UK hantavirus, renal failure, and pet rats

Rare and Imported Pathogens Department, Porton Down, UK. Electronic address: .
The Lancet (Impact Factor: 45.22). 03/2013; 381(9871):1070. DOI: 10.1016/S0140-6736(13)60599-1


In November, 2012, a 28-year-old man, presented with a 4-day history of fever, shivers, sweating, and vomiting. He had type-2 diabetes, which was being treated with sitagliptin and metformin. On admission he had evi dence of a systemic infl ammatory response (temperature 39·3°C, pulse 160 bpm, respiratory rate 30 per min, white cell count 15·0×10⁹ per L, with 12·3 neutrophils and 0·2 mye locytes), abnormalities of blood clotting (INR 1·6, PTT 57 s, fi brinogen 0·99 g/L (normal range 1·5–4·5); plate lets 19×10⁹ per L), multi-organ failure (creatinine 167 μmol/L, raised alanine aminotransferase 511 U/L and bilirubin 87 μmol/L), progressive hypoxia, hyperglycaemia glucose 20·6 mmol/L), and lactic acidosis (PH 7·29, lactate 7·5 mmol/L). He was diagnosed with overwhelming sepsis and transferred to the intensive care unit. Initial treatment was with piperacillin-tazobactam, insulin, oxygen, and aggressive fl uid replacement, including platelet infusions, fresh frozen plasma, and cryo-precipitate. Ventilatory support was required 15 h after admission, at which time he was anuric. Renal replace-ment therapy was needed for 21 days and ventilatory support for 38 days, partly because of pseudomonas superinfection of the chest that was diagnosed on day 17. Tests for legionella and leptospira and initial blood cultures were negative. Serum taken 30 days after admission had a high IgG titre to Seoul hantavirus (1:10 000 by IFA, Euroimmun, Medizinische Labor-diagnostika AG), although serum from 1 month before admission (sent for hepatitis screening because of a mild transaminasaemia) was negative. Hantavirus RNA was not detected in either sample. We learnt that he kept two pet agouti rats (Rattus norvegicus) that he had acquired from a larger pack bred in England. Seoul hantavirus RNA was detected by RT-PCR 1 in blood taken from these two rats and from seven of the larger group. In November, 2011, one of the English owners had been hospitalised with fever, renal impairment, spleno megaly, and thrombo cytopenia that was secondary to an unidentifi ed viral illness. Retrospective Seoul hantavirus serological Lancet 2013; 381: 1070 Rare and Imported Pathogens Department (S

Download full-text


Available from: Lisa Jane Jameson, Oct 03, 2015
96 Reads
  • Source
    • "However, more recently the virus has been isolated from wild brown rats in the UK [17] and pet rats in the UK and Sweden [18-20]. In addition, SEOV associated HFRS has been reported in four cases in the UK and France, all of which were clinically severe and involved renal impairment [17,21,22]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Hantaviruses are single-stranded RNA viruses, which are transmitted to humans primarily via inhalation of aerosolised virus in contaminated rodent urine and faeces. Whilst infected reservoir hosts are asymptomatic, human infections can lead to two clinical manifestations, haemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS), with varying degrees of clinical severity. The incidence of rodent and human cases of Seoul virus (SEOV) in Europe has been considered to be low, and speculated to be driven by the sporadic introduction of infected brown rats (Rattus norvegicus) via ports. Between October 2010 and March 2012, 128 brown rats were caught at sites across the Lyon region in France. SEOV RNA was detected in the lungs of 14% (95% CI 8.01 - 20.11) of brown rats tested using a nested pan-hantavirus RT-PCR (polymerase gene). Phylogenetic analysis supports the inclusion of the Lyon SEOV within Lineage 7 with SEOV strains originating from SE Asia and the previously reported French & Belgian SEOV strains. Sequence data obtained from the recent human SEOV case (Replonges) was most similar to that obtained from one brown rat trapped in a public park in Lyon city centre. We obtained significantly improved recovery of virus genome sequence directly from SEOV infected lung material using a simple viral enrichment approach and NGS technology. The detection of SEOV in two wild caught brown rats in the UK and the multiple detection of SEOV infected brown rats in the Lyon region of France, suggests that SEOV is circulating in European brown rats. Under-reporting and difficulties in identifying the hantaviruses associated with HFRS may mask the public health impact of SEOV in Europe.
    Virology Journal 02/2014; 11(1):32. DOI:10.1186/1743-422X-11-32 · 2.18 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In humans, hantaviruses can cause haemorrhagic fever with renal syndrome (HFRS) or hantavirus cardiopulmonary syndrome (HCPS). Currently it is estimated that 150,000 to 200,000 cases of hantavirus disease occur each year, the majority being reported in Asia. However, human hantavirus infections are increasingly reported in the Americas and Europe. Although many of the underlying pathogenic mechanisms still remain unclear, recent evidence rather argues against a purely immune-mediated pathophysiology of human disease. Despite the high morbidity and case-fatality rates of HFRS and HCPS, respectively, no vaccine or drug is currently proven to be preventive or therapeutic. This review summarises clinical features and current epidemiological findings, as well as concepts regarding the immunology, pathogenesis and intervention strategies of human hantaviral diseases.
    Schweizerische medizinische Wochenschrift 03/2014; 144:w13937. DOI:10.4414/smw.2014.13937 · 2.09 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hantaviruses are an established cause of haemorrhagic fever with renal syndrome (HFRS) in Europe. Following a confirmed case of HFRS in the UK, in an individual residing on a farm in North Yorkshire and the Humber, a tidal estuary on the east coast of Northern England, and the subsequent isolation of a Seoul hantavirus from rats trapped on the patient's farm, it was considered appropriate to further investigate the public health risk of this virus in the region. Of a total 119 individuals tested, nine (7.6%) were seropositive for hantavirus antibodies. Seven of the seropositive samples showed a stronger reaction to Seoul and Hantaan compared to other clinically relevant hantaviruses. Observation of rodents during the day, in particular mice, was associated with a reduced risk of seropositivity. In addition to one region known to be at risk following an acute case, five further potential risk areas have been identified. This study supports recently published evidence that hantaviruses are likely to be of public health interest in the region.
    Viruses 09/2014; 6(2):524-34. DOI:10.3390/v6020524 · 3.35 Impact Factor
Show more