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Chapter 44 : Orthobunyaviruses, Phleboviruses Nairoviruses, and Hantaviruses

Authors: Gregory J. Mertz1, Clas Ahlm2, Colleen B. Jonsson3
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Affiliations: 1: Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131-0001; 2: Division of Infectious Diseases, Department of Clinical Microbiology, Umeå University S-901 85, Umeå, Sweden; 3: Department of Microbiology, University of Tennessee-Knoxville, Knoxville, TN 37996-3410
Content Type: Reference
Publication Year: 2017

Category: Viruses and Viral Pathogenesis

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Abstract:

The family is the largest family of viruses and includes many known human, animal, and plant pathogens. The clinical diseases produced in humans range from acute febrile illnesses, such as sandfly fever, to more distinct clinical syndromes such as California encephalitis (CE), Rift Valley fever (RVF), Crimean-Congo hemorrhagic fever (CCHF), hemorrhagic fever with renal syndrome (HFRS), and hantavirus cardiopulmonary syndrome (HCPS), which is also referred to in the literature as hantavirus pulmonary syndrome (HPS). Sandfly fever, RVF, and HFRS are common. Although most of the remaining diseases probably cause no more than a few hundred cases each year, some are associated with a high mortality rate (particularly CCHF and HCPS), and two (CE and HCPS) are endemic in North America.

Citation: Mertz G, Ahlm C, Jonsson C. 2017. Orthobunyaviruses, Phleboviruses Nairoviruses, and Hantaviruses, p 1059-1087. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch44
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Bunyaviridae: Orthobunyaviruses, Phleboviruses Nairoviruses, and Hantaviruses
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Citation: Mertz G, Ahlm C, Jonsson C. 2017. Orthobunyaviruses, Phleboviruses Nairoviruses, and Hantaviruses, p 1059-1087. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch44
/content/10.1128/9781555819439.ch44.ch44fig1
FIGURE 1

Model for replication. The principal steps in replication are (1) attachment of Gn to integrin receptor; (2) entry and uncoating; (3) replication, cRNA synthesis from vRNA genome; (4) transcription, mRNA synthesis from vRNA genome; (5) replication, vRNA synthesis from cRNA template; (6) translation, L and M mRNA translated on free ribosomes and M translation on RER; N and RdRp and L, M, and S genomes move to Golgi; (7) packaging, assembly of genomic RNAs and proteins at Golgi (some evidence for New World viruses assembling on plasma membrane); and (8) budding. Virion release, Golgi vesicles release virion by budding with plasma membrane.

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10.1128/9781555819439/9439ch44fig1.gif
Image of FIGURE 1
FIGURE 1

Model for replication. The principal steps in replication are (1) attachment of Gn to integrin receptor; (2) entry and uncoating; (3) replication, cRNA synthesis from vRNA genome; (4) transcription, mRNA synthesis from vRNA genome; (5) replication, vRNA synthesis from cRNA template; (6) translation, L and M mRNA translated on free ribosomes and M translation on RER; N and RdRp and L, M, and S genomes move to Golgi; (7) packaging, assembly of genomic RNAs and proteins at Golgi (some evidence for New World viruses assembling on plasma membrane); and (8) budding. Virion release, Golgi vesicles release virion by budding with plasma membrane.

Citation: Mertz G, Ahlm C, Jonsson C. 2017. Orthobunyaviruses, Phleboviruses Nairoviruses, and Hantaviruses, p 1059-1087. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch44
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FIGURE 2

Distribution of and location of HPS cases as of 9 May 2006. Total cases (N = 438 in 30 states) (from Centers for Disease Control and Prevention).

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FIGURE 2

Distribution of and location of HPS cases as of 9 May 2006. Total cases (N = 438 in 30 states) (from Centers for Disease Control and Prevention).

Citation: Mertz G, Ahlm C, Jonsson C. 2017. Orthobunyaviruses, Phleboviruses Nairoviruses, and Hantaviruses, p 1059-1087. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch44
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FIGURE 3

Peripheral blood smear from a patient with the cardiopulmonary stage of hantavirus cardiopulmonary syndrome. Note the immunoblast with basophilic cytoplasm, prominent nucleolus, and high nuclear to cytoplasmic ratio. Also note immature neutrophils. Courtesy of R. Feddersen.

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Image of FIGURE 3
FIGURE 3

Peripheral blood smear from a patient with the cardiopulmonary stage of hantavirus cardiopulmonary syndrome. Note the immunoblast with basophilic cytoplasm, prominent nucleolus, and high nuclear to cytoplasmic ratio. Also note immature neutrophils. Courtesy of R. Feddersen.

Citation: Mertz G, Ahlm C, Jonsson C. 2017. Orthobunyaviruses, Phleboviruses Nairoviruses, and Hantaviruses, p 1059-1087. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch44
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FIGURE 4

Pulmonary histology in a patient who died from hantavirus cardiopulmonary syndrome. Note the intra-alveolar and septal edema, interstitial infiltrates with mononuclear cells, and sparse hyaline membrane. In contrast to patients with ARDS, the hyaline membranes are largely devoid of inflammatory cells and cellular debris. Courtesy of Dr. K Nolte.

