title: Lymphocytic choriomeningitis, Ljungan and orthopoxvirus seroconversions in patients hospitalized due to acute Puumala hantavirus infection.
abstract: The emergence and re-emergence of zoonotic and vector-borne diseases are increasing in Europe. Prominent rodent-borne zoonotic viruses include Puumala hantavirus (PUUV; the causative agent of nephropathia epidemica, NE), lymphocytic choriomeningitis virus (LCMV), and orthopoxviruses (OPV). In addition, Ljungan virus (LV) is considered a potentially zoonotic virus.
  
  
  
  The aim of this study was to compare clinical picture between acute PUUV patients with and without additional rodent-borne viral infections, to investigate if concurrent infections influence disease severity.
  
  
  
  We evaluated seroprevalence of and seroconversions to LCMV, LV and OPV in 116 patients hospitalized for NE. Clinical and laboratory variables were closely monitored during hospital care.
  
  
  
  A total of five LCMV, 15 LV, and one OPV seroconversions occurred. NE patients with LCMV seroconversions were younger, and had lower plasma creatinine concentrations and platelet counts than patients without LCMV seroconversions. No differences occurred in clinical or laboratory findings between patients with and without seroconversions to LV and OPV. We report, for the first time, LCMV seroprevalence in Finland, with 8.5% of NE patients seropositive for this virus. Seroprevalences for LV and OPV were 47.8% and 32.4%, respectively.
  
  
  
  Cases with LCMV seroconversions were statistically younger, had milder acute kidney injury and more severe thrombocytopenia than patients without LCMV. However, the low number of seroconversion cases precludes firm conclusions. Concurrent LV or OPV infections do not appear to influence clinical picture for NE patients.
authors.affiliation: Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Biodiversity and Molecular Ecology, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, TN, Italy. Electronic address: cristina.fevola@helsinki.fi.
authors.forename: Cristina
authors.initials: C
authors.lastname: Fevola
authors.affiliation: Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland. Electronic address: kristian.forbes@helsinki.fi.
authors.forename: Kristian M
authors.initials: KM
authors.lastname: Forbes
authors.affiliation: School of Medicine, University of Tampere, Tampere, Finland; Department of Internal Medicine, Tampere University Hospital, Tampere, Finland. Electronic address: satu.marjo.makela@uta.fi.
authors.forename: Satu
authors.initials: S
authors.lastname: Mäkelä
authors.affiliation: Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland. Electronic address: niina.putkuri@helsinki.fi.
authors.forename: Niina
authors.initials: N
authors.lastname: Putkuri
authors.affiliation: Department of Biodiversity and Molecular Ecology, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, TN, Italy. Electronic address: heidi.hauffe@fmach.it.
authors.forename: Heidi C
authors.initials: HC
authors.lastname: Hauffe
authors.affiliation: Department of Virology and Immunology, University of Helsinki and Helsinki University Hospital, HUSLAB, Helsinki, Finland. Electronic address: hannimari.kallio-kokko@hus.fi.
authors.forename: Hannimari
authors.initials: H
authors.lastname: Kallio-Kokko
authors.affiliation: School of Medicine, University of Tampere, Tampere, Finland; Department of Internal Medicine, Tampere University Hospital, Tampere, Finland. Electronic address: jukka.mustonen@uta.fi.
authors.forename: Jukka
authors.initials: J
authors.lastname: Mustonen
authors.affiliation: Department of Virology and Immunology, University of Helsinki and Helsinki University Hospital, HUSLAB, Helsinki, Finland. Electronic address: anne.jaaskelainen@helsinki.fi.
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Jääskeläinen
authors.affiliation: Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland. Electronic address: antti.vaheri@helsinki.fi.
authors.forename: Antti
authors.initials: A
authors.lastname: Vaheri
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood*; D060085:Coinfection / Q000453:epidemiology / Q000821:virology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D006476:Orthohantavirus / Q000302:isolation & purification; D006480:Hemorrhagic Fever with Renal Syndrome / Q000150:complications* / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D006801:Humans; D008216:Lymphocytic Choriomeningitis / Q000150:complications* / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D008297:Male; D008875:Middle Aged; D018155:Orthopoxvirus / Q000276:immunology*; D030061:Parechovirus / Q000276:immunology*; D010850:Picornaviridae Infections / Q000150:complications*; D011213:Poxviridae Infections / Q000150:complications*; D029262:Puumala virus / Q000302:isolation & purification; D000069078:Seroconversion; D016036:Seroepidemiologic Studies; D015047:Zoonoses / Q000453:epidemiology / Q000821:virology
chemical_list: D000914:Antibodies, Viral
keywords: Ljungan virus; Lymphocytic choriomeningitis virus; Orthopox virus; Puumala hantavirus; Seroprevalence; Zoonosis