Human infection with Seoul orthohantavirus in Korea, 2019

Abstract

Of various rodent-borne hantaviruses, Seoul orthohantavirus (SEOV) causes haemorrhagic fever with renal syndrome (HFRS), as does Hantaan orthohantavirus (HTNV). Given global-scale of cases of human infection with SEOV, it is of great clinical importance to distinguish SEOV from other HFRS-causing hantaviruses. In May 2019, a middle-aged patient who had lived in a suburban area of Chungcheong Province, Republic of Korea and enjoyed outdoor activities was transferred to Asan Medical Center in Seoul, Republic of Korea with HFRS; his symptoms included high fever and generalized myalgia. The rapid diagnostic test performed immediately after his transfer detected HTNV-specific antibodies, and the patient was treated accordingly. However, two consecutive IFAs performed at ten-day intervals showed no HTNV-specific immunoglobulin (Ig) G. During continuous supportive care, next-generation sequencing successfully identified viral genomic sequences in the patient's serum, which were SEOV and not HTNV. Phylogenetic analysis grouped the L, M, and S genes of this SEOV strain together with those of rat- or human-isolated Korean strains reported previously. Given global outbreaks and public health threats of zonotic hantaviruses, a causative pathogen of hantavirus HFRS should be identified correctly at the time of diagnosis and by point-of-care testing.

Author summary

Rodent-borne Seoul orthohantavirus (SEOV) has provoked human cases from Asia to the Americas and Europe whereas most orthohantaviruses cause regional cases. Despite this, SEOV gets less attention than other orthohantaviruses. In Korea, 2019, a middle-aged man was initially diagnosed with Hantaan orthohantavirus (HTNV) and treated accordingly. However, next-generation sequencing identified SEOV, not HTNV, in the patient's serum. Given its global outbreaks and public health threats, zoonotic SEOV should be diagnosed correctly on point of care to reduce unnecessary medical costs.