title: Signs of general inflammation and kidney function are associated with the ocular features of acute Puumala hantavirus infection.
abstract: BACKGROUND
  Puumala hantavirus (PUUV) causes nephropathia epidemica (NE), a type of viral haemorrhagic fever with renal syndrome (HFRS). This febrile infection may affect the kidneys, central nervous system (CNS), and the eye. Acute illness is associated with increased tissue permeability and tissue oedema, and many patients experience reduced vision. The aim of this study was to explore the physiological events associated with the ocular features of acute NE.
  
  
  METHODS
  This was a prospective study of 46 NE patients who were examined during the acute infection and 1 month after hospitalization. Visual acuity, refraction, intraocular pressure (IOP), and ocular dimensions were evaluated. Cerebrospinal fluid and blood samples were collected, brain magnetic resonance imaging and electroencephalography were recorded, and HLA haplotype was analyzed. The degrees of tissue oedema and fluid imbalance were evaluated.
  
  
  RESULTS
  CNS examinations did not reveal the source of the ocular changes in acute NE. The plasma C-reactive protein concentration correlated with the lens thickness and the IOP. The plasma creatinine level was associated with the change in anterior chamber depth. However, oliguric and polyuric patients displayed similar ocular findings. Patients positive for the DR3-DQ2 haplotype experienced the least diminished visual acuity.
  
  
  CONCLUSIONS
  The level of systemic inflammation rather than CNS involvement appears to account for the ocular changes during acute PUUV infection, and the severity of kidney dysfunction may also have a significant role. In addition, the genetic properties of the host may well explain the ocular features of acute hantavirus infection.
authors: Department of Ophthalmology, Oulu University Hospital, Oulu, Finland. timo.hautala@oulu.fi
authors: Nina
authors: N
authors: Hautala
authors: Heikki
authors: H
authors: Kauma
authors: Saara-Mari
authors: SM
authors: Rajaniemi
authors: Tarja
authors: T
authors: Sironen
authors: Olli
authors: O
authors: Vapalahti
authors: Eija
authors: E
authors: Pääkkö
authors: Ari
authors: A
authors: Karttunen
authors: Jorma
authors: J
authors: Ilonen
authors: Seppo
authors: S
authors: Rytky
authors: Olli
authors: O
authors: Vainio
authors: Antti
authors: A
authors: Vaheri
authors: Timo
authors: T
authors: Hautala
mesh_terms: D003404:Creatinine / Q000097:blood; D005128:Eye Diseases / Q000473:pathology* / Q000821:virology*; D005260:Female; D006480:Hemorrhagic Fever with Renal Syndrome / Q000150:complications* / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029262:Puumala virus / Q000472:pathogenicity*; D014792:Visual Acuity
chemical_list: D003404:Creatinine