Department of Internal Medicine, Oulu University Hospital, Oulu, Finland.
Ann Med. 2010 Jul;42(5):344-51. doi: 10.3109/07853890.2010.480979.
Puumala hantavirus (PUUV) causes a hemorrhagic fever with renal syndrome (HFRS) also called nephropathia epidemica (NE). Recent case reports and retrospective studies suggest that NE may damage the pituitary gland. Based on these observations, our goal was to explore the nature of this complication prospectively.
A total of 58 hospitalized patients with acute NE volunteered to participate. Central nervous system (CNS) symptoms were recorded, cerebrospinal fluid (CSF) samples were collected, human leukocyte antigen (HLA) haplotype was analyzed, brain magnetic resonance imaging (MRI) was acquired, and electroencephalography (EEG) was recorded. Patients with abnormal pituitary MRI finding were examined by an endocrinologist.
Most patients experienced CNS symptoms, and half of the CSF samples were positive for PUUV IgM, elevated protein level, or leukocyte count. CSF of patients negative for DR15(2)-DQ6 haplotype was less frequently affected. MRI revealed pituitary hemorrhage in two patients; these two patients suffered sudden loss of vision associated with headache, and they both developed hypopituitarism. Only one patient required long-term hormonal replacement therapy.
CNS-related symptoms and inflammation in the CSF are common in acute NE. Genetic properties of the host may predispose to CNS involvement. It does seem that pituitary injury and subsequent hormonal insufficiency may complicate the recovery.
普马拉型汉坦病毒（PUUV）可引起肾综合征出血热（HFRS），也称为流行性肾病（NE）。最近的病例报告和回顾性研究表明，NE 可能会损害脑垂体。基于这些观察，我们的目标是前瞻性地探讨这种并发症的性质。
共有 58 名因急性 NE 住院的患者自愿参与。记录中枢神经系统（CNS）症状，采集脑脊液（CSF）样本，分析人类白细胞抗原（HLA）单倍型，获取脑磁共振成像（MRI），记录脑电图（EEG）。有异常垂体 MRI 发现的患者由内分泌专家进行检查。
大多数患者出现 CNS 症状，半数 CSF 样本 PUUV IgM、蛋白水平或白细胞计数升高。未携带 DR15(2)-DQ6 单倍型的患者的 CSF 较少受到影响。MRI 显示两名患者有垂体出血；这两名患者均突然出现视力丧失伴头痛，并均发生垂体功能减退。仅有一名患者需要长期激素替代治疗。
急性 NE 中常见与 CNS 相关的症状和 CSF 炎症。宿主的遗传特性可能导致 CNS 受累。似乎垂体损伤和随后的激素缺乏会使恢复复杂化。
