{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T01:05:25Z","timestamp":1780794325942,"version":"3.54.1"},"reference-count":57,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T00:00:00Z","timestamp":1646006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research funding provided by the Tampere University Hospital","award":["-"],"award-info":[{"award-number":["-"]}]},{"name":"Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital","award":["9AA050, 9AB046"],"award-info":[{"award-number":["9AA050, 9AB046"]}]},{"name":"Finnish Foundation for the Promotion of Laboratory Medicine and the Finnish Society of Clinical Chemistry","award":["-"],"award-info":[{"award-number":["-"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Puumala hantavirus (PUUV) causes hemorrhagic fever with renal syndrome. Characteristic clinical findings include acute kidney injury (AKI), thrombocytopenia, and capillary leakage. Smoking increases the risk of severe AKI, but it is not known whether alcohol consumption predisposes patients to a more severe infection. Liver and pancreatic enzymes, as well as biomarkers of alcohol consumption (gamma-glutamyl transferase, GGT; carbohydrate-deficient transferrin, CDT; GGT-CDT combination; and ethyl glucuronide, EtG), were measured from 66 patients with acute PUUV infection during hospitalization and at the convalescence phase. Alcohol consumption was present in 41% of the study population, 15% showing signs of heavy drinking. Alcohol use did not affect the severity of PUUV induced AKI nor the overall clinical picture of the infection. Liver enzyme levels (GGT or alanine aminotransferase, ALT) were elevated in 64% of the patients, but the levels did not associate with the markers reflecting the severity of the disease. Serum amylase activities at the convalescent stage were higher than those at the acute phase (p &lt; 0.001). No cases with acute pancreatitis were found. In conclusion, our findings indicate that alcohol consumption does not seem to affect the clinical course of an acute PUUV infection.<\/jats:p>","DOI":"10.3390\/v14030500","type":"journal-article","created":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T20:11:57Z","timestamp":1646079117000},"page":"500","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Alcohol Consumption and Its Influence on the Clinical Picture of Puumala Hantavirus Infection"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9474-0285","authenticated-orcid":false,"given":"Laura","family":"Tervo","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland"},{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuula K.","family":"Outinen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland"},{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satu","family":"M\u00e4kel\u00e4","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland"},{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna","family":"Mustalahti","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland"},{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1372-430X","authenticated-orcid":false,"given":"Heini","family":"Huhtala","sequence":"additional","affiliation":[{"name":"Faculty of Social Sciences, Tampere University, 33520 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4905-7564","authenticated-orcid":false,"given":"Ilkka","family":"P\u00f6rsti","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland"},{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaana","family":"Syrj\u00e4nen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland"},{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3462-2129","authenticated-orcid":false,"given":"Jukka T.","family":"Mustonen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland"},{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Onni","family":"Niemel\u00e4","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland"},{"name":"Department of Laboratory Medicine and Medical Research Unit, Sein\u00e4joki Central Hospital, 60220 Sein\u00e4joki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1016\/j.femsre.2005.04.012","article-title":"Viral Zoonoses in Europe","volume":"29","author":"Uzcategui","year":"2005","journal-title":"FEMS Microbiol. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1038\/nrmicro3066","article-title":"Uncovering the Mysteries of Hantavirus Infections","volume":"11","author":"Vaheri","year":"2013","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1584","DOI":"10.3201\/eid1610.100242","article-title":"Mortality Rate Patterns for Hemorrhagic Fever with Renal Syndrome Caused by Puumala Virus","volume":"16","author":"Hjertqvist","year":"2010","journal-title":"Emerg. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1017\/S0950268810000087","article-title":"Disease Burden of Puumala Virus Infections, 1995\u20132008","volume":"138","author":"Makary","year":"2010","journal-title":"Epidemiol. Infect."