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Cardiopulmonary involvement in Puumala hantavirus infection.

Rasmuson J, Lindqvist P, Sörensen K, Hedström M, Blomberg A, Ahlm C - BMC Infect. Dis. (2013)

Bottom Line: Furthermore, patients experiencing impaired general condition at follow-up had significantly lower gas diffusing capacity and higher pulmonary vascular resistance, compared to those feeling fully recovered.The results demonstrate vascular leakage in the lungs that most likely is responsible for impaired gas diffusing capacity and increased pulmonary vascular resistance with secondary pulmonary hypertension and right heart distress.The method of simultaneous investigations of important cardiac and respiratory measurements improves the interpretation of the underlying pathophysiologic mechanisms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Microbiology, Umeå University, SE - 901 85 Umeå, Sweden. johan.rasmuson@climi.umu.se.

ABSTRACT

Background: Hantavirus infections cause potentially life-threatening disease in humans world-wide. Infections with American hantaviruses may lead to hantavirus pulmonary syndrome characterised by severe cardiopulmonary distress with high mortality. Pulmonary involvement in European Puumala hantavirus (PUUV) infection has been reported, whereas knowledge of potential cardiac manifestations is limited. We aimed to comprehensively investigate cardiopulmonary involvement in patients with PUUV-infection.

Methods: Twenty-seven hospitalised patients with PUUV-infection were examined with lung function tests, chest high-resolution CT (HRCT), echocardiography including speckle tracking strain rate analysis, ECG and measurements of cardiac biomarkers N-terminal pro-B-type natriuretic peptide (NT-ProBNP) and troponin T. Patients were re-evaluated after 3 months. Twenty-five age and sex-matched volunteers acted as controls for echocardiography data.

Results: Two-thirds of the patients experienced respiratory symptoms as dry cough or dyspnoea. Gas diffusing capacity was impaired in most patients, significantly improving at follow-up but still subnormal in 38%. HRCT showed thoracic effusions or pulmonary oedema in 46% of the patients. Compared to controls, the main echocardiographic findings in patients during the acute phase were significantly higher pulmonary vascular resistance, higher systolic pulmonary artery pressure, lower left ventricular ejection fraction and impaired left atrial myocardial motion. Pathological ECG, atrial fibrillation or T-wave changes, was demonstrated in 26% of patients. NT-ProBNP concentrations were markedly increased and were inversely associated with gas diffusing capacity but positively correlated to pulmonary vascular resistance. Furthermore, patients experiencing impaired general condition at follow-up had significantly lower gas diffusing capacity and higher pulmonary vascular resistance, compared to those feeling fully recovered.

Conclusions: In a majority of patients with PUUV-infection, both cardiac and pulmonary involvement was demonstrated with implications on patients' recovery. The results demonstrate vascular leakage in the lungs that most likely is responsible for impaired gas diffusing capacity and increased pulmonary vascular resistance with secondary pulmonary hypertension and right heart distress. Interestingly, NT-ProBNP was markedly elevated even in the absence of overt ventricular heart failure. The method of simultaneous investigations of important cardiac and respiratory measurements improves the interpretation of the underlying pathophysiologic mechanisms.

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Chest high-resolution computed tomography image from a patient with Puumala hantavirus infection. Investigation was performed four days post onset of disease and shows bilateral pleural effusion and pulmonary oedema in a previously healthy non-smoking patient with pronounced clinical lung manifestations.
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Figure 1: Chest high-resolution computed tomography image from a patient with Puumala hantavirus infection. Investigation was performed four days post onset of disease and shows bilateral pleural effusion and pulmonary oedema in a previously healthy non-smoking patient with pronounced clinical lung manifestations.

Mentions: Abnormal chest HRCT was evident in 14 patients (58%). Thoracic effusions or pulmonary oedema (Figure 1) were found in 11 patients (46%). Enlarged thoracic lymph nodes and pneumonic infiltrates were also detected (Table 3). Patients with abnormal chest HRCT had lower DLCO (P < 0.05), higher CRP (P < 0.05), higher leukocyte count (P = 0.053) and were more likely to require oxygen treatment (P < 0.05), compared to patients with normal chest HRCT (data not shown). Patients with pulmonary oedema had higher leukocyte count (P < 0.05) and lactate dehydrogenase concentration (P < 0.05), lower nadir platelet count (P < 0.05) and a non-significantly lower DLCO (P = 0.064), compared to patients without pulmonary oedema (data not shown). There was no statistical difference in maximum creatinine concentrations between patients with abnormal HRCT or pulmonary oedema and those with normal findings (P = 0.241 and P = 0.197 respectively, data not shown).


