Central nervous system-related symptoms and findings are common in acute Puumala hantavirus infection
Central nervous system-related symptoms and findings are common in acute Puumala hantavirus infection
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DOI：
10.3109/07853890.2010.480979
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发表时间：
2010-07-01
影响因子：
4.4
通讯作者：
Kauma, Heikki
中科院分区：
文献类型：
--
作者：
Hautala, Timo;Mahonen, Saara-Mari;Kauma, Heikki
背景普马拉汉坦病毒（PUUV）引起肾综合征出血热（HFRS），也称为肾病综合征（NE）。最近的病例报告和回顾性研究表明，NE可能损害垂体。基于这些观察，我们的目标是前瞻性地探讨这种并发症的性质。共有58名急性NE住院患者自愿参加。记录中枢神经系统（CNS）症状，采集脑脊液（CSF）样本，分析人类白细胞抗原（HLA）单倍型，获取脑磁共振成像（MRI），记录脑电图（EEG）。所有垂体MRI异常的患者均由内分泌科医生进行检查。大多数患者出现CNS症状，一半的CSF样本PUUV IgM阳性，蛋白水平升高或白细胞计数。DR 15（2）-DQ 6单倍型阴性患者的CSF受影响的频率较低。MRI显示两名患者垂体出血;这两名患者突然失明并伴有头痛，他们都出现了垂体功能减退。仅1例患者需长期激素替代治疗。CNS相关症状和CSF中的炎症在急性NE中是常见的。宿主的遗传特性可能使中枢神经系统受累。看来脑垂体损伤和随后的激素不足可能会使恢复复杂化。
Background. Puumala hantavirus (PUUV) causes a hemorrhagic fever with renal syndrome (HFRS) also called nephropathia epidemica (NE). Recent case reports and retrospective studies suggest that NE may damage the pituitary gland. Based on these observations, our goal was to explore the nature of this complication prospectively.Methods. A total of 58 hospitalized patients with acute NE volunteered to participate. Central nervous system (CNS) symptoms were recorded, cerebrospinal fluid (CSF) samples were collected, human leukocyte antigen (HLA) haplotype was analyzed, brain magnetic resonance imaging (MRI) was acquired, and electroencephalography (EEG) was recorded. Patients with abnormal pituitary MRI finding were examined by an endocrinologist.Results. Most patients experienced CNS symptoms, and half of the CSF samples were positive for PUUV IgM, elevated protein level, or leukocyte count. CSF of patients negative for DR15(2)-DQ6 haplotype was less frequently affected. MRI revealed pituitary hemorrhage in two patients; these two patients suffered sudden loss of vision associated with headache, and they both developed hypopituitarism. Only one patient required long-term hormonal replacement therapy.Conclusion. CNS-related symptoms and inflammation in the CSF are common in acute NE. Genetic properties of the host may predispose to CNS involvement. It does seem that pituitary injury and subsequent hormonal insufficiency may complicate the recovery.