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Background and study aims There are conflicting data regarding the risk of post-ERCP pancreatitis (PEP) with self-expandable metallic stents (SEMS) compared to polyethylene stents (PS) in malignant biliary obstructions and limited data related to benign obstructions. Patients and methods A retrospective cohort study was performed of 1136 patients who underwent ERCP for biliary obstruction and received SEMS or PS at a tertiary-care medical center between January 2011 and October 2016. We evaluated the association between stent type (SEMS vs PS) and PEP in malignant and benign biliary obstructions. Results Among the 1136 patients included in our study, 399 had SEMS placed and 737 had PS placed. Patients with PS were more likely to have pancreatic duct cannulation, pancreatic duct stent placement, double guidewire technique, sphincterotomy and sphincteroplasty as compared to the SEMS group.âOn multivariate analysis, PEP rates were higher in the SEMS group (8.0â%) versus the PS group (4.8â%) (OR 2.27 [CI, 1.22, 4.24]) for all obstructions. For malignant obstructions, PEP rates were 7.8â% and 6.6â% for SEMS and plastic stents, respectively (OR 1.54 [CI, 0.72, 3.30]). For benign obstructions the PEP rate was higher in the SEMS group (8.8â%) compared to the PS group (4.2â%) (OR 3.67 [CI, 1.50, 8.97]). No significant differences between PEP severity were identified based on stent type when stratified based on benign and malignant. Conclusions PEP rates were higher when SEMS were used for benign obstruction as compared to PS. For malignant obstruction, no difference was identified in PEP rates with use of SEMS vs PS.
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PURPOSE OF REVIEW: Indeterminate biliary strictures (IDBS) continue to be an area of frustration for clinicians. Standard endoscopic retrograde cholangiopancreatography (ERCP) with conventional brush cytology and/or forceps biopsy has a low sensitivity for distinguishing benign from malignant biliary strictures. A delay in diagnosis of malignancy has consequences for subsequent therapy or surgery. In this article, we review current and emerging technologies that may aid in this diagnostic dilemma. RECENT FINDINGS: Several technologies have been utilized in IDBS to establish a diagnosis which include peroral cholangioscopy, confocal laser endomicroscopy, endoscopic ultrasound with fine needle aspiration, intraductal ultrasound, optical coherence tomography, fluorescence in situ hybridization, next generation sequencing, integrated molecular pathology, and DNA-image cytometry. While cholangioscopy and confocal laser endomicroscopy have become standards of care in expert centers for the evaluation of patients with IDBS, there are several endoscopic and molecular modalities that may also aid in establishing a diagnosis. Further head-to-head prospective diagnostic studies as well as cost-efficacy studies are needed.
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Doenças dos Ductos Biliares/diagnóstico por imagem , Constrição Patológica/diagnóstico por imagem , Técnicas de Diagnóstico do Sistema Digestório , Doenças dos Ductos Biliares/genética , Doenças dos Ductos Biliares/patologia , Diagnóstico por Imagem , Técnicas Genéticas , HumanosRESUMO
BACKGROUND: The Eternal Love Winning Africa (ELWA) Clinic was the first clinic to provide free, comprehensive care to Ebola virus disease (EVD) survivors in Liberia. The objectives of this analysis were to describe the demographics and symptoms of EVD survivors at ELWA from January 2015 through March 2017 and to identify risk factors for development of sequelae. METHODS: Patients' demographic and clinical information was collected by chart review in June 2016 and March 2017. Associations with clinical sequelae were analyzed using the chi-square test, t test, and multivariate logistic regression. RESULTS: From January 2015 to March 2017, 329 EVD survivors were evaluated at ELWA. Most survivors experienced myalgia/arthralgia (73%; n = 239) and headache (53%; n = 173). The length of time from Ebola Treatment Unit (ETU) discharge to first clinic visit ranged from 0 to 30 months. Many visits (30%) occurred 24 or more months after ETU discharge. The proportion of visits for headache, weight loss, joint pain, visual problems, insomnia, fatigue, memory loss, decreased libido, depression, and uveitis decreased over time. More men than women had visits for depression; however, these differences were not significant. Symptom prevalence differed in adults and children; significantly more adults experienced myalgia/arthralgia (77% vs 44%), visual problems (41% vs 12%), post-EVD-related musculoskeletal pain (42% vs 15%), and insomnia (17% vs 2%). CONCLUSIONS: EVD survivors frequented ELWA for EVD-related symptoms many months after ETU discharge, indicating a long-term need for care. Reported symptoms changed over time, which may reflect eventual resolution of some sequelae.
