title: Molecular Diagnosis of Hemorrhagic Fever with Renal Syndrome Caused by Puumala Virus.
abstract: Rodent-borne hantaviruses cause two severe acute diseases: hemorrhagic fever with renal syndrome (HFRS) in Eurasia, and hantavirus pulmonary syndrome (HPS; also called hantavirus cardiopulmonary syndrome [HCPS]) in the Americas. Puumala virus (PUUV) is the most common causative agent of HFRS in Europe. Current routine diagnostic methods are based on serological analyses and can yield inconclusive results. Hantavirus-infected patients are viremic during the early phase of disease; therefore, detection of viral RNA genomes can be a valuable complement to existing serological methods. However, the high genomic sequence diversity of PUUV has hampered the development of molecular diagnostics, and currently no real-time reverse transcription-quantitative (RT)-PCR assay is available for routine diagnosis of HFRS. Here, we present a novel PUUV RT-PCR assay. The assay was validated for routine diagnosis of HFRS on samples collected in Sweden during the winter season from 2013 to 2014. The assay allowed detection of PUUV RNA in 98.7% of confirmed clinical HFRS samples collected within 8 days after symptomatic onset. In summary, this study shows that real-time RT-PCR can be a reliable alternative to serological tests during the early phase of HFRS.
authors.affiliation: Public Health Agency of Sweden, Solna, Sweden Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Nina
authors.initials: N
authors.lastname: Lagerqvist
authors.affiliation: National Veterinary Institute, Uppsala, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Hagström
authors.affiliation: Public Health Agency of Sweden, Solna, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Lundahl
authors.affiliation: Swedish Defence Research Agency, Umeå, Sweden.
authors.forename: Elin
authors.initials: E
authors.lastname: Nilsson
authors.affiliation: National Veterinary Institute, Uppsala, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Juremalm
authors.affiliation: Sunderbyn Hospital, Luleå, Sweden.
authors.forename: Inger
authors.initials: I
authors.lastname: Larsson
authors.affiliation: Public Health Agency of Sweden, Solna, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Alm
authors.affiliation: Swedish Defence Research Agency, Umeå, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Bucht
authors.affiliation: Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden.
authors.forename: Clas
authors.initials: C
authors.lastname: Ahlm
authors.affiliation: Public Health Agency of Sweden, Solna, Sweden Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden jonas.klingstrom@ki.se.
authors.forename: Jonas
authors.initials: J
authors.lastname: Klingström
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006480:Hemorrhagic Fever with Renal Syndrome / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D029262:Puumala virus / Q000302:isolation & purification*; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods*; D013548:Sweden