Central Nervous System and Ocular Manifestations in Puumala Hantavirus Infection.

Puumala hantavirus (PUUV), carried and spread by the bank vole (Myodes glareolus), causes a mild form of hemorrhagic fever with renal syndrome (HFRS) called nephropathia epidemica (NE). Acute high fever, acute kidney injury (AKI), thrombocytopenia, and hematuria are typical features of this syndrome. In addition, headache, blurred vision, insomnia, vertigo, and nausea are commonly associated with the disease. This review explores the mechanisms and presentations of ocular and central nervous system involvement in acute NE.

Heterozygous TLR3 Mutation in Patients with Hantavirus Encephalitis.

Puumala hantavirus (PUUV) hemorrhagic fever with renal syndrome (HFRS) is common in Northern Europe; this infection is usually self-limited and severe complications are uncommon. PUUV and other hantaviruses, however, can rarely cause encephalitis. The pathogenesis of these rare and severe events is unknown. In this study, we explored the possibility that genetic defects in innate anti-viral immunity, as analogous to Toll-like receptor 3 (TLR3) mutations seen in HSV-1 encephalitis, may explain PUUV encephalitis. We completed exome sequencing of seven adult patients with encephalitis or encephalomyelitis during acute PUUV infection. We found heterozygosity for the TLR3 p.L742F novel variant in two of the seven unrelated patients (29%, p = 0.0195). TLR3-deficient P2.1 fibrosarcoma cell line and SV40-immortalized fibroblasts (SV40-fibroblasts) from patient skin expressing mutant or wild-type TLR3 were tested functionally. The TLR3 p.L742F allele displayed low poly(I:C)-stimulated cytokine induction when expressed in P2.1 cells. SV40-fibroblasts from three healthy controls produced increasing levels of IFN-λ and IL-6 after 24 h of stimulation with increasing concentrations of poly(I:C), whereas the production of the cytokines was impaired in TLR3 L742F/WT patient SV40-fibroblasts. Heterozygous TLR3 mutation may underlie not only HSV-1 encephalitis but also PUUV hantavirus encephalitis. Such possibility should be further explored in encephalitis caused by these and other hantaviruses.

Long-term hormonal follow-up after human Puumala hantavirus infection.

OBJECTIVE: Nephropathia epidemica (NE) is a haemorrhagic fever with renal syndrome (HFRS) caused by Puumala hantavirus (PUUV). Pituitary haemorrhage and hypopituitarism may complicate recovery from acute NE. DESIGN: Forty-seven of our recent cohort of 58 NE patients volunteered to be re-examined in order to estimate the burden of hormonal deficiency 4 to 8 years after the acute illness. Two patients had suffered from pituitary haemorrhage, but many others exhibited pituitary oedema during their acute infection. In this study, we searched for symptoms of hormonal deficiency, performed hormonal laboratory screening, and most patients underwent pituitary MRI examination. RESULTS: The pituitary size had diminished in all patients in whom MRI was performed (P < 0·001). One patient with acute phase haemorrhage had made a complete recovery while the other continued to require hormonal substitution. In addition, hormonal laboratory abnormalities were observed in nine other patients; these being attributable to several reasons, for example independent peripheral hormonal diseases, side effects of medication or other secondary causes such as obesity. None of them had signs of late-onset pituitary insufficiency caused by their previous NE. Health-related quality of life (mean and median 15D score) of patients was comparable to that of age-standardized general population. CONCLUSIONS: None of our patients had developed obvious late-onset hypopituitarism despite of the fact that pituitary gland can be affected during acute NE. We recommend requesting a history of hantavirus infection whenever the possibility of pituitary dysfunction is suspected at least in patients originating from regions with high NE infection rate.

Elevated cerebrospinal fluid neopterin concentration is associated with disease severity in acute Puumala hantavirus infection.

Nephropathia epidemica (NE) caused by Puumala hantavirus (PUUV) is the most common hemorrhagic fever with renal syndrome (HFRS) in Europe. The infection activates immunological mechanisms that contribute to the pathogenesis and characteristics of the illness. In this study we measured cerebrospinal fluid (CSF) neopterin concentration from 23 acute-phase NE patients. We collected data on kidney function, markers of tissue permeability, haemodynamic properties, blood cell count, length of hospitalisation, inflammatory parameters, and ophthalmological properties. The neopterin levels were elevated (> 5.8 nmol/L) in 22 (96%) NE-patients (mean 45.8 nmol/L); these were especially high in patients with intrathecal PUUV-IgM production (mean 58.2 nmol/L, P = 0.01) and those with elevated CSF protein concentrations (mean 63.6 nmol/L, P < 0.05). We also observed a correlation between the neopterin and high plasma creatinine value (r = 0.66, P = 0.001), low blood thrombocyte count (r = -0.42, P < 0.05), and markedly disturbed refractory properties of an eye (r = 0.47, P < 0.05). Length of hospitalisation correlated with the neopterin (r = 0.42, P < 0.05; male patients r = 0.69, P < 0.01). Patients with signs of tissue oedema and increased permeability also had high neopterin concentrations. These results reinforce the view that PUUV-HFRS is a general infection that affects the central nervous system and the blood-brain barrier.

[Influenza A(H1N1)v-patients treated in Oulu University hospital]. / Oulun yliopistollisessa sairaalassa hoidetut influenssa a(H1N1)v-potilaat.

BACKGROUND: In Finland, the pandemic A(H1N1)v-influenza was experienced in late 2009. MATERIAL AND METHODS: A(H1N1)v-patients hospitalized in Oulu University Hospital were evaluated. RESULTS: Altogether, 159 A(H1N1)v-patients, including 37 children, were hospitalized. Their median age was 35. Eighteen (11 %) patients required admission to ICU; three of them died. As many as 62% of the patients suffered from radiologically confirmed pneumonia. The incidences of hospitalization, ICU care and death were 40,5, 4,6 and 0,8 per 100000, respectively. CONCLUSIONS: Despite the low mortality rate, a rather high number of patients required hospitalization. Findings in chest radiography were common and prominent.

Constructing and negotiating 'change' in follow-up meetings for intimately violent men.

This study reports on follow-up meetings of a group treatment program for intimately violent men. The focus is on the construction of change narratives; on how indicators of 'successful change' are negotiated and produced in the conversations. We describe in detail five discursive strategies used by client and therapist participants, e.g., the construction of temporal differences, personalizing the problem, reformulations of failure stories, taking presence at the follow-up as evidence of success, and the use of out-siders as an audience. We also demonstrate how the notion of success is ascertained and to whom credit is given for achieving it. We conclude that the followup meetings are established as an integrated part of the whole treatment program, and contribute to the promotion of the treatment ideology.

Loss of self-control as excuse in group-therapy conversations for intimately violent men.

This article examines the constructions of loss of self-control by male perpetrators of intimate violence in therapy-group conversations. It looks at discursive strategies used by therapists and clients in therapy-group negotiations concerning the issue of self-control. The data are part of a larger corpus of videotaped and transcribed recordings of treatment groups for male perpetrators and consists of four treatment group processes. The analysis concentrates on episodes of self-control talk where a participant referred to loss of self-control when accounting for his violent behavior. The loss of self-control was found to be a fundamental constituent of excuses and was used to account for the clients' behavior in past violent situations. It allowed the speaker to admit the reprehensible character of his behavior, while denying full responsibility for it. It also permitted the speaker to be portrayed as a responsible person in the present conversational group therapy context. These different representations of the past and present selves gave those presentations the appearance of inconsistency. The therapists used this inconsistency in the clients' talk to challenge the use of loss of self-control as excuse, and thus called for more responsible accounts.