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We report here the complete genome sequences for all three segments of the New York hantavirus (New York 1). This is the first reported L segment sequence for hantaviruses maintained in Peromyscus spp. endemic to the eastern United States and Canada.
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In 2012, an unprecedented number of four distinct, partially overlapping filovirus-associated viral hemorrhagic fever outbreaks were detected in equatorial Africa. Analysis of complete virus genome sequences confirmed the reemergence of Sudan virus and Marburg virus in Uganda, and the first emergence of Bundibugyo virus in the Democratic Republic of the Congo.
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Surtos de Doenças , Infecções por Filoviridae/epidemiologia , Filoviridae/genética , Filoviridae/isolamento & purificação , Genoma Viral , Febres Hemorrágicas Virais/epidemiologia , RNA Viral/genética , República Democrática do Congo/epidemiologia , Filoviridae/classificação , Infecções por Filoviridae/virologia , Febres Hemorrágicas Virais/virologia , Humanos , Dados de Sequência Molecular , Análise de Sequência de DNA , Uganda/epidemiologiaRESUMO
Surveillance work was initiated to study the presence of highly infectious diseases like Ebola-Reston, Marburg, Nipah and other possible viruses that are known to be found in the bat species and responsible for causing diseases in humans. A novel adenovirus was isolated from a common species of fruit bat (Rousettus leschenaultii) captured in Maharashtra State, India. Partial sequence analysis of the DNA polymerase gene shows this isolate to be a newly recognized member of the genus Mastadenovirus (family Adenoviridae), approximately 20% divergent at the nucleotide level from Japanese BatAdV, its closest known relative.
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Infecções por Adenoviridae/veterinária , Quirópteros/virologia , Mastadenovirus/isolamento & purificação , Infecções por Adenoviridae/diagnóstico , Infecções por Adenoviridae/virologia , Animais , DNA Polimerase Dirigida por DNA/análise , DNA Polimerase Dirigida por DNA/genética , Índia , Mastadenovirus/classificação , Mastadenovirus/genética , RNA Viral/genéticaRESUMO
During the last decade Crimean-Congo hemorrhagic fever (CCHF) emerged and/or re-emerged in several Balkan countries, Turkey, southwestern regions of the Russian Federation, and the Ukraine, with considerable high fatality rates. Reasons for re-emergence of CCHF include climate and anthropogenic factors such as changes in land use, agricultural practices or hunting activities, movement of livestock that may influence host-tick-virus dynamics. In order to be able to design prevention and control measures targeted at the disease, mapping of endemic areas and risk assessment for CCHF in Europe should be completed. Furthermore, areas at risk for further CCHF expansion should be identified and human, vector and animal surveillance be strengthened.
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Febre Hemorrágica da Crimeia/epidemiologia , Animais , Europa (Continente)/epidemiologia , Febre Hemorrágica da Crimeia/diagnóstico , Febre Hemorrágica da Crimeia/tratamento farmacológico , Febre Hemorrágica da Crimeia/mortalidade , Febre Hemorrágica da Crimeia/prevenção & controle , Humanos , Vigilância da População , Medição de Risco , Carrapatos/microbiologiaRESUMO
A virus isolated from dead Chaerephon plicata bats collected near Kampot, Cambodia, was identified as a member of the family Bunyaviridae by electron microscopy. The only bunyavirus previously isolated from Chaerephon species bats in South-East Asia is Kaeng Khoi (KK) virus (genus Orthobunyavirus), detected in Thailand over 30 years earlier and implicated as a public health problem. Using RT-PCR, nucleotide sequences from the M RNA segment of several virus isolates from the Cambodian C. plicata bats were found to be almost identical and to differ from those of the prototype KK virus by only 2.6-3.2 %, despite the temporal and geographic separation of the viruses. These results identify the Cambodian bat viruses as KK virus, extend the known virus geographic range and document the first KK virus isolation in 30 years. These genetic data, together with earlier serologic data, show that KK viruses represent a distinct group within the genus Orthobunyavirus.
