PUUMALA HANTAVIRUS GENOME IN PATIENTS WITH NEPHROPATHIA-EPIDEMICA - CORRELATION OF PCR POSITIVITY WITH HLA HAPLOTYPE AND LINK TO VIRAL SEQUENCES IN LOCAL RODENTS

Reverse transcription-PCR was used to analyze specimens from 20 Finnis h nephropathia epidemica (NE) patients hospitalized during the period from October 1994 to January 1995. Blood and/or urine sediment specime ns from seven patients were found to be positive for the genome sequen ces of Puumala hantavirus (PUU). PCR positivity of the specimens from the patients correlated well with the HLA-DRB10301 and HLA B8 alleles , which previously were shown to associate with severe courses of NE. Genetic analysis of the partial M- and/or S-segment sequences obtained from three severely ill NE patients revealed three PUU strains relate d to but distinct from previously reported strains from Finland. The M -segment sequence of PUU from bank voles trapped near the probable sit e of infection for one of the patients showed 98.2% identity to that o f the PUU strain obtained from the patient, suggesting a link between wild-type PUU from the natural focus and the NE case. The S-segment se quences from the patient and the bank voles, however, showed substanti ally lower identity (95.8%). As this difference in diversity for M and S genes (1.8 and 4.2%) is atypical for PUU genetic drift, one possibi lity is that the strain acquired at the putative place of infection is a reassortant one.