Cardiopulmonary involvement in Puumala hantavirus infection.

Rasmuson J, Lindqvist P, Sörensen K, Hedström M, Blomberg A, Ahlm C - BMC Infect. Dis. (2013)

Chest high-resolution computed tomography image from a patient with Puumala hantavirus infection. Investigation was performed four days post onset of disease and shows bilateral pleural effusion and pulmonary oedema in a previously healthy non-smoking patient with pronounced clinical lung manifestations.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231367&req=5

Figure 1: Chest high-resolution computed tomography image from a patient with Puumala hantavirus infection. Investigation was performed four days post onset of disease and shows bilateral pleural effusion and pulmonary oedema in a previously healthy non-smoking patient with pronounced clinical lung manifestations.
Mentions: Abnormal chest HRCT was evident in 14 patients (58%). Thoracic effusions or pulmonary oedema (Figure 1) were found in 11 patients (46%). Enlarged thoracic lymph nodes and pneumonic infiltrates were also detected (Table 3). Patients with abnormal chest HRCT had lower DLCO (P < 0.05), higher CRP (P < 0.05), higher leukocyte count (P = 0.053) and were more likely to require oxygen treatment (P < 0.05), compared to patients with normal chest HRCT (data not shown). Patients with pulmonary oedema had higher leukocyte count (P < 0.05) and lactate dehydrogenase concentration (P < 0.05), lower nadir platelet count (P < 0.05) and a non-significantly lower DLCO (P = 0.064), compared to patients without pulmonary oedema (data not shown). There was no statistical difference in maximum creatinine concentrations between patients with abnormal HRCT or pulmonary oedema and those with normal findings (P = 0.241 and P = 0.197 respectively, data not shown).

Bottom Line: Furthermore, patients experiencing impaired general condition at follow-up had significantly lower gas diffusing capacity and higher pulmonary vascular resistance, compared to those feeling fully recovered.The results demonstrate vascular leakage in the lungs that most likely is responsible for impaired gas diffusing capacity and increased pulmonary vascular resistance with secondary pulmonary hypertension and right heart distress.The method of simultaneous investigations of important cardiac and respiratory measurements improves the interpretation of the underlying pathophysiologic mechanisms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Microbiology, Umeå University, SE - 901 85 Umeå, Sweden. johan.rasmuson@climi.umu.se.

ABSTRACT

Background: Hantavirus infections cause potentially life-threatening disease in humans world-wide. Infections with American hantaviruses may lead to hantavirus pulmonary syndrome characterised by severe cardiopulmonary distress with high mortality. Pulmonary involvement in European Puumala hantavirus (PUUV) infection has been reported, whereas knowledge of potential cardiac manifestations is limited. We aimed to comprehensively investigate cardiopulmonary involvement in patients with PUUV-infection.

Methods: Twenty-seven hospitalised patients with PUUV-infection were examined with lung function tests, chest high-resolution CT (HRCT), echocardiography including speckle tracking strain rate analysis, ECG and measurements of cardiac biomarkers N-terminal pro-B-type natriuretic peptide (NT-ProBNP) and troponin T. Patients were re-evaluated after 3 months. Twenty-five age and sex-matched volunteers acted as controls for echocardiography data.

Results: Two-thirds of the patients experienced respiratory symptoms as dry cough or dyspnoea. Gas diffusing capacity was impaired in most patients, significantly improving at follow-up but still subnormal in 38%. HRCT showed thoracic effusions or pulmonary oedema in 46% of the patients. Compared to controls, the main echocardiographic findings in patients during the acute phase were significantly higher pulmonary vascular resistance, higher systolic pulmonary artery pressure, lower left ventricular ejection fraction and impaired left atrial myocardial motion. Pathological ECG, atrial fibrillation or T-wave changes, was demonstrated in 26% of patients. NT-ProBNP concentrations were markedly increased and were inversely associated with gas diffusing capacity but positively correlated to pulmonary vascular resistance. Furthermore, patients experiencing impaired general condition at follow-up had significantly lower gas diffusing capacity and higher pulmonary vascular resistance, compared to those feeling fully recovered.

Conclusions: In a majority of patients with PUUV-infection, both cardiac and pulmonary involvement was demonstrated with implications on patients' recovery. The results demonstrate vascular leakage in the lungs that most likely is responsible for impaired gas diffusing capacity and increased pulmonary vascular resistance with secondary pulmonary hypertension and right heart distress. Interestingly, NT-ProBNP was markedly elevated even in the absence of overt ventricular heart failure. The method of simultaneous investigations of important cardiac and respiratory measurements improves the interpretation of the underlying pathophysiologic mechanisms.

Show MeSH
Related in: MedlinePlus