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Infecções por Bunyaviridae/veterinária , Bunyaviridae/classificação , Bunyaviridae/isolamento & purificação , Quirópteros/virologia , Animais , Encéfalo/virologia , Bunyaviridae/genética , Bunyaviridae/patogenicidade , Infecções por Bunyaviridae/virologia , Camboja , Chlorocebus aethiops , Camundongos , Filogenia , RNA Viral/análise , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Células VeroRESUMO
Hantavirus pulmonary syndrome (HPS) has been recognized increasingly as a significant public health problem in South America since Andes virus was first discovered in Argentina. Here, the isolation of Andes virus is reported from an infected rodent captured in Argentina in close vicinity to the place of the first HPS case, AH1. The complete nucleotide sequences of the virus M segment, partial L segment and the termini of the S, M and L segment genome RNAs were determined. The Andes virus M RNA segment is 3671 nt in length and is predicted to encode a glycoprotein precursor 1138 aa in length; it generally resembles the other HPS-associated hantaviruses in its organization. Relative to the G1 glycoprotein of other HPS-associated hantaviruses, an additional potential glycosylation site was found but this is located in the predicted cytoplasmic domain and is therefore unlikely to be glycosylated. In phylogenetic analyses, Andes virus, together with the more related hantaviruses, represented a monophyletic lineage. The S-terminal nucleotides were conserved relative to other New World hantaviruses. The M and L segment RNA termini had short deletions in the region believed to contain the sequence and structural features necessary for initiation of virus RNA replication and transcription. Clinical manifestations of Andes virus infections range from fulminant respiratory disease with high lethality to mild course without sequelae. Andes virus has also been associated with person-to-person transmission. Accumulation of Andes virus genetic data will be essential for understanding the factors that regulate virus replication and transmission and to determine the pathogenesis of HPS.
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Orthohantavírus/genética , RNA Viral/genética , Roedores/virologia , Animais , Clonagem Molecular , Variação Genética , Orthohantavírus/química , Orthohantavírus/isolamento & purificação , Humanos , Dados de Sequência Molecular , Filogenia , RNA Viral/química , Alinhamento de Sequência , Sequências Repetidas TerminaisRESUMO
In this study, two different hantaviruses, Puumala virus (PUUV) and Dobrava virus (DOBV), were demonstrated for the first time to coexist and cause hemorrhagic fever with renal syndrome (HFRS) in Croatia. Phylogenetic analysis showed some differences among the nucleotide sequences of PUUV originating from Dinara mountain, which was more closely related to Austrian PUUV than other Croatian PUUV from Mala Kapela mountain. More consistency was found among the Croatian DOBV. HFRS was verified in 85 of 201 suspected cases recorded in 1995 during the largest HFRS outbreak in Croatia. Most of these cases were soldiers. With the exception of the coastal region and islands, all of Croatia was found to be an area endemic for HFRS. A statistically significantly higher proportion of DOBV-infected patients had acute renal failure, visual disturbance, severe thrombocytopenia, and elevated levels of nonsegmented leukocytes, creatine, and total bilirubin. The prevalence of gastrointestinal and electrocardiography disorders also was greater in DOBV-infected patients. Interestingly, significantly more PUUV-infected patients had elevated systolic blood pressure on admission to the hospital. Further prospective studies are necessary to shed more light on differences in HFRS severity associated with PUU and DOB viruses.
