Abstract
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.
Highlights
Hemorrhagic fever with renal syndrome (HFRS) is a zoonosis caused by Puumala hantavirus (PUUV)
Genetic susceptibility to PUUV encephalitis has been suggested in a recent study by Partanen et al They found a variant in the Toll-like receptor 3 (TLR3) gene leading to compromised receptor activity and an abnormal interferon response [8]
central nervous system (CNS) and ocular symptoms appear to be very common in acute nephropathia epidemica (NE) [6]
Summary
Hemorrhagic fever with renal syndrome (HFRS) is a zoonosis caused by Puumala hantavirus (PUUV). Patients commonly complain of central nervous system (CNS) or ocular-related symptoms during their acute infection [1,4]. Alexeyev et al investigated 811 NE patients’ records, paying particular attention to data regarding neurological manifestations [10] They found that the most common symptoms were headache (97%), blurred vision (40%), and vomiting (31%). These case series demonstrate that the CNS is commonly affected in NE. The vision loss resolved spontaneously some minutes later Both patients had a pituitary hemorrhage in their acute brain magnetic resonance imaging (MRI), whilst the other developed long-term hormonal deficiency. Confusion, somnolence, and vision loss, mainly among young male patients, have been reported [8,13,14] These reports highlight the potential of the acute NE to cause serious and possibly irreversible CNS complications
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