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Clinical and Developmental Immunology
Volume 2013 (2013), Article ID 634632, 4 pages
Research Article

Elevated Cerebrospinal Fluid Neopterin Concentration Is Associated with Disease Severity in Acute Puumala Hantavirus Infection

1Department of Internal Medicine, Oulu University Hospital, P.O. Box 20, 90029 Oulu, Finland
2Department of Virology, Haartman Institute, University of Helsinki, P.O. Box 21, 00014 Helsinki, Finland
3Institute of Diagnostics, Department of Medical Microbiology, University of Oulu, 90014 Oulu, Finland
4Department of Ophthalmology, Oulu University Hospital, P.O. Box 21, 90029 Oulu, Finland
5Clinical Microbiology Laboratory, Oulu University Hospital, P.O. Box 50, 90029 Oulu, Finland
6Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 66, 00014 Helsinki, Finland
7Department of Virology and Immunology, HUSLAB, Helsinki University Central Hospital, HUS, 00029 Helsinki, Finland

Received 2 May 2013; Accepted 19 July 2013

Academic Editor: James Curtin

Copyright © 2013 Timo Hautala et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Nephropathia epidemica (NE) caused by Puumala hantavirus (PUUV) is the most common hemorrhagic fever with renal syndrome (HFRS) in Europe. The infection activates immunological mechanisms that contribute to the pathogenesis and characteristics of the illness. In this study we measured cerebrospinal fluid (CSF) neopterin concentration from 23 acute-phase NE patients. We collected data on kidney function, markers of tissue permeability, haemodynamic properties, blood cell count, length of hospitalisation, inflammatory parameters, and ophthalmological properties. The neopterin levels were elevated (>5.8 nmol/L) in 22 (96%) NE-patients (mean 45.8 nmol/L); these were especially high in patients with intrathecal PUUV-IgM production (mean 58.2 nmol/L, ) and those with elevated CSF protein concentrations (mean 63.6 nmol/L, ). We also observed a correlation between the neopterin and high plasma creatinine value ( , ), low blood thrombocyte count ( , ), and markedly disturbed refractory properties of an eye ( , ). Length of hospitalisation correlated with the neopterin ( , ; male patients , ). Patients with signs of tissue oedema and increased permeability also had high neopterin concentrations. These results reinforce the view that PUUV-HFRS is a general infection that affects the central nervous system and the blood-brain barrier.