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Surtos de Doenças , Febre Hemorrágica com Síndrome Renal/epidemiologia , Febre Hemorrágica com Síndrome Renal/fisiopatologia , Militares , Orthohantavírus/classificação , Virus Puumala/classificação , Adulto , Croácia/epidemiologia , Orthohantavírus/genética , Febre Hemorrágica com Síndrome Renal/virologia , Humanos , Masculino , Filogenia , Virus Puumala/genética , Análise de Sequência de DNA , GuerraRESUMO
Hantaviruses, family Bunyaviridae, are rodent-borne RNA viruses that can cause hantavirus pulmonary syndrome (HPS) in various regions of the Americas. A coevolutionary relationship exists between hantaviruses and their specific rodent reservoir hosts; the phylogeny of the viruses generally matches that of the rodents. There are several Peromyscus-borne hantaviruses, including Sin Nombre virus, the most common cause of HPS in North America. This report describes the genetic detection and characterization of a newly discovered Peromyscus boylii-borne virus, Limestone Canyon (LSC) virus, the most divergent member of the Peromyscus-borne hantaviruses to date. Analysis of a 1209-nucleotide region of the S segment of LSC virus showed it to be more closely related to hantaviruses found in harvest mice (Reithrodontomys megalotis and R. mexicanus) than to other Peromyscus-associated hantaviruses (Sin Nombre, New York, and Monongahela). Phylogenetic analysis of virtually the entire M genome segment (3489 nucleotides) of LSC virus revealed a similar picture in which LSC virus was found to be very distinct from other Peromyscus-associated viruses, but its exact relationship to the other Peromyscus-borne and the Reithrodontomys-borne viruses was not resolved. These results indicate that hantavirus host species-jumping events can occur by which a hantavirus may switch to, and become established in, a rodent host belonging to a different genus. P. boylii are present throughout the southwestern United States and central Mexico. More extensive screening of HPS patients by using RT-PCR assays will be necessary to determine if LSC virus can cause human disease.
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Anticorpos Antivirais/sangue , Infecções por Hantavirus/veterinária , Orthohantavírus/classificação , Orthohantavírus/genética , Peromyscus/virologia , Doenças dos Roedores/virologia , Animais , DNA Viral/análise , Orthohantavírus/imunologia , Infecções por Hantavirus/virologia , Dados de Sequência Molecular , Filogenia , Reação em Cadeia da Polimerase , RNA Viral/isolamento & purificação , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Análise de Sequência de DNARESUMO
In Canada, hantavirus infected deer mice (Peromyscus maniculatus) have been collected from British Columbia to Newfoundland. Partial sequencing of G1 and N protein encoding regions from Canadian Peromyscus maniculatus-borne hantaviruses demonstrated the existence of significant genotypic divergence among strains. Phylogenetic analysis showed that Sin Nombre (SN)-like viruses from eastern and western Canadian deer mice can be divided into at least two broad-based genogroups. Sequencing of mitochondrial DNA from infected deer mice originating from various eastern and western provinces showed that SN-like virus genogroups appeared to be associated with distinct haplotypes of mice. Sera from deer mice infected with eastern and western viral genotypes neutralized the Sin Nombre virus strain, Convict Creek 107, but not the New York 1 hantavirus. Despite the genetic heterogeneity of Canadian SN-like strains these hantaviruses do not appear to define unique hantavirus serotypes.
