Pathophysiology of a severe case of Puumala hantavirus infection successfully treated with bradykinin receptor antagonist icatibant

Antti Vaheri; Tomas Strandin; Anne J Jääskeläinen; Olli Vapalahti; Hanna Jarva; Marja-Liisa Lokki; Jaakko Antonen; Ilona Leppänen; Satu Mäkelä; Seppo Meri; Jukka Mustonen

doi:10.1016/j.antiviral.2014.08.007

Pathophysiology of a severe case of Puumala hantavirus infection successfully treated with bradykinin receptor antagonist icatibant

Antiviral Res. 2014 Nov:111:23-5. doi: 10.1016/j.antiviral.2014.08.007. Epub 2014 Sep 3.

Authors

Affiliations

¹ Haartman Institute, University of Helsinki, Finland; Department of Virology and Immunology, Helsinki University Central Hospital Laboratory, Finland. Electronic address: antti.vaheri@helsinki.fi.
² Haartman Institute, University of Helsinki, Finland.
³ Haartman Institute, University of Helsinki, Finland; Department of Virology and Immunology, Helsinki University Central Hospital Laboratory, Finland.
⁴ Haartman Institute, University of Helsinki, Finland; Department of Virology and Immunology, Helsinki University Central Hospital Laboratory, Finland; Department of Veterinary Biosciences, University of Helsinki, Finland.
⁵ Haartman Institute, University of Helsinki, Finland; Immunobiology Research Program, University of Helsinki, Finland.
⁶ Tampere University Hospital, Finland.
⁷ Tampere University Hospital, Finland; School of Medicine, University of Tampere, Finland.

PMID: 25194993
DOI: 10.1016/j.antiviral.2014.08.007

Abstract

We recently described a patient with very severe Puumala hantavirus infection manifested by capillary leakage syndrome and shock. He was successfully treated with the bradykinin receptor antagonist, icatibant (Antonen et al., 2013). Here we report analysis of the pathophysiology which indicated pronounced complement activation, prolonged leukocytosis, extensive fibrinolysis, circulating histones, and defects in liver function. The patient had an uncommon HLA-phenotype, which may have contributed to the severe course of the disease.

Keywords: Bradykinin; Capillary leakage; Complement activation; Hantavirus; Icatibant; Pathophysiology.

Publication types

Case Reports
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Bradykinin / administration & dosage
Bradykinin / analogs & derivatives*
Bradykinin Receptor Antagonists / administration & dosage*
Hemorrhagic Fever with Renal Syndrome / drug therapy*
Hemorrhagic Fever with Renal Syndrome / metabolism
Hemorrhagic Fever with Renal Syndrome / pathology
Hemorrhagic Fever with Renal Syndrome / virology
Humans
Male
Puumala virus / drug effects*
Puumala virus / physiology
Receptors, Bradykinin / genetics
Receptors, Bradykinin / metabolism

Substances

Bradykinin Receptor Antagonists
Receptors, Bradykinin
icatibant
Bradykinin