Use of a diagnostic Puumala virus real-time RT-PCR in an orthohantavirus endemic region in the Netherlands

• Published in: Microbiology spectrum Vol. 12; no. 7; p. e0381323
• Main Authors: Geeraedts, Felix, Wevers, Mariska, Bosma, Froukje, Boer, Maria de, Brinkman, J N, Delsing, Corine, GeurtsvanKessel, Corine, Rockx, Barry, van der Zanden, Adri, Laverman, Gozewijn D
• Format: Journal Article
• Language: English
• Published: United States American Society for Microbiology 02-07-2024
• Subjects: Antibodies, Viral - blood; Clinical Microbiology; Endemic Diseases; Female; hantavirus; Hantavirus Infections - diagnosis; Hantavirus Infections - epidemiology; Hantavirus Infections - virology; Hemorrhagic Fever with Renal Syndrome - diagnosis; Hemorrhagic Fever with Renal Syndrome - epidemiology; Hemorrhagic Fever with Renal Syndrome - virology; Humans; Immunoglobulin M - blood; Male; molecular methods; Netherlands - epidemiology; nucleic acid amplification test; Orthohantavirus - classification; Orthohantavirus - genetics; Orthohantavirus - isolation & purification; Puumala virus; Puumala virus - genetics; Puumala virus - isolation & purification; Real-Time Polymerase Chain Reaction - methods; Research Article; Reverse Transcriptase Polymerase Chain Reaction - methods; RNA, Viral - genetics; Serologic Tests - methods; serology; zoonotic infections; Netherlands; molecular methods; nephrology; diagnostics; Puumala virus; zoonotic infections; hantavirus; serology; nucleic acid amplification test
• DOI: 10.1128/spectrum.03813-23
• EISSN: 2165-0497

Laboratory diagnosis of orthohantavirus infection is primarily based on serology. However, for a confirmed serological diagnosis, evaluation of a follow-up serum sample is essential, which is time consuming and causes delay. Real-time reverse transcription polymerase chain reaction (RT-PCR) tests, if positive, provide an immediate and definitive diagnosis, and accurately identify the causative agent, where the discriminative nature of serology is suboptimal. We re-evaluated sera from orthohantavirus-suspected clinical cases in the Dutch regions of
and
from July 2014 to April 2016 for the presence of Puumala orthohantavirus (PUUV), Tula orthohantavirus (TULV), and Seoul orthohantavirus (SEOV) RNA. PUUV RNA was detected in 11% of the total number (
= 85) of sera tested, in 50% of sera positive for anti-PUUV/TULV IgM (
= 16), and in 1.4% of sera negative or indeterminate for anti-PUUV/TULV IgM (
= 69). No evidence was found for the presence of TULV or SEOV viral RNA. Based on these findings, we propose two algorithms to implement real-time RT-PCR testing in routine orthohantavirus diagnostics, which optimally provide clinicians with early confirmed diagnoses and could prevent possible further invasive testing and treatment.
The addition of a real-time reverse transcription polymerase chain reaction test to routine orthohantavirus diagnostics may better aid clinical decision making than the use of standard serology tests alone. Awareness by clinicians and clinical microbiologists of this advantage may ultimately lead to a reduction in over-hospitalization and unnecessary invasive diagnostic procedures.