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Proteínas do Capsídeo , Orthohantavírus/classificação , Peromyscus/virologia , Sequência de Aminoácidos , Animais , Canadá , Capsídeo/genética , Orthohantavírus/genética , Orthohantavírus/imunologia , Dados de Sequência Molecular , Testes de Neutralização , Filogenia , Alinhamento de Sequência , Proteínas do Core Viral/genética , Proteínas do Envelope Viral/genéticaRESUMO
In late 1997 and early 1998, a large outbreak of hemorrhagic fever occurred in East Africa. Clinical samples were collected in Kenya and southern Somalia, and 27 of 115 (23%) hemorrhagic fever patients tested showed evidence of acute infection with Rift Valley fever (RVF) virus as determined by IgM detection, virus isolation, detection of virus RNA by reverse transcription-polymerase chain reaction (RT-PCR), or immunohistochemistry. However, two patients (one from Kenya and the other from Somalia) whose illness met the hemorrhagic fever case definition yielded virus isolates that were not RVF. Electron microscopy suggested these two virus isolates were members of the family Bunyaviridae. RT-PCR primers were designed to detect bunyavirus RNA in these samples. Regions of the S and L segments of the two isolates were successfully amplified, and their nucleotide sequences exhibited nearly complete identity with Bunyamwera virus, a mosquito-borne virus not previously associated with severe human disease. Unexpectedly, the virus M segment appeared to be reassorted, as the sequences detected exhibited 32-33% nucleotide and 28% amino acid differences relative to the corresponding M segment sequence of Bunyamwera virus. The association of this reassortant bunyavirus, proposed name Garissa virus, with severe disease is supported by the detection of the virus RNA in acute-phase sera taken from 12 additional hemorrhagic fever cases in the region.
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Vírus Bunyamwera/genética , Infecções por Bunyaviridae/virologia , Febres Hemorrágicas Virais/virologia , Vírus Reordenados/genética , Animais , Anticorpos Antivirais/sangue , Sequência de Bases , Vírus Bunyamwera/classificação , Vírus Bunyamwera/isolamento & purificação , Vírus Bunyamwera/ultraestrutura , Infecções por Bunyaviridae/epidemiologia , Infecções por Bunyaviridae/imunologia , Chlorocebus aethiops , Surtos de Doenças , Febres Hemorrágicas Virais/epidemiologia , Febres Hemorrágicas Virais/imunologia , Humanos , Quênia/epidemiologia , Dados de Sequência Molecular , Filogenia , RNA Viral/análise , Vírus Reordenados/classificação , Vírus Reordenados/isolamento & purificação , Vírus Reordenados/ultraestrutura , Recombinação Genética , Somália/epidemiologia , Células VeroRESUMO
The first two recognized cases of rapidly fatal hantavirus pulmonary syndrome in Pennsylvania occurred within an 8-month period in 1997. Illness in the two patients was confirmed by immunohistochemical techniques on autopsy material. Reverse transcription-polymerase chain reaction analysis of tissue from one patient and environmentally associated Peromyscus leucopus (white-footed mouse) identified the Monongahela virus variant. Physicians should be vigilant for such Monongahela virus-associated cases in the eastern United States and Canada, particularly in the Appalachian region.
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Infecções por Hantavirus/etiologia , Pneumopatias/etiologia , Orthohantavírus/classificação , Adulto , Animais , Feminino , Orthohantavírus/genética , Orthohantavírus/isolamento & purificação , Infecções por Hantavirus/patologia , Humanos , Pulmão/virologia , Masculino , Pennsylvania , Peromyscus/virologiaRESUMO
Hantavirus pulmonary syndrome (HPS), a severe respiratory disease with high mortality caused by rodent-borne hantaviruses, has previously been identified in the United States and Canada as well as central and southern South America. In late 1999 and early 2000, an outbreak of acute illness compatible with HPS was reported in Los Santos, Panama, with the death of 3 of the 12 (25%) suspected cases. Hantavirus-specific antibodies were detected in patient sera, and virus RNA was detected by reverse transcriptase-polymerase chain reaction. Sequence analysis of virus genome N-, G1-, and G2-encoding fragments showed this to be a novel hantavirus, Choclo virus. Serologic and virus genetic analyses of rodents trapped in the area showed Oligoryzomys fulvescens to be the likely reservoir for the HPS-associated Choclo virus. In addition, Zygodontomys brevicauda rodents were shown to harbor another genetically unique hantavirus, Calabazo virus.
