Department of Hematology, XiangYa Hospital, Central South University, Changsha, Hunan, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Virol J. 2022 Apr 22;19(1):75. doi: 10.1186/s12985-022-01766-6.
Patients with allogeneic hematopoietic stem cell transplantation (allo-HSCT) are prone to complicate viral infection. Central nervous system (CNS) involvement caused by the viruses is rare but with poor prognosis. Hantavirus, which usually cause hemorrhagic fever with renal syndrome (HFRS), and none case has been reported about these infection in allo-HSCT patients.
In August 2021, a 13-year-old male child developed intermittent fever and refractory hypotension after allo-HSCT. Magnetic resonance imaging of the head revealed abnormal signal foci in the left midbrain cerebral peduncle and bilateral thalamus. His family reported traces of mouse activity in the patient's home kitchen. HFRS was suspected, but with no significant kidney damage. The specific immunoglobulin (Ig) G and M of hantavirus were negative. The metagenomic next-generation sequencing (mNGS) detected Seoul Orthohantavirus (SEOV) sequences directly in cerebrospinal fluid and blood.
Allo-HSCT patients are a high-risk group for infection. Usually the causative agent of infection is difficult to determine, and sometimes the site of infection is concealed. This report highlights the importance of suspecting hantavirus infection in allo-HSCT patients with CNS symptoms despite the absence of renal syndromes. The mNGS is a powerful tool for detecting pathogens. CNS infection with Seoul orthohantavirus in transplant patients is rare but possible as demonstrated in this case. To the best of our knowledge, this is the first reported case employing mNGS to diagnose SEOV caused CNS infection in an allo-HSCT patient.
异基因造血干细胞移植（allo-HSCT）患者易并发病毒感染。由病毒引起的中枢神经系统（CNS）受累很少见，但预后较差。汉坦病毒通常引起肾综合征出血热（HFRS），尚无 allo-HSCT 患者感染此类病毒的报道。
2021 年 8 月，一名 13 岁男性患儿 allo-HSCT 后出现间歇性发热和难治性低血压。头部磁共振成像显示左中脑脑桥和双侧丘脑异常信号灶。其家人报告患者家厨房有老鼠活动痕迹。怀疑为 HFRS，但无明显肾损伤。汉坦病毒特异性免疫球蛋白（Ig）G 和 M 均为阴性。宏基因组下一代测序（mNGS）直接在脑脊液和血液中检测到首尔型汉坦病毒（SEOV）序列。
allo-HSCT 患者是感染的高危人群。通常感染的病原体难以确定，有时感染部位隐匿。本报告强调了在 allo-HSCT 患者出现 CNS 症状而无肾综合征时，应怀疑汉坦病毒感染的重要性。mNGS 是检测病原体的有力工具。本例提示，在移植患者中，汉坦病毒引起的 CNS 感染虽然罕见，但也可能发生。据我们所知，这是首例采用 mNGS 诊断 allo-HSCT 患者 SEOV 引起的 CNS 感染的报道。