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Vaheri, A., Henttonen, H., and Mustonen, J. (2021). Hantavirus Research in Finland: Highlights and Perspectives. Viruses, 13.","DOI":"10.3390\/v13081452"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1017\/S0950268817002904","article-title":"Population-Based Seroprevalence of Puumala Hantavirus in Finland: Smoking as a Risk Factor","volume":"146","author":"Latronico","year":"2018","journal-title":"Epidemiol. Infect."},{"key":"ref_7","first-page":"1","article-title":"Nephropathia Epidemica in Finland. A Clinical, Histological and Epidemiological Study","volume":"3","year":"1971","journal-title":"Ann. Clin. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.antiviral.2013.10.001","article-title":"The Pathogenesis of Nephropathia Epidemica: New Knowledge and Unanswered Questions","volume":"100","author":"Mustonen","year":"2013","journal-title":"Antivir. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3109\/00365549409008583","article-title":"Nephropathia Epidemica in Finland: A Retrospective Study of 126 Cases","volume":"26","author":"Mustonen","year":"1994","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.thromres.2011.11.007","article-title":"Polymorphisms of PAI-1 and Platelet GP Ia May Associate with Impairment of Renal Function and Thrombocytopenia in Puumala Hantavirus Infection","volume":"129","author":"Laine","year":"2012","journal-title":"Thromb. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1086\/342413","article-title":"Human Leukocyte Antigen\u2013B8-DR3 Is a More Important Risk Factor for Severe Puumala Hantavirus Infection than the Tumor Necrosis Factor\u2013\u03b1(\u2212308) G\/A Polymorphism","volume":"186","author":"Mustonen","year":"2002","journal-title":"J. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1038\/ki.1996.29","article-title":"Genetic Susceptibility to Severe Course of Nephropathia Epidemica Caused by Puumala Hantavirus","volume":"49","author":"Mustonen","year":"1996","journal-title":"Kidney Int."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Mantula, P.S., Outinen, T.K., Jaatinen, P., H\u00e4m\u00e4l\u00e4inen, M., Huhtala, H., P\u00f6rsti, I.H., Vaheri, A., Mustonen, J.T., and M\u00e4kel\u00e4, S.M. (2018). High Plasma Resistin Associates with Severe Acute Kidney Injury in Puumala Hantavirus Infection. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0208017"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Outinen, T.K., Mantula, P., Jaatinen, P., H\u00e4m\u00e4l\u00e4inen, M., Moilanen, E., Vaheri, A., Huhtala, H., M\u00e4kel\u00e4, S., and Mustonen, J. (2019). Glycoprotein YKL-40 Is Elevated and Predicts Disease Severity in Puumala Hantavirus Infection. Viruses, 11.","DOI":"10.3390\/v11090767"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1159\/000459634","article-title":"Glomerular Proteinuria Predicts the Severity of Acute Kidney Injury in Puumala Hantavirus-Induced Tubulointerstitial Nephritis","volume":"136","author":"Mantula","year":"2017","journal-title":"Nephron"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1016\/j.ekir.2019.05.770","article-title":"Glucosuria Predicts the Severity of Puumala Hantavirus Infection","volume":"4","author":"Mantula","year":"2019","journal-title":"Kidney Int. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Tiet\u00e4v\u00e4inen, J., M\u00e4kel\u00e4, S., Huhtala, H., P\u00f6rsti, I.H., Strandin, T., Vaheri, A., and Mustonen, J. (2021). The Clinical Presentation of Puumala Hantavirus Induced Hemorrhagic Fever with Renal Syndrome Is Related to Plasma Glucose Concentration. Viruses, 13.","DOI":"10.3390\/v13061177"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/S1473-3099(03)00774-6","article-title":"Hantavirus Infections in Europe","volume":"3","author":"Vapalahti","year":"2003","journal-title":"Lancet Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1093\/clinids\/11.6.921","article-title":"Clinical Characteristics of Nephropathia Epidemica in Sweden: Prospective Study Of 74 Cases","volume":"11","author":"Settergren","year":"1989","journal-title":"Rev. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Pal, E., Korva, M., Resman Rus, K., Kej\u017ear, N., Bogovi\u010d, P., Kurent, A., Av\u0161i\u010d-\u017dupanc, T., and Strle, F. (2018). Sequential Assessment of Clinical and Laboratory Parameters in Patients with Hemorrhagic Fever with Renal Syndrome. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0197661"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/00004836-199307000-00010","article-title":"Liver Involvement in Hemorrhagic Fever with Renal Syndrome","volume":"17","author":"Elisaf","year":"1993","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12879-021-05964-5","article-title":"Acute Pancreatitis Associated with Hemorrhagic Fever with Renal Syndrome: A Cohort Study of 346 Patients","volume":"21","author":"Guo","year":"2021","journal-title":"BMC Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1007\/s12250-012-3231-3","article-title":"Hemorrhagic Fever with Renal Syndrome Associated with Acute Pancreatitis","volume":"27","author":"Puca","year":"2012","journal-title":"Virol. Sin."