Abstract
BackgroundNephropathia epidemica (NE) is a Scandinavian type of hemorrhagic fever with renal syndrome caused by Puumala hantavirus. The clinical course of the disease varies greatly in severity. The aim of the present study was to evaluate whether plasma C-reactive protein (CRP) and interleukin (IL)-6 levels associate with the severity of NE.MethodsA prospectively collected cohort of 118 consecutive hospital-treated patients with acute serologically confirmed NE was examined. Plasma IL-6, CRP, and creatinine, as well as blood cell count and daily urinary protein excretion were measured on three consecutive days after admission. Plasma IL-6 and CRP levels higher than the median were considered high.ResultsWe found that high IL-6 associated with most variables reflecting the severity of the disease. When compared to patients with low IL-6, patients with high IL-6 had higher maximum blood leukocyte count (11.9 vs 9.0 × 109/l, P = 0.001) and urinary protein excretion (2.51 vs 1.68 g/day, P = 0.017), as well as a lower minimum blood platelet count (55 vs 80 × 109/l, P < 0.001), hematocrit (0.34 vs 0.38, P = 0.001), and urinary output (1040 vs 2180 ml/day, P < 0.001). They also stayed longer in hospital than patients with low IL-6 (8 vs 6 days, P < 0.001). In contrast, high CRP did not associate with severe disease.ConclusionsHigh plasma IL-6 concentrations associate with a clinically severe acute Puumala hantavirus infection, whereas high plasma CRP as such does not reflect the severity of the disease.
Highlights
Nephropathia epidemica (NE) is a Scandinavian type of hemorrhagic fever with renal syndrome caused by Puumala hantavirus
We have previously found plasma and urinary levels of interleukin (IL)-6, tumor necrosis factor-α, IL-1, and IL-1-receptor antagonist to be increased during the acute phase of NE, so that the observed levels of IL-6 were exceptionally high [15]
We studied whether plasma IL-6 or C-reactive protein (CRP) levels are associated with the severity of NE, in order to evaluate if IL-6 or CRP are good markers for disease severity in NE
Summary
Nephropathia epidemica (NE) is a Scandinavian type of hemorrhagic fever with renal syndrome caused by Puumala hantavirus. Nephropathia epidemica (NE) is a Scandinavian type of hemorrhagic fever with renal syndrome. The causative agent, Puumala virus (PUUV), is a member of the genus Hantavirus in the family Bunyaviridae [1]. Other hantaviruses causing more severe forms of HFRS include Hantaan, Seoul, and Dobrava viruses [2]. Many hantaviruses in North and South America, e.g. Sin Nombre, Andes, and Black Creek Canal viruses, cause hantavirus pulmonary syndrome (HPS) [2]. Nephropathia epidemica is prevalent in Finland, elsewhere in Scandinavia, in Western Russia, in the Balkan region and in many parts of Western Europe [2,4]. 1000 serological diagnoses of PUUV infection are made in Finland annually [5]. The seroprevalence in the Finnish population is 5%, implying that most infections are subclinical or undiagnosed [5]
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