Upon the patients admission to the hospital, at the end of September 2012, his conditions deteriorated. areas where TULV circulates. Despite the massive populace of common voles in the Czech Republic and a high prevalence of TULV in its rodent reservoir, human TULV contamination has not been reported. The Patient A 14-year-old young man from a rural region in the northeast part of the Czech Republic (Opava region) has received treatment for acute lymphoblastic leukemia since July 2011. Because of the biologic properties of the malignity, the young man was classified into the high-risk group of the treatment protocol. The rigorous part of the treatment was finished in August 2012, and the patient has continued maintenance therapy since then. During his first week of maintenance therapy, the patient experienced a respiratory contamination with temperatures of 38C, moderate dyspnea, and a cough. These symptoms spontaneously disappeared. One week later, the patient experienced temperatures up to 38.5C. He reported a headache, lack of appetite, and vomiting but no cough or respiratory distress. Upon the patients admission to the hospital, at the end of September 2012, his conditions deteriorated. He was febrile at 39.3C and moderately dehydrated. Dyspnea with desaturation developed, so he was transferred to the intensive care unit to receive oxygenotherapy. The antileukemic maintenance therapy therefore had to be interrupted. The x-ray and high-resolution computed tomographic scan revealed severe bilateral bronchopneumonia with a major fluidothorax and bilateral dystelectasis. He was then given amoxicillin/clavulanate, amikacin, and antimycotic drugs. Oliguria also developed, with a minimum of 0.3 mL/kg/h, and it was managed by diuretic medication. Hemodialysis was not needed. He had transiently increased blood pressure followed by hypotension. Laboratory results revealed eosinophilia in the patients differential leukocyte count at a maximum of 59.3% Upadacitinib (ABT-494) (reference range 0%C5%), anemia with a minimal value of hemoglobin of 60.0 g/L (reference range 135C175 g/L), thrombocytopenia at 12 109/L (reference range 150C440 109/L), and C-reactive protein 70 mg/L (reference range 0C10 mg/L). Elevated values were detected for serum Upadacitinib (ABT-494) urea measured at 8.40 mmol/L (reference range 1.8C6.4 mmol/L), creatinine at 103 mol/L (reference range 27C88 mol/L), and D-dimers at 3.53 g/mL (reference range 0C0.5 g/mL). Other coagulation parameters were not affected. Moreover, erythrocyturia and hyaline cylinders were observed in urine samples. The serum amylase and liver enzyme levels were within reference ranges. The relapse of acute lymphoblastic leukemia was excluded by the bone marrow examination. Because of the patients severe thrombocytopenia, thromboconcentrate was administered. During the course of the patients hospitalization, his clinical condition, computed tomographic scan, and chest radiographic findings, and laboratory parameters improved. His renal failure gradually subsided with a transient polyuric phase. After 3 weeks of hospitalization, the patient resumed maintenance antileukemic therapy, and he was discharged from the hospital in good condition. Serum samples taken on days 11, 12, 20, and 39 were tested for IgG and IgM antibodies to hantaviruses by using ELISA (Anti-Hanta Computer virus Pool 1 Eurasia; Euroimmun, Lbeck, Germany). The serum sample taken on day 12 was further tested for IgG and IgM antibodies by using Immunoblot (Anti-Hanta Profile 1; Euroimmun). ELISA results are considered positive when the index value (optical density divided by the cutoff value) is COL12A1 usually 1.1. Serology results suggested that this causative agent was Upadacitinib (ABT-494) a hantavirus antigenically closer to PUUV (Table 1). Table 1 Results of hantavirus serologic screening, Ostrava, Czech Republic, October 2012 * thead th rowspan=”2″ valign=”bottom” align=”left” scope=”col” colspan=”1″ Computer virus /th th valign=”bottom” colspan=”4″ align=”center” scope=”colgroup” rowspan=”1″ Serum samples obtained on day hr / /th th rowspan=”2″ valign=”bottom” align=”center” scope=”col” colspan=”1″ Positivity range (IP)? /th th valign=”bottom” colspan=”1″ align=”center” scope=”colgroup” rowspan=”1″ 11 /th th valign=”bottom” align=”center” scope=”col” rowspan=”1″ colspan=”1″ 12 /th th valign=”bottom” align=”center” scope=”col” rowspan=”1″ colspan=”1″ 20 /th th valign=”bottom” align=”center” scope=”col” rowspan=”1″ colspan=”1″ 39 /th /thead Hantavirus IgG ELISA0.260.38 2.69 2.60 1.1Hantavirus IgM ELISA 1.17 3.12 4.07 2.78 1.1Puumala computer virus IgG ImmunoblotNDNegativeNDNDNDPuumala computer virus IgM ImmunoblotND Positive NDNDNDDobrava computer virus IgG ImmunoblotNDNegativeNDNDNDDobrava computer virus IgM ImmunoblotNDNegativeNDNDNDHantaan computer virus IgG ImmunoblotNDNegativeNDNDNDHantaan computer virus IgM ImmunoblotNDNegativeNDNDND Open in a separate window *Bold font indicates positive results. IP, positivity index; ND, not carried out. ?ELISA serology is considered positive when the index value (optical density divided by the cutoff value) is 1.1. RNA was extracted from an EDTA plasma sample taken on day 11. Hantavirus RNA was detected by nested reverse transcription PCR performed with pan-hantaviral large (L) segment specific primers ( em 5 /em ) (Table 2). Direct sequencing was performed with.