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e18916","DOI":"10.1097\/MD.0000000000018916","article-title":"Clinical Analysis of Patients with Acute Pancreatitis Complicated with Hemorrhagic Fever with Renal Syndrome and Acute Biliary Pancreatitis","volume":"99","author":"Wang","year":"2020","journal-title":"Medicine"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Zhu, Y., Chen, Y.X., Zhu, Y., Liu, P., Zeng, H., and Lu, N.H. (2013). A Retrospective Study of Acute Pancreatitis in Patients with Hemorrhagic Fever with Renal Syndrome. BMC Gastroenterol., 13.","DOI":"10.1186\/1471-230X-13-171"},{"key":"ref_26","first-page":"59","article-title":"A Rare Cause of Acute Pancreatitis: Hantavirus Infection","volume":"80","author":"Kilit","year":"2017","journal-title":"Acta Gastro-Enterol. Belg."},{"key":"ref_27","first-page":"167","article-title":"Acute Pancreatitis in Patients with Hemorrhagic Fever with Renal Syndrome","volume":"166","author":"Torrington","year":"2018","journal-title":"Mil. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"229","DOI":"10.4269\/ajtmh.2011.10-0024","article-title":"Short Report: Experience with Extrarenal Manifestations of Hemorrhagic Fever with Renal Syndrome in a Tertiary Care Hospital in South Korea","volume":"84","author":"Park","year":"2011","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1159\/000186883","article-title":"A Case of Nephropathia Epidemica Associated with Panhypopituitarism and Nephrotic Syndrome","volume":"61","author":"Settergren","year":"1992","journal-title":"Nephron"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Kitterer, D., Artunc, F., Segerer, S., Dominik Alscher, M., Braun, N., and Latus, J. (2015). Evaluation of Lipase Levels in Patients with Nephropathia Epidemica\u2014No Evidence for Acute Pancreatitis. BMC Infect. Dis., 15.","DOI":"10.1186\/s12879-015-1031-8"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1093\/ndt\/gfv273","article-title":"Smoking Is Associated with Aggravated Kidney Injury in Puumala Hantavirus-Induced Haemorrhagic Fever with Renal Syndrome","volume":"30","author":"Tervo","year":"2015","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/0376-8716(91)90011-M","article-title":"Alcohol Drinking and Cigarette Smoking: An Exploration of the Association in Middle-Aged Men and Women","volume":"27","author":"Friedman","year":"1991","journal-title":"Drug Alcohol Depend."},{"key":"ref_33","first-page":"201","article-title":"Epidemiologic Analysis of Alcohol and Tobacco Use","volume":"24","author":"Anthony","year":"2000","journal-title":"Alcohol Res. Health"},{"key":"ref_34","first-page":"162","article-title":"An Epidemiologic Analysis of Co-Occurring Alcohol and Tobacco Use and Disorders: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions","volume":"29","author":"Daniel","year":"2006","journal-title":"Alcohol Res. Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1016\/S0140-6736(20)31310-6","article-title":"Acute Pancreatitis","volume":"396","author":"Boxhoorn","year":"2020","journal-title":"Lancet"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/MEG.0000000000000233","article-title":"A Systematic Review of the Prevalence of Mildly Abnormal Liver Function Tests and Associated Health Outcomes","volume":"27","author":"Radcke","year":"2015","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1038\/nri744","article-title":"Alcohol, Host Defence and Society","volume":"2","author":"Nelson","year":"2002","journal-title":"Nat. Rev. Immunol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e022344","DOI":"10.1136\/bmjopen-2018-022344","article-title":"Alcohol and the Risk of Pneumonia: A Systematic Review and Meta-Analysis","volume":"8","author":"Simou","year":"2018","journal-title":"BMJ Open"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.alcohol.2007.07.001","article-title":"Association of Chronic Alcohol Consumption and Increased Susceptibility to and Pathogenic Effects of Pulmonary Infection with Respiratory Syncytial Virus in Mice","volume":"41","author":"Jerrells","year":"2007","journal-title":"Alcohol"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1111\/j.1530-0277.2008.00842.x","article-title":"A Recent Perspective on Alcohol, Immunity, and Host Defense","volume":"33","author":"Szabo","year":"2009","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.cccn.2003.07.016","article-title":"A New Modified \u03b3-%CDT Method Improves the Detection of Problem Drinking: Studies in Alcoholics with or without Liver Disease","volume":"338","author":"Anttila","year":"2003","journal-title":"Clin. Chim. Acta"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1093\/alcalc\/agl050","article-title":"Comparison