These authors contributed equally to this work.
Viral load and humoral immune response in association with disease severity in Puumala hantavirus-infected patients—implications for treatment
Version of Record online: 7 JUN 2013
© 2013 The Authors. Clinical Microbiology and Infection published by John Wiley & Sons Ltd on behalf of the European Society of Clinical Microbiology and Infectious Disease.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Clinical Microbiology and Infection
Volume 20, Issue 3, pages 235–241, March 2014
How to Cite
Clin Microbiol Infect 2014; 20: 235–241
- Issue online: 12 FEB 2014
- Version of Record online: 7 JUN 2013
- Accepted manuscript online: 29 APR 2013 07:31AM EST
- Manuscript Accepted: 25 APR 2013
- Manuscript Revised: 10 APR 2013
- Manuscript Received: 3 JAN 2013
- Swedish Heart-Lung Foundation
- Kempe foundation
- County Council of Västerbotten
- Medical Faculty of Umeå University
- County Councils of Northern Sweden
- Swedish Research Council
- Lars Kleberg foundation
- disease severity;
- haemorrhagic fever with renal syndrome;
- humoral immune response;
- Puumala virus;
- viral load;
- white blood cell count
Hantaviruses are the causative agents of haemorrhagic fever with renal syndrome (HFRS) in Eurasia and of hantavirus cardiopulmonary syndrome (HCPS) in the Americas. The case fatality rate varies between different hantaviruses and can be up to 40%. At present, there is no specific treatment available. The hantavirus pathogenesis is not well understood, but most likely, both virus-mediated and host-mediated mechanisms are involved. The aim of the present study was to investigate the association among Puumala hantavirus (PUUV) viral RNA load, humoral immune response and disease severity in patients with HFRS. We performed a study of 105 PUUV-infected patients that were followed during the acute phase of disease and for up to 1–3 months later. Fifteen of the 105 patients (14%) were classified as having moderate/severe disease. A low PUUV-specific IgG response (p <0.05) and also a higher white blood cell count (p <0.001) were significantly associated with more severe disease. The PUUV RNA was detected in a majority of patient plasma samples up to 9 days after disease onset; however, PUUV RNA load or longevity of viraemia were not significantly associated with disease severity. We conclude that a low specific IgG response was associated with disease severity in patients with HFRS, whereas PUUV RNA load did not seem to affect the severity of HFRS. Our results raise the possibility of passive immunotherapy as a useful treatment for hantavirus-infected patients.