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Image of FIGURE 4
FIGURE 4

Pulmonary histology in a patient who died from hantavirus cardiopulmonary syndrome. Note the intra-alveolar and septal edema, interstitial infiltrates with mononuclear cells, and sparse hyaline membrane. In contrast to patients with ARDS, the hyaline membranes are largely devoid of inflammatory cells and cellular debris. Courtesy of Dr. K Nolte.

Citation: Mertz G, Ahlm C, Jonsson C. 2017. Orthobunyaviruses, Phleboviruses Nairoviruses, and Hantaviruses, p 1059-1087. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch44
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FIGURE 5

Clinical course and typical laboratory findings in severe hantavirus cardiopulmonary syndrome and severe hemorrhagic fever with renal syndrome. Reprinted from reference ( ) with permission of the publisher.

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Image of FIGURE 5
FIGURE 5

Clinical course and typical laboratory findings in severe hantavirus cardiopulmonary syndrome and severe hemorrhagic fever with renal syndrome. Reprinted from reference ( ) with permission of the publisher.

Citation: Mertz G, Ahlm C, Jonsson C. 2017. Orthobunyaviruses, Phleboviruses Nairoviruses, and Hantaviruses, p 1059-1087. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch44
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FIGURE 6

Bilateral pulmonary edema in a patient with the cardiopulmonary stage of HCPS. Courtesy of L Ketai.

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Image of FIGURE 6
FIGURE 6

Bilateral pulmonary edema in a patient with the cardiopulmonary stage of HCPS. Courtesy of L Ketai.

Citation: Mertz G, Ahlm C, Jonsson C. 2017. Orthobunyaviruses, Phleboviruses Nairoviruses, and Hantaviruses, p 1059-1087. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch44
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FIGURE 7

Flow diagram for the management of patients suspected of having hantavirus cardiopulmonary syndrome in the cardiopulmonary stage pending IgG and IgM antihantavirus antibody results. Reprinted from reference ( ) with permission of the publisher.

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Image of FIGURE 7
FIGURE 7

Flow diagram for the management of patients suspected of having hantavirus cardiopulmonary syndrome in the cardiopulmonary stage pending IgG and IgM antihantavirus antibody results. Reprinted from reference ( ) with permission of the publisher.

Citation: Mertz G, Ahlm C, Jonsson C. 2017. Orthobunyaviruses, Phleboviruses Nairoviruses, and Hantaviruses, p 1059-1087. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch44
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FIGURE 8

Survival without extracorporeal membrane oxygenation among ribavirin recipients versus placebo recipients in a trial of intravenous ribavirin therapy for hantavirus cardiopulmonary syndrome. Solid line, ribavirin recipients (N = 10); broken line, placebo recipients (N = 13). Reprinted from reference ( ) with permission of the publisher.

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Image of FIGURE 8
FIGURE 8

Survival without extracorporeal membrane oxygenation among ribavirin recipients versus placebo recipients in a trial of intravenous ribavirin therapy for hantavirus cardiopulmonary syndrome. Solid line, ribavirin recipients (N = 10); broken line, placebo recipients (N = 13). Reprinted from reference ( ) with permission of the publisher.

Citation: Mertz G, Ahlm C, Jonsson C. 2017. Orthobunyaviruses, Phleboviruses Nairoviruses, and Hantaviruses, p 1059-1087. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch44
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FIGURE 9

Kaplan-Meier survival analysis by treatment arm and severity at entry. 1: significance between methylprednisolone and placebo arm. 2: significance between sequential organ failure assessment (SOFA) >8 and ≤8 at entry. Reprinted from reference ( ) with permission of the publisher.

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Image of FIGURE 9
FIGURE 9

Kaplan-Meier survival analysis by treatment arm and severity at entry. 1: significance between methylprednisolone and placebo arm. 2: significance between sequential organ failure assessment (SOFA) >8 and ≤8 at entry. Reprinted from reference ( ) with permission of the publisher.

Citation: Mertz G, Ahlm C, Jonsson C. 2017. Orthobunyaviruses, Phleboviruses Nairoviruses, and Hantaviruses, p 1059-1087. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch44
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FIGURE 10

Worldwide distribution of CCHF virus. Reprinted from reference ( ) with permission of the publisher.

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Image of FIGURE 10
FIGURE 10

Worldwide distribution of CCHF virus. Reprinted from reference ( ) with permission of the publisher.

Citation: Mertz G, Ahlm C, Jonsson C. 2017. Orthobunyaviruses, Phleboviruses Nairoviruses, and Hantaviruses, p 1059-1087. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch44
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FIGURE 11

Clinical and laboratory course of CCHF. Reprinted from reference ( ) with permission of the publisher.

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Image of FIGURE 11
FIGURE 11

Clinical and laboratory course of CCHF. Reprinted from reference ( ) with permission of the publisher.

Citation: Mertz G, Ahlm C, Jonsson C. 2017. Orthobunyaviruses, Phleboviruses Nairoviruses, and Hantaviruses, p 1059-1087. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch44
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