title: Hantavirus cardiopulmonary syndrome due to Puumala virus in Germany.
abstract: In Germany Puumala virus (PUUV), known to cause mild forms of hemorrhagic fever with renal syndrome (HFRS), is the predominating endemic hantavirus. We herein describe an unusually severe case of a PUUV infection that occurred in summer 2015 in South Eastern Germany in a region known to be endemic for PUUV since over ten years. A 54-year-old female gardener was admitted to hospital with fever, cough and dyspnea. Within 48hours the patient developed a rapid progressive adult respiratory distress syndrome (ARDS) with circulatory failure and required ECMO (extracorporeal membrane oxygenation) treatment. Serological and molecular biological examinations of serum samples confirmed an infection with PUUV. Partial sequences of the S- and M-segment clustered to a strain previously described in South Eastern Germany. Our reported case highlights, that in rare incidents PUUV can cause hantavirus cardiopulmonary syndrome, a syndrome that is usually found after infections with New World hantaviruses, and neurological symptoms.
authors.affiliation: Bundeswehr Institute of Microbiology, Neuherbergstr. 11, D- 80937 München, Germany. Electronic address: patrickvollmar@bundeswehr.org.
authors.forename: Patrick
authors.initials: P
authors.lastname: Vollmar
authors.affiliation: Department of Internal Medicine II, Universityhospital Regensburg, Franz-Josef-Strauß-Allee 11, D- 93053 Regensburg, Germany. Electronic address: matthias.lubnow@ukr.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Lubnow
authors.affiliation: Institute of Clinical Microbiology and Hygiene, Franz-Josef-Strauß-Allee 11, D-93053 Regensburg, Germany. Electronic address: michaela.simon@ukr.de.
authors.forename: Michaela
authors.initials: M
authors.lastname: Simon
authors.affiliation: Department of Internal Medicine II, Universityhospital Regensburg, Franz-Josef-Strauß-Allee 11, D- 93053 Regensburg, Germany. Electronic address: thomas.mueller@ukr.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Müller
authors.affiliation: Department of Internal Medicine II, Universityhospital Regensburg, Franz-Josef-Strauß-Allee 11, D- 93053 Regensburg, Germany. Electronic address: tobias.bergler@ukr.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Bergler
authors.affiliation: Department of Cardiothoracic Surgery, Universityhospital Regensburg, Franz-Josef-Strauß-Allee 11, D- 93053 Regensburg, Germany. Electronic address: alois.philipp@ukr.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Alois
authors.affiliation: Bundeswehr Institute of Microbiology, Neuherbergstr. 11, D- 80937 München, Germany. Electronic address: bryanthoma@bundeswehr.org.
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Thoma
authors.affiliation: Bundeswehr Institute of Microbiology, Neuherbergstr. 11, D- 80937 München, Germany. Electronic address: sandraessbauer@bundeswehr.org.
authors.forename: Sandra
authors.initials: S
authors.lastname: Essbauer
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005858:Germany / Q000453:epidemiology; D018804:Hantavirus Pulmonary Syndrome / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D006321:Heart / Q000503:physiopathology / Q000821:virology; D006480:Hemorrhagic Fever with Renal Syndrome / Q000453:epidemiology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008875:Middle Aged; D010802:Phylogeny; D029262:Puumala virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D012769:Shock / Q000821:virology
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M
keywords: ECMO; Hantavirus; Hantavirus cardiopulmonary syndrome; Puumala virus