Dobrava Hantavirus Infection Complicated by Panhypopituitarism, Istanbul, Turkey, 2010

Nevin Sarıgüzel¹

, Jörg Hofmann¹, Alper Tunga Canpolat, Ali Türk, Jakob Ettinger, Deniz Atmaca, Işın Akyar, Serap Yücel, Ender Arıkan, Yavuz Uyar, Dilek Y. Çağlayık, Ayşe Sesin Kocagöz, Ayşin Kaya, and Detlev H. Kruger

Author affiliations: Acıbadem Hospital, Istanbul, Turkey (N. Sarıgüzel, A.T. Canpolat, D. Atmaca, Serap Yücel, Ender Arıkan); Charité University Medicine, Berlin, Germany (J. Hofmann, J. Ettinger, D.H. Kruger); Labor Berlin Charité-Vivantes GmbH, Berlin (J. Hofmann, J. Ettinger, D. H. Kruger); Acıbadem University, Istanbul (A.Türk, I. Akyar, A. S. Kocagöz); Refik Saydam National Public Health Agency, Ankara, Turkey (Y. Uyar, D. Y. Çağlayık); and University of Geneva, Geneva, Switzerland (A. Kaya)

Abstract

We identified Dobrava-Belgrade virus infection in Turkey (from a strain related to hantavirus strains from nearby countries) in a patient who had severe symptoms leading to panhypopituitarism, but no known risk for hantavirus. Our findings emphasize the need for increased awareness of hantaviruses in the region and assessment of symptomatic persons without known risk factors for infection.

Hemorrhagic fever with renal syndrome (HFRS) is caused by infection with hantaviruses. Most patients with HFRS recover completely, but acute and chronic complications may develop. HFRS patients with severe lung involvement resembling hantavirus cardiopulmonary syndrome have been described (1). In addition, pituitary hemorrhage, followed by hypopituitarism, is a possible complication of HFRS. Involvement of the pituitary gland has been observed in some patients infected with Puumala virus, a hantavirus commonly found in western and central Europe (2–4).
We report on a patient who experienced shock, pulmonary failure, and panhypopituitarism as complications of HFRS. By testing for neutralizing antibodies and by amplification and molecular characterization of virus samples, we identified the causative pathogen as a strain of Dobrava-Belgrade virus (DOBV) that is closely related to a hantavirus strain typically carried by the yellow-necked field mouse (Apodemus flavicollis), strain DOBV-Af.