Open Access Research article

Young male patients are at elevated risk of developing serious central nervous system complications during acute Puumala hantavirus infection

Timo Hautala1*, Nina Hautala2, Saara-Mari Mähönen3, Tarja Sironen6, Eija Pääkkö4, Ari Karttunen4, Pasi I Salmela1, Olli Vainio37, Seppo Rytky5, Alexander Plyusnin6, Antti Vaheri6, Olli Vapalahti6 and Heikki Kauma1

Author Affiliations

1 Department of Internal Medicine, Oulu University Hospital, Oulu, Finland

2 Department of Ophthalmology, Oulu University Hospital, Oulu, Finland

3 Institute of Diagnostics, Department of Medical Microbiology and Immunology, University of Oulu, Oulu, Finland

4 Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland

5 Department of Clinical Neurophysiology, Oulu University Hospital, Oulu, Finland

6 Department of Virology, Infection Biology Research Program, Haartman Institute, University of Helsinki, Helsinki, Finland

7 Clinical Microbiology Laboratory, Oulu University Hospital, Oulu, Finland

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BMC Infectious Diseases 2011, 11:217  doi:10.1186/1471-2334-11-217

Published: 14 August 2011



Our aim was to characterize clinical properties and laboratory parameters in patients with or without cerebrospinal fluid (CSF) findings suggestive of central nervous system (CNS) involvement, and especially those who developed serious CNS complications during acute nephropathia epidemica (NE) caused by Puumala hantavirus (PUUV) infection.


A prospective cohort of 40 patients with acute NE and no signs of major CNS complications was analyzed. In addition, 8 patients with major CNS complications associated with NE were characterized. We collected data of CNS symptoms, CSF analysis, brain magnetic resonance imaging (MRI) results, electroencephalography (EEG) recordings, kidney function, and a number of laboratory parameters. Selected patients were evaluated by an ophthalmologist.


Patients with a positive CSF PUUV IgM finding or major CNS complications were more often males (p < 0.05) and they had higher plasma creatinine values (p < 0.001) compared to those with negative CSF PUUV IgM. The degree of tissue edema did not explain the CSF findings. Patients with major CNS complications were younger than those with negative CSF PUUV IgM finding (52.9 vs. 38.5 years, p < 0.05). Some patients developed permanent neurological and ophthalmological impairments.


CNS and ocular involvement during and after acute NE can cause permanent damage and these symptoms seem to be attributable to true infection of the CNS rather than increased tissue permeability. The possibility of this condition should be borne in mind especially in young male patients.

hantavirus; encephalitis; hypopituitarism