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

Author:

Geeraedts Felix1ORCID,Wevers Mariska1,Bosma Froukje1,Boer Maria de1,Brinkman J. N.2,Delsing Corine2,GeurtsvanKessel Corine3,Rockx Barry4,van der Zanden Adri1,Laverman Gozewijn D.5

Affiliation:

1. Laboratory for Medical Microbiology and Public Health, Hengelo, Overijssel, the Netherlands

2. Department of Internal Medicine, Medisch Spectrum Twente, Enschede, Overijssel, the Netherlands

3. Viroscience, Erasmus University Medical Center, Rotterdam, Zuid-Holland, the Netherlands

4. Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Utrecht, the Netherlands

5. Department of Internal Medicine, Ziekenhuis Groep Twente, Almelo/Hengelo, Overijssel, the Netherlands

Abstract

ABSTRACT 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 Twente and Achterhoek 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 ( n = 85) of sera tested, in 50% of sera positive for anti-PUUV/TULV IgM ( n = 16), and in 1.4% of sera negative or indeterminate for anti-PUUV/TULV IgM ( n = 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. IMPORTANCE 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.

Publisher

American Society for Microbiology

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