A unifying hypothesis and a single name for a complex globally emerging infection: hantavirus disease

Excerpt

In the January 2011 issue of this journal, Swedish authors described three severe cases of predominantly pulmonary infection with the European hantavirus Puumala virus (PUUV), leading to death due to refractory shock in two of these patients [1]. Of note, the kidneys in these two fatal cases had, on autopsy, no prominent inflammatory infiltrates or haemorrhages, in contrast with the lungs which showed extensive interstitial oedema and mononuclear cell infiltrates, mainly CD8⁺ T lymphocytes. As the authors justly point out, even in the title of their communication, it is now, perhaps, time to revise the sacro-saint paradigm existing since 1994 of two “different” infectious diseases caused by the same genus of rodent-borne hantaviruses of the Old and the New World, respectively. The former would target mainly the human kidney, and the latter mainly the human lung, resulting in the so-called “haemorrhagic fever with renal syndrome” (HFRS) [2] or the “hantavirus pulmonary syndrome” (HPS) [3]. When it appeared that the failing heart was, in fact, the most direct cause of death in refractory shock in HPS, yet another name, “hantavirus cardio-pulmonary syndrome” (HCPS), was added to the already bewildering list of over 60 mostly exotic synonyms for a disease described already in 1913 by Russian doctors in Vladivostok. On the other side of the Eurasian landmass and in 1934, Swedish doctors described an epidemic renal affection which they called “nephropathia epidemica” (NE), which was proven in 1979 to be, in fact, a milder variant of HFRS, caused by PUUV [4]. …