Characterisation of disease progression in hantavirus haemorrhagic fever with renal syndrome

Hantaviruses can cause haemorrhagic fever with renal syndrome (HFRS), a clinically variable disease. Researchers used proteomics to compare disease progression in patients infected with two types of hantaviruses - Dobrava virus and Puumala virus. Patients with severe disease had higher viral load at the beginning of hospitalization, with Dobrava virus causing higher viral load than Puumala virus. Proteomic signatures revealed a strong acute-phase response in both mild and severe disease. Severe disease was associated with activation of pathways related to endothelial dysfunction, low platelet count, vascular leakage, and kidney injury. The findings suggest that severe HFRS is driven by sustained activation of inflammatory, complement, and platelet/coagulation pathways, rather than viral burden alone.