Tula Hantavirus Infection in Immunocompromised Host, Czech Republic

Hana Zelená¹

, Jakub Mrázek¹, and Tomáš Kuhn¹

Author affiliations: Institute of Public Health, Ostrava, Czech Republic (H. Zelená, J. Mrázek); University of Defence, Hradec Králové, Czech Republic (H. Zelená); University Hospital, Ostrava (T. Kuhn)

Abstract

We report molecular evidence of Tula hantavirus as an etiologic agent of pulmonary-renal syndrome in an immunocompromised patient. Acute hantavirus infection was confirmed by using serologic and molecular methods. Sequencing revealed Tula virus genome RNA in the patient’s blood. This case shows that Tula virus can cause serious disease in humans.

Hantaviruses are enveloped RNA viruses carried by rodents and insectivore species. At least 5 hantavirus species are known to circulate in Europe: Dobrava-Belgrade virus, Puumala virus (PUUV), Seoul virus, Saarema virus, and Tula virus (TULV). The first 3 are well-characterized human pathogens; however, little is known about TULV human pathogenicity.
The species Tulavirus was first described by Plyusnin et al. (1) in voles (Microtus arvalis and M. levis) caught in Tula, Russia, in 1987. The presence of TULV was also documented in other vole species in several European countries including Germany, Switzerland, Slovenia, Czech Republic, Slovakia, Austria, Poland, and Serbia (2). In Central Europe, M. arvalis is the main reservoir of TULV. The TULV antigen was found in 10% of the population of common voles in southern Moravia in the Czech Republic (3). The pathogenic potential of Tula virus in humans is considered to be low.
The causative agents of hemorrhagic fever with renal syndrome in Central Europe are Dobrava-Belgrade virus and PUUV (4). These viruses seem to circulate in geographic areas that overlap with the areas where TULV circulates. Despite the massive population of common voles in the Czech Republic and a high prevalence of TULV in its rodent reservoir, human TULV infection has not been reported.

The Patient

A 14-year-old boy from a rural region in the northeast part of the Czech Republic (Opava region) has received treatment for acute lymphoblastic leukemia since July 2011. Because of the biologic properties of the malignity, the boy was classified into the high-risk group of the treatment protocol. The intensive part of the treatment was finished in August 2012, and the patient has continued maintenance therapy since then.