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Reservatórios de Doenças , Síndrome Pulmonar por Hantavirus/virologia , Orthohantavírus/classificação , Filogenia , Animais , Canadá , Primers do DNA , Genoma Viral , Orthohantavírus/genética , Orthohantavírus/isolamento & purificação , Síndrome Pulmonar por Hantavirus/classificação , Humanos , Nucleocapsídeo/genética , Panamá , Ratos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sorotipagem , América do Sul , Estados UnidosAssuntos
Doenças Transmissíveis Emergentes/virologia , Surtos de Doenças , Infecções por Hantavirus/epidemiologia , Doença pelo Vírus Ebola/epidemiologia , Infecções por Orthomyxoviridae/epidemiologia , Infecções por Paramyxoviridae/epidemiologia , Paramyxovirinae/fisiologia , Animais , Ásia/epidemiologia , República Democrática do Congo/epidemiologia , Reservatórios de Doenças , Transmissão de Doença Infecciosa , Infecções por Hantavirus/transmissão , Infecções por Hantavirus/virologia , Doença pelo Vírus Ebola/virologia , Hong Kong/epidemiologia , Humanos , Malásia/epidemiologia , Infecções por Orthomyxoviridae/transmissão , Infecções por Orthomyxoviridae/virologia , Infecções por Paramyxoviridae/virologia , Infecções por Vírus de RNA/epidemiologia , Infecções por Vírus de RNA/transmissão , Infecções por Vírus de RNA/virologia , Sudão/epidemiologia , Suínos/virologiaRESUMO
The arenavirus Lassa virus causes Lassa fever, a viral hemorrhagic fever that is endemic in the countries of Nigeria, Sierra Leone, Liberia, and Guinea and perhaps elsewhere in West Africa. To determine the degree of genetic diversity among Lassa virus strains, partial nucleoprotein (NP) gene sequences were obtained from 54 strains and analyzed. Phylogenetic analyses showed that Lassa viruses comprise four lineages, three of which are found in Nigeria and the fourth in Guinea, Liberia, and Sierra Leone. Overall strain variation in the partial NP gene sequence was found to be as high as 27% at the nucleotide level and 15% at the amino acid level. Genetic distance among Lassa strains was found to correlate with geographic distance rather than time, and no evidence of a "molecular clock" was found. A method for amplifying and cloning full-length arenavirus S RNAs was developed and used to obtain the complete NP and glycoprotein gene (GP1 and GP2) sequences for two representative Nigerian strains of Lassa virus. Comparison of full-length gene sequences for four Lassa virus strains representing the four lineages showed that the NP gene (up to 23.8% nucleotide difference and 12.0% amino acid difference) is more variable than the glycoprotein genes. Although the evolutionary order of descent within Lassa virus strains was not completely resolved, the phylogenetic analyses of full-length NP, GP1, and GP2 gene sequences suggested that Nigerian strains of Lassa virus were ancestral to strains from Guinea, Liberia, and Sierra Leone. Compared to the New World arenaviruses, Lassa and the other Old World arenaviruses have either undergone a shorter period of diverisification or are evolving at a slower rate. This study represents the first large-scale examination of Lassa virus genetic variation.