of the Combined Marker GGT-CDT and the Conventional Laboratory Markers of Alcohol Abuse in Heavy Drinkers, Moderate Dinkers and Abstainers","volume":"41","author":"Hietala","year":"2006","journal-title":"Alcohol Alcohol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Niemel\u00e4, O. (2016). Biomarker-Based Approaches for Assessing Alcohol Use Disorders. Int. J. Environ. Res. Public Health, 13.","DOI":"10.3390\/ijerph13020166"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1002\/rmv.581","article-title":"How to Diagnose Hantavirus Infections and Detect Them in Rodents and Insectivores","volume":"18","author":"Vaheri","year":"2008","journal-title":"Rev. Med. Virol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1093\/jn\/nxz146","article-title":"Urinary Ethyl Glucuronide Can Be Used as a Biomarker of Habitual Alcohol Consumption in the General Population","volume":"149","author":"Beulens","year":"2019","journal-title":"J. Nutr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1093\/alcalc\/agz002","article-title":"Assessment of Alcohol Consumption in Depression Follow-up Using Self-Reports and Blood Measures Including Inflammatory Biomarkers","volume":"54","author":"Archer","year":"2019","journal-title":"Alcohol Alcohol."},{"key":"ref_47","first-page":"c179","article-title":"KDIGO Clinical Practice Guidelines for Acute Kidney Injury","volume":"120","author":"Khwaja","year":"2012","journal-title":"Nephron"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Niemel\u00e4, O., Niemel\u00e4, M., Bloigu, R., Aalto, M., and Laatikainen, T. (2017). Where Should the Safe Limits of Alcohol Consumption Stand in Light of Liver Enzyme Abnormalities in Alcohol Consumers?. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0188574"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Sironen, T., Sane, J., Lokki, M.-L., Meri, S., Andersson, L.C., Hautala, T., Kauma, H., Vuorinen, S., Rasmuson, J., and Evander, M. (2017). Fatal Puumala Hantavirus Disease: Involvement of Complement Activation and Vascular Leakage in the Pathobiology. Open Forum Infect. Dis., 4.","DOI":"10.1093\/ofid\/ofx229"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Libraty, D.H., M\u00e4kel\u00e4, S., Vlk, J., Hurme, M., Vaheri, A., Ennis, F.A., and Mustonen, J. (2012). The Degree of Leukocytosis and Urine GATA-3 MRNA Levels Are Risk Factors for Severe Acute Kidney Injury in Puumala Virus Nephropathia Epidemica. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0035402"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.1053\/j.gastro.2020.08.044","article-title":"Prevalence, Risk Factors, and Outcomes of Hospitalized Patients with Coronavirus Disease 2019 Presenting as Acute Pancreatitis","volume":"159","author":"Inamdar","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/S0140-6736(96)90078-1","article-title":"Urinary Trypsinogen-2 Test Strip for Acute Pancreatitis","volume":"347","author":"Korvuo","year":"1996","journal-title":"Lancet"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Latus, J., Tenner-Racz, K., Racz, P., Kitterer, D., Cadar, D., Ott, G., Alscher, M.D., Schmidt-Chanasit, J., and Braun, N. (2014). Detection of Puumala Hantavirus Antigen in Human Intestine during Acute Hantavirus Infection. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0098397"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.jcv.2011.11.003","article-title":"Hantavirus and Acute Appendicitis\u2014The Diagnosis behind the Diagnosis?","volume":"53","author":"Latus","year":"2012","journal-title":"J. Clin. Virol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1093\/alcalc\/agl027","article-title":"Phosphatidylethanol (PEth) Concentrations in Blood Are Correlated to Reported Alcohol Intake in Alcohol-Dependent Patients","volume":"41","author":"Aradottir","year":"2006","journal-title":"Alcohol Alcohol."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Zhang, J., Tang, K., Zhang, Y., Ma, Y., Zhang, C., Hu, H., Jia, X., Zhuang, R., Jin, B., and Wang, M. (2021). The Presence of Circulating Nucleated Red Blood Cells Is Associated with Disease Severity in Patients of Hemorrhagic Fever with Renal Syndrome. Front. Med., 8.","DOI":"10.3389\/fmed.2021.665410"},{"key":"ref_57","first-page":"30","article-title":"Biomarkers for Alcohol Use and Abuse: A Summary","volume":"28","author":"Peterson","year":"2004","journal-title":"Alcohol Res. Health"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/14\/3\/500\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:29:43Z","timestamp":1760135383000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/14\/3\/500"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,28]]},"references-count":57,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["v14030500"],"URL":"https:\/\/doi.org\/10.3390\/v14030500","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,28]]}}}