Transcript Development of a quantitative real time PCR assay for the

FIRST HUMAN CASE OF HANTA VIRUS INFECTION
IN SWITZERLAND
D. Schultze
1
2
3
4
1,
Å. Lundkvist
2,
U. Blauenstein
3,
P. Heyman
Institute for Clinical Microbiology and Immunology,St. Gallen, Switzerland
Swedish Institute for Infectious Disease Control, Karolinska Institutet, Stockholm,
Sweden
University Childrens Hospital, Basel, Switzerland
Research Laboratory for Vector-Borne Diseases and National Reference Center for
Hantavirus Infections, Queen Astrid Military Hospital, Brussels, Belgium
Prologue
[Troillet N. Institut Central des Hopitaux Valaisans; Rev Med Suisse Romande 1997 Jan;117(1):3-11]
Switzerland - a white spot for hantaviruses ?
[Vaheri A. 2000, Haartman Institute, Helsinki, 2000;personal communication]
Introduction to Hantaviruses
Worldwide natural reservoir of hantaviruses
pathogenic for humans : Rodentia (Order),
Muridae (Family) with chronic persistent infection
Microtus arvalis, known to carry Tula
virus
Transmission of Hantaviruses to
humans via
- respiratory route (common)
- bite (rare)
- person-to-person (only Andes
virus)
Case report
Hantavirus serology
Day 42
Day 49
5.9
2.1
0.052
-
0.47
-
Hantavirus IgM (MRL)
Hantavirus IgG (MRL)
TULV-IgM (EIA)
TULV-FRNT
Day 146
0.3
6.5
0.030
160
Out-patient
Day
Incident
0
Rodent bite
6-11
Paronychia
Incision of
8
paronychia
8-11
Fever
18
Fever
39-41 Fever
Day 294
0.3
2.5
-
Hantavirus serology indicates a recent infection with TULV:
- high IgM index in acute-phase serum samples and a rise of IgG
index (Hantavirus ELISA, MRL Diagnostics, USA)
- confirmed by seroconversion of IgM in Tula virus (TULV) enzyme
immuno assay*
Definite diagnosis and serological typing of TULV by:
- Tula virus -specific focus reduction neutralisation test (FRNT)**
- on convalescent serum, 21 weeks after the rodent bite
*Lundkvist Å et al. Virus Research (1996) 45:29-44. **Lundkvist Å et al. Journal of Medical Virology (1997) 53:51-59.
Hantavirus foci
peroxidase-stained in
one well from a tissue
culture plate
[Niklasson et al. Am. J.Trop.Med.Hyg.
1991, 660-665]
- Asymptomatic & non-specific mild
infections outnumber symptomatic,
characteristic infections
Two broad clinical presentations :
- HFRS - Hemorrhagic Fever with Renal
Syndrome, Asia & Europe
- Hantavirus Pulmonary Syndrome, North
& South America
60'000 to 100'000 hospitalised cases of
hantavirus disease / year
August 2000 Kaiseraugst, nearby Basel: a 12 year old boy caught a
small rodent, hours later rodent bit the boy
Medical
record
Serology
61st Annual Assembly of
Swiss Society for Microbiology, Luzern, 20-21
February 2002
Clinical features of Hantavirus
infections
Hantavirus: an ignored pandemic in Switzerland ?
Family Bunyaviridae, Genus Hantavirus, > 20 sero
/ genotypes, 100 nm, enveloped, negative sense,
tri-segmented RNA
4
Hospital stay
Day
Incident
42
Fever
42-49
Exanthema
Antibiotic
49-62
treatment
Follow-up
Day
Incident
146
None
294
None
The history of Tula virus
[Plyusnin A et al. Journ Virol (1994) 68:7833-7839 / [Plyusnin A, Morzunov SP; Microbiology and Immunology
(2001) 256: 47-75]
1994
Tula virus in Microtus arvalis, trapped 1987 in Tula,
100 km south of Moskow
1996/7 Tula virus in voles from Czech Rep, Slovakia & Austria
2001
Tula virus -genome sequences in rodents in CH
2001
Tula virus -specific antibodies in one serum from a
healthy blood donor from the Czech Republic
Tula virus considered apathogenic to humans so far
Summary
 First documented case of Hantavirus infection in CH
 First documented case of acute infection with serotype
Tula virus, associated with symptoms uncommon for
Hantavirus disease
 Rare case of Hantavirus infection in context with a
rodent bite
 Awareness of Hantavirus diseases in Switzerland is
warranted
Acknowledgement
This work was enabled by cooperation of the authors within the European Network of <Imported> Viral Diseases (http://www.enivd.de)