNA and antigen in endothelial cells within the parotid gland of HFRS patients [ 42 ]. In a recent study, the anti-Hantavirus antibodies in saliva was detected in a risk group in farms in Yorkshire, UK [ 43 ].…”

Parotitis associated with Crimean Congo hemorrhagic fever virus

“…16 In suppurative parotitis, bacteria such as Staphylococcus aureus and oral aerobes/anaerobes are the agents involved and are more frequently encountered in debilitated, dehydrated and elderly patients who have undergone surgery, while in non-suppurative parotitis the most frequent cause is mumps, although influenza, parainfluenza, coxsackie, echo viruses, CMV, HSV, HIV, EBV, lymphocytic choriomeningitis virus, hemorrhagic fever viruses such as hantavirus, dengue virus, Mycobacterium tuberculosis and other atypical microbacteria may also, rarely, cause parotitis. 12,13,16 Clinical findings are very similar among the hemorrhagic fever viruses which caused by parotitis. So serologic and molecular tests are essential for the differential diagnosis of them.…”

“…12 Pettersson et al were detected hantavirus-specific IgA in saliva and viral antigen in the parotid gland in patients with hemorrhagic fever with renal syndrome. 13 …”

“…At laboratory analysis, serum white blood cell (WBC) count was 2300/L (4.800-10.800), hemoglobin (Hb) 11.5 g/dL (12)(13)(14)(15)(16)(17), platelet (Plt) count 27.000/L, sedimentation 33 mm/h (0-20), Creactive protein (CRP) 0.85 mg/dL (0-5) and procalcitonin (PCT) 0.5 ng/mL (<0.5). Peripheral blood smear revealed a lymphomonocytic series predominance of 40-50%.…”