Life-threatening Dobrava hantavirus infection with unusually extended pulmonary involvement

Hemorrhagic Fever with Renal Syndrome Caused by 2 Lineages of Dobrava Hantavirus, Russia1

“…Region 1 comprises the Balkan area in southeastern Europe where the classic DOBV (our DOBV-Af) was found in A. fl avicollis animals as well as in human patients (7,8). Region 2 encompasses northeastern Germany and other regions of central Europe (13,15) as well as the central part of European Russia (this study) where the DOBVAa variant from A. agrarius causes mainly mild to moderate HFRS but also severe, life-threatening disease (17). The Sochi region, with its novel animal reservoir of DOBV, A. ponticus, and the DOBV-Ap-associated HFRS cases is marked as region 3.…”

“…This particular virus lineage is named DOBV-Aa, and a cell culture isolate of DOBV-Aa has been generated (14,15). The severity of HFRS caused by DOBV-Aa in central Europe is mild to moderate, less severe than its clinical course in Balkan countries associated with the DOBV-Af variant hosted by A. fl avicollis (14,16,17).…”

A unifying hypothesis and a single name for a complex globally emerging infection: hantavirus disease

“…A 19-year-old British soldier stationed in Bosnia as a member of the United Nations Protection Force (UNPROFOR) was reported as a sudden severe case of wild rat-transmitted SEOV (though, in hindsight, probably DOBV)-induced ARDS followed by ARF, urgently needing intubation and ventilation in a local military field hospital, emergency repatriation by air while on positive-pressure O 2 supplementation, followed by intensive care therapy in London, UK [18]. Another DOBV case in northern Germany developed life-threatening pulmonary oedema 2 days before any renal impairment [19]. A first HFRS case associated with Tula virus infection, presenting both renal and pulmonary involvement, was documented in northern Germany [20].…”

Verbreitung von Hantavirusinfektionen in Deutschland

“…In Deutschland wurde seit Beschreibung des ersten klinischen Falls einer Hantavirusinfektion [49] über weitere Fälle mit zumeist milden bis moderaten Verläufen berichtet [50,51,52,53,54], wäh-rend schwere Krankheitsverläufe sehr selten waren [55,56,57]. Bisher wurde die Hantavirusinfektion nur in einer Fallbeschreibung als kausales Ereignis für einen letalen Krankheitsverlauf diskutiert [58].…”

“…Diese in Deutschland beobachtete weniger schwere Form des HFRS führt kaum zu hämorrhagischen Komplikationen. Extrarenale Manifestationen kön-nen eine Begleithepatitis umfassen, vereinzelt wurde auch von einer Myokarditis sowie von Beteiligungen der Lunge [30,57,59,60] oder des zentralen Nervensystems [61] berichtet.…”