Early Chest Imaging in Patients with Puumala Hantavirus Infection

Olivier Lebecque,Cécile Abraham,Ana Falticeanu,Michael Dupont

doi:10.5334/jbsr.2039

Olivier Lebecque, Cécile Abraham + Show 2 more

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https://doi.org/10.5334/jbsr.2039

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Abstract

Purpose:To describe early chest imaging abnormalities in patients with acute Puumala virus infection.Materials and Methods:This retrospective study (2005–2017) comprised 64 patients who were admitted to the emergency department of a Belgian hospital. These patients were diagnosed with serologically confirmed acute Puumala virus infection and had at least one chest X-ray (CRX). Imaging studies were evaluated by two experienced chest radiologists reaching agreement by consensus, and abnormalities were reported according to the Fleischner Society glossary of terms for thoracic imaging. When a patient underwent multiple CRX, only the findings of the first were recorded. Six patients underwent chest high-resolution computed tomography (HRCT).Results:CRX showed abnormal findings in 33 patients (51.5%). Most common findings were linear atelectasis (29.7%) and small pleural effusion (20.3%). HRCT showed interlobular septal thickening in four patients and crazy-paving pattern with consolidations in one patient with adult respiratory distress syndrome.Conclusions:Early CRX commonly showed linear atelectasis and small pleural effusion in Puumala virus infected patients above 30 years of age. Chest HRCT most frequently showed atelectasis and smooth interlobular septal thickening. While uncommon, early and severe pulmonary involvement can be associated with Puumala virus infection, albeit these findings are not specific.

Highlights

The hantaviruses are enveloped RNA viruses, each carried by a specific rodent species
Subjects The study group was retrospectively constituted of consecutive patients who were admitted to the emergency department of a Southern Belgian hospital from 2005 to 2017 with a diagnosis of acute Puumala virus infection serologically confirmed with specific IgM antibodies
Lebecque et al: Early Chest Imaging in Patients with Puumala Hantavirus Infection patients were excluded because they neither had CRX nor a chest high resolution computed tomography (HRCT), one because of morbid obesity and non-contributive bedside CRX, one because of synchronous trauma and six because their chest X-ray could not be retrieved from our picture archiving and communication system (PACS)

Summary

Introduction

The hantaviruses are enveloped RNA viruses, each carried by a specific rodent species. Puumala virus is mostly known for causing acute kidney injury It can affect multiple organs, including brain, heart, or lungs [4]. Respiratory manifestations, such as cough or dyspnea, have been reported in about one fifth up to two thirds of the patients infected with Puumala virus [3, 5,6,7]. Respiratory involvement has commonly been attributed, at least in part, to fluid overload as a result of renal failure, but there is increasing evidence that the involvement of the lung and heart is common during the acute phase of hemorrhagic fever with renal syndrome [8]. This study aimed to evaluate the early thoracic features, at the time of admission in the emergency department, in serologically proved Puumala virus infected patients, using the Fleischner Society glossary of terms

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