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Variação Genética , Febre Lassa/virologia , Vírus Lassa/genética , Nucleoproteínas/genética , Proteínas Virais/genética , África Ocidental , Animais , Arenaviridae/genética , Sequência de Bases , Evolução Molecular , Humanos , Febre Lassa/epidemiologia , Vírus Lassa/classificação , Vírus Lassa/isolamento & purificação , Dados de Sequência Molecular , Filogenia , RNA Viral/análise , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Análise de Sequência de DNA , Proteínas do Envelope Viral/genéticaAssuntos
Infecções por Hantavirus/etiologia , Orthohantavírus/classificação , Roedores/virologia , Adulto , Animais , Humanos , Masculino , FilogeniaRESUMO
Hantaviruses are rodent-borne viruses, and they, mainly the Hantaan (HTN) serotype, are the causative agents of a group of febrile nephropathies known as "hemorrhagic fever with renal syndrome (HFRS). " Despite the fact that HFRS is frequently reported in China, with an annual incidence of 50,000-100,000 cases, one puzzling observation that no local case of HFRS has been confirmed in Taiwan has yet to be explained. We hypothesized that the hantavirus strain prevailing in Taiwan mainly belongs to the mild strain, the Seoul (SEO) strain, and the absence of severe disease was related to the absence of HTN. To test these hypotheses, this epidemiologic study was performed, including a seroprevalence survey and phylogenetic analysis on hantavirus isolated from the rodent population trapped in major seaports, rural, and mountainous areas of Taiwan. This study also included rodents and viruses from two isolated islands, Kinmen and Matzu, which are geographically adjacent to the east coast of mainland China. There were a total of 5,461 rodents of 16 species captured, and R. norvegicus was the most common species, with an antibody prevalence much higher in international seaports (20%) than in rural regions (approximately 5%) and intermediate in some domestic seaports. By reverse transcriptase polymerase chain reaction (RT-PCR), 33.9% of the seropositive R. norvegicus were found to have amplifiable hantavirus sequences in their lung tissues, and subsequent phylogenetic analyses indicated that almost all hantavirus in Taiwan was most closely related to the prototype SEO strain, and no HTN strain was recovered from any rodent species indigenous to Taiwan. The seroprevalence of SEO infection in R. norvegicus on Kinmen and Matzu was also different from that in southern provinces of China but closely resembled that in seaports in Taiwan, and the SEO identified was genetically linked to Taiwanese SEO strains. These results substantiate our hypotheses, and suggest that the epidemiology of hantavirus infection in Taiwan are different from that in China, where the HTN and SEO strains and HFRS concurrently prevail.
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Infecções por Hantavirus/veterinária , Orthohantavírus/isolamento & purificação , RNA Viral/análise , Doenças dos Roedores/epidemiologia , Animais , Reservatórios de Doenças , Ensaio de Imunoadsorção Enzimática , Geografia , Orthohantavírus/genética , Infecções por Hantavirus/epidemiologia , Infecções por Hantavirus/virologia , Humanos , Filogenia , Ratos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Doenças dos Roedores/virologia , Roedores , Alinhamento de Sequência , Estudos Soroepidemiológicos , Taiwan/epidemiologiaRESUMO
Although hantavirus pulmonary syndrome (HPS) was discovered in North America in 1993, more recent investigations have shown that the disease is a much larger problem in South America, where a greater number of cases and HPS-associated viruses have now been detected. Here we describe the genetic investigation of three fatal HPS cases from Brazil, including a 1995 case in Castelo dos Sonhos (CAS) in the state of Mato Grosso and two 1996 cases in the counties of Araraquara (ARA) and Franca (FRA), in the state of São Paulo. Reverse transcription-polymerase chain reaction (RT-PCR) products representing fragments of the hantavirus N, G1, and G2 coding regions were amplified from patient acute-phase serum samples, and the nucleotide (nt) sequences (394, 259, and 139 nt, respectively) revealed high deduced amino acid sequence identity between ARA and FRA viruses (99.2%, 96.5%, and 100%, respectively). However, amino acid differences of up to 14.0% were observed when ARA and FRA virus sequences were compared with those of the geographically more distant CAS virus. Analysis of a 643-nt N coding region and a 1734-nt predominantly G2-encoding region of ARA and CAS virus genomes confirmed that these Brazilian viruses were distinct and monophyletic with previously characterized Argentinean hantaviruses, and suggested that Laguna Negra (LN) virus from Paraguay was ancestral to both the Brazilian and Argentinean viruses. The phylogenetic tree based on the N coding fragment also placed LN in a separate clade with Rio Mamore virus from Bolivia. At the amino acid level, ARA and CAS viruses appeared more closely related to the Argentinean viruses than they were to each other. Similarly, analysis of the diagnostic 139-nt G2 fragment showed that the Juquitiba virus detected in a 1993 fatal HPS case close to São Paulo city, Brazil was closer to Argentinean viruses than to ARA or CAS viruses. These data indicate that at least three different hantavirus genetic lineages are associated with Brazilian HPS cases.