title: Pathophysiology of a severe case of Puumala hantavirus infection successfully treated with bradykinin receptor antagonist icatibant.
abstract: We recently described a patient with very severe Puumala hantavirus infection manifested by capillary leakage syndrome and shock. He was successfully treated with the bradykinin receptor antagonist, icatibant (Antonen et al., 2013). Here we report analysis of the pathophysiology which indicated pronounced complement activation, prolonged leukocytosis, extensive fibrinolysis, circulating histones, and defects in liver function. The patient had an uncommon HLA-phenotype, which may have contributed to the severe course of the disease.
authors.affiliation: Haartman Institute, University of Helsinki, Finland; Department of Virology and Immunology, Helsinki University Central Hospital Laboratory, Finland. Electronic address: antti.vaheri@helsinki.fi.
authors.forename: Antti
authors.initials: A
authors.lastname: Vaheri
authors.affiliation: Haartman Institute, University of Helsinki, Finland.
authors.forename: Tomas
authors.initials: T
authors.lastname: Strandin
authors.affiliation: Haartman Institute, University of Helsinki, Finland; Department of Virology and Immunology, Helsinki University Central Hospital Laboratory, Finland.
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Jääskeläinen
authors.affiliation: Haartman Institute, University of Helsinki, Finland; Department of Virology and Immunology, Helsinki University Central Hospital Laboratory, Finland; Department of Veterinary Biosciences, University of Helsinki, Finland.
authors.forename: Olli
authors.initials: O
authors.lastname: Vapalahti
authors.affiliation: Haartman Institute, University of Helsinki, Finland; Immunobiology Research Program, University of Helsinki, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Jarva
authors.affiliation: Haartman Institute, University of Helsinki, Finland.
authors.forename: Marja-Liisa
authors.initials: ML
authors.lastname: Lokki
authors.affiliation: Tampere University Hospital, Finland.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Antonen
authors.affiliation: Tampere University Hospital, Finland.
authors.forename: Ilona
authors.initials: I
authors.lastname: Leppänen
authors.affiliation: Tampere University Hospital, Finland; School of Medicine, University of Tampere, Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Mäkelä
authors.affiliation: Haartman Institute, University of Helsinki, Finland; Immunobiology Research Program, University of Helsinki, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Meri
authors.affiliation: Tampere University Hospital, Finland; School of Medicine, University of Tampere, Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Mustonen
mesh_terms: D000328:Adult; D001920:Bradykinin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D065168:Bradykinin Receptor Antagonists / Q000008:administration & dosage*; D006480:Hemorrhagic Fever with Renal Syndrome / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000821:virology; D006801:Humans; D008297:Male; D029262:Puumala virus / Q000187:drug effects* / Q000502:physiology; D018002:Receptors, Bradykinin / Q000235:genetics / Q000378:metabolism
chemical_list: D065168:Bradykinin Receptor Antagonists; D018002:Receptors, Bradykinin; C065679:icatibant; D001920:Bradykinin
keywords: Bradykinin; Capillary leakage; Complement activation; Hantavirus; Icatibant; Pathophysiology