{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T19:50:51Z","timestamp":1785009051687,"version":"3.55.0"},"reference-count":28,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Hemorrhagic fever with renal syndrome (HFRS) is the most common zoonotic disease in Russia, with about a 98% abundance of Puumala virus in all HFRS cases. We report clinical manifestations and genomic characteristics of the Puumala virus strain that caused an unconventional course of HFRS with sudden death. The patient was admitted to the hospital on the third day from fever onset with hyperthermia, cough, shortness of breath, and severe weakness, and died 28 h after hospitalization despite intensive care. Further analyses of autopsy samples led to Puumala virus detection. The viral genome was sequenced, followed by phylogenetic and similarity plot analyses. The genomic sequences of three viral segments were identified as endemic for the Moscow region strain. Phylogenetic and similarity plot analysis revealed the reassortant origin of the strain via M segment exchange. This finding increases the explored molecular diversity of Puumala virus in the Central Federal District and underscores the need for heightened awareness of HFRS manifestations that deviate from regular clinical presentation.<\/jats:p>","DOI":"10.3390\/pathogens15030321","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T09:35:57Z","timestamp":1773740157000},"page":"321","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Fatal Case of Puumala Virus Infection with Pulmonary and Renal Syndrome in Moscow Region, Russia"],"prefix":"10.3390","volume":"15","author":[{"given":"Ekaterina","family":"Blinova","sequence":"first","affiliation":[{"name":"Federal Budget Institute of Science \u00abCentral Research Institute of Epidemiology\u00bb, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, 111123 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Dzagurova","sequence":"additional","affiliation":[{"name":"Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products, Russian Academy of Sciences (Institute of Poliomyelitis), 117218 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Galina","family":"Gopatsa","sequence":"additional","affiliation":[{"name":"Federal Budget Institute of Science \u00abCentral Research Institute of Epidemiology\u00bb, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, 111123 Moscow, Russia"},{"name":"State Budgetary Healthcare Institution of Moscow \u201cInfectious Clinical Hospital No. 1 of the Department of Healthcare of Moscow\u201d, 125310 Moscow, Russia"},{"name":"Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation, 125993 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalya","family":"Pshenichnaya","sequence":"additional","affiliation":[{"name":"Federal Budget Institute of Science \u00abCentral Research Institute of Epidemiology\u00bb, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, 111123 Moscow, Russia"},{"name":"Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation, 125993 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8407-2623","authenticated-orcid":false,"given":"Evgeny","family":"Morozkin","sequence":"additional","affiliation":[{"name":"Federal Budget Institute of Science \u00abCentral Research Institute of Epidemiology\u00bb, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, 111123 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4228-9044","authenticated-orcid":false,"given":"Vasiliy","family":"Akimkin","sequence":"additional","affiliation":[{"name":"Federal Budget Institute of Science \u00abCentral Research Institute of Epidemiology\u00bb, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, 111123 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1111\/j.1863-2378.2008.01210.x","article-title":"Genetic diversity and geographic distribution of hantaviruses in Russia","volume":"56","author":"Garanina","year":"2009","journal-title":"Zoonoses Public Health"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Tkachenko, E., Kurashova, S., Balkina, A., Ivanov, A., Egorova, M., Leonovich, O., Popova, Y., Teodorovich, R., Belyakova, A., and Tkachenko, P. (2023). Cases of Hemorrhagic Fever with Renal Syndrome in Russia during 2000\u20132022. Viruses, 15.","DOI":"10.3390\/v15071537"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5476","DOI":"10.3390\/v7102884","article-title":"Complete Genome and Phylogeny of Puumala Hantavirus Isolates Circulating in France","volume":"7","author":"Castel","year":"2015","journal-title":"Viruses"},{"key":"ref_4","first-page":"156","article-title":"Clinical manifestations of hemorrhagic fever with renal syndrome in Russia","volume":"5","author":"Morozov","year":"2017","journal-title":"Med. Counc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1002\/jmv.22263","article-title":"Co-circulation of two Puumala hantavirus lineages in Latvia: A russian lineage described previously and a novel Latvian lineage","volume":"84","author":"Razzauti","year":"2012","journal-title":"J. Med. Virol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.3201\/eid2907.221731","article-title":"Evolutionary Formation and Distribution of Puumala Virus Genome Variants, Russia","volume":"29","author":"Blinova","year":"2023","journal-title":"Emerg. Infect. Dis."},{"key":"ref_7","first-page":"62","article-title":"Assessment of epidemiological situation on hemorhhagic fever with renal syndrome around the world and in Russia, forecast for 2020","volume":"2","author":"Savitskaya","year":"2020","journal-title":"Probl. Espec. Danger. Infect."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Davidyuk, Y., Shamsutdinov, A., Kabwe, E., Ismagilova, R., Martynova, E., Belyaev, A., Shuralev, E., Trifonov, V., Savitskaya, T., and Isaeva, G. (2020). Prevalence of the Puumala orthohantavirus strains in the pre-kama area of the Republic of Tatarstan, Russia. Pathogens, 9.","DOI":"10.3390\/pathogens9070540"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Davidyuk, Y.N., Kabwe, E., Shamsutdinov, A.F., Knyazeva, A.V., Martynova, E.V., Ismagilova, R.K., Trifonov, V.A., Savitskaya, T.A., Isaeva, G.S., and Urbanowicz, R.A. (2021). The Distribution of Puumala orthohantavirus Genome Variants Correlates with the Regional Landscapes in the Trans-Kama Area of the Republic of Tatarstan. Pathogens, 10.","DOI":"10.3390\/pathogens10091169"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kabwe, E., Shamsutdinov, A.F., Suleimanova, S., Martynova, E.V., Ismagilova, R.K., Shakirova, V.G., Savitskaya, T.A., Isaeva, G.S., Rizvanov, A.A., and Khaiboullina, S.F. (2023). Puumala Orthohantavirus Reassortant Genome Variants Likely Emerging in the Watershed Forests. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24021018"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Kabwe, E., Al Sheikh, W., Shamsutdinov, A.F., Ismagilova, R.K., Martynova, E.V., Ohlopkova, O.V., Yurchenko, Y.A., Savitskaya, T.A., Isaeva, G.S., and Khaiboullina, S.F. (2022). Analysis of Puumala orthohantavirus Genome Variants Identified in the Territories of Volga Federal District. Trop. Med. Infect. Dis., 7.","DOI":"10.3390\/tropicalmed7030046"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1007\/s11262-018-1590-z","article-title":"Reassortment events in the evolution of hantaviruses","volume":"54","author":"Klempa","year":"2018","journal-title":"Virus Genes"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Razzauti, M., Plyusnina, A., Henttonen, H., and Plyusnin, A. (2013). Microevolution of Puumala hantavirus during a Complete Population Cycle of Its Host, the Bank Vole (Myodes glareolus). PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0064447"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1099\/vir.0.011304-0","article-title":"Analysis of Puumala hantavirus in a bank vole population in northern Finland: Evidence for co-circulation of two genetic lineages and frequent reassortment between strains","volume":"90","author":"Razzauti","year":"2009","journal-title":"J. Gen. Virol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1099\/vir.0.2008\/001248-0","article-title":"Accumulation of point mutations and reassortment of genomic RNA segments are involved in the microevolution of Puumala hantavirus in a bank vole (Myodes glareolus) population","volume":"89","author":"Razzauti","year":"2008","journal-title":"J. Gen. Virol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1093\/molbev\/msy096","article-title":"MEGA X: Molecular Evolutionary Genetics Analysis across Computing Platforms","volume":"35","author":"Kumar","year":"2018","journal-title":"Mol. Biol. Evol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1128\/JVI.73.1.152-160.1999","article-title":"Full-Length Human Immunodeficiency Virus Type 1 Genomes from Subtype C-Infected Seroconverters in India, with Evidence of Intersubtype Recombination","volume":"73","author":"Lole","year":"1999","journal-title":"J. Virol."},{"key":"ref_18","first-page":"7","article-title":"Hemorrhagic fever with renal syndrome in the Kirov region at the present stage","volume":"5","author":"Bondarenko","year":"2015","journal-title":"Epidemiol. Infect. Deseases"},{"key":"ref_19","first-page":"1","article-title":"Hemorrhagic fever with renal syndrome (puumala) in the natural focuses at the territory of central volga area: Dynamics of clinical and laboratory manifestations over the period of 1997\u20132012","volume":"4","author":"Suzdaltsev","year":"2014","journal-title":"Infect. Dis. News Opin. Educ."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Santini, M., Ljubi\u0107, J., \u0160o\u0161tar, N., Vilibi\u0107-\u010cavlek, T., Bogdani\u0107, M., Zakotnik, S., Av\u0161i\u010d-\u017dupanc, T., Korva, M., Kurolt, I.C., and Radmani\u0107, L. (2023). Hantavirus Pulmonary Syndrome Caused by Puumala Orthohantavirus\u2014A Case Report and Literature Review. Microorganisms, 11.","DOI":"10.3390\/microorganisms11122963"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"150","DOI":"10.3201\/eid2601.181685","article-title":"Hantavirus Pulmonary Syndrome in Traveler Returning from Nepal to Spain","volume":"26","author":"Sulleiro","year":"2020","journal-title":"Emerg. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1007\/s10096-010-1141-6","article-title":"Time to revise the paradigm of hantavirus syndromes? Hantavirus pulmonary syndrome caused by European hantavirus","volume":"30","author":"Rasmuson","year":"2011","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1080\/23744235.2016.1274421","article-title":"Kidney disease in Puumala hantavirus infection","volume":"49","author":"Mustonen","year":"2017","journal-title":"Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Rasmuson, J., Lindqvist, P., S\u00f6rensen, K., Hedstr\u00f6m, M., Blomberg, A., and Ahlm, C. (2013). Cardiopulmonary involvement in Puumala hantavirus infection. BMC Infect. Dis., 13.","DOI":"10.1186\/1471-2334-13-501"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.virusres.2013.12.036","article-title":"Hemorrhagic Fever with Renal Syndrome in the New, and Hantavirus Pulmonary Syndrome in the old world: Paradi(se)gm lost or regained?","volume":"187","author":"Clement","year":"2014","journal-title":"Virus Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1007\/s10096-013-1885-x","article-title":"Another case of \u201cEuropean hantavirus pulmonary syndrome\u201d with severe lung, prior to kidney, involvement, and diagnosed by viral inclusions in lung macrophages","volume":"32","author":"Gizzi","year":"2013","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"297","DOI":"10.5414\/CNP59297","article-title":"Pulmonary-renal syndrome due to hemorrhagic fever with renal syndrome: An unusual manifestation of Puumala virus infection in France","volume":"59","author":"Launay","year":"2003","journal-title":"Clin. Nephrol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.3201\/eid2112.150891","article-title":"Life-Threatening Sochi Virus Infections, Russia","volume":"21","author":"Kruger","year":"2015","journal-title":"Emerg. Infect. Dis."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/3\/321\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T11:22:40Z","timestamp":1773746560000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/3\/321"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,17]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["pathogens15030321"],"URL":"https:\/\/doi.org\/10.3390\/pathogens15030321","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,17]]}}}