RESUMO
Hantavirus pulmonary syndrome remains an uncommon yet emerging viral zoonosis that causes respiratory failure and hemodynamic instability in children and adolescents. Due to its acutely progressive course and high mortality rate, clinicians treating hantavirus pulmonary syndrome should understand its epidemiologic risk factors, clinical syndrome and radiographic findings. We present a case of hantavirus pulmonary syndrome in a 14-year-old female from North Dakota who survived the infection without sequelae.
Assuntos
Síndrome Pulmonar por Hantavirus , Adolescente , Humanos , Feminino , Síndrome Pulmonar por Hantavirus/diagnóstico , North Dakota , Orthohantavírus/isolamento & purificação , AnimaisRESUMO
In 1993, the Southwest found itself staring down a disease then known as "unexplained adult respiratory syndrome." During the outbreak, 12 of 23 known patients died. What we now recognize as hantavirus cardiopulmonary syndrome still remains a rare and deadly disease. Although no cure exists, modern supportive techniques such as extracorporeal membrane oxygenation have increased survival among these patients. Early diagnosis has become the primary factor in patient survival. The initial presentation of hantavirus is similar to acute respiratory distress syndrome, necessitating a high index of suspicion to afford the patient the best chance of survival. Diagnosis is further complicated by prolonged and nonspecific incubation periods making it difficult to pinpoint an exposure. Familiarizing oneself with common clinical presentations, diagnostic strategies, and testing is the best way to increase patient survival. Because hantavirus has a predilection for rural areas, transport to a tertiary facility is paramount to provide the resources necessary to care for these complex patients. Rapid sequence intubation, although common in airway-compromised patients, could prove fatal in the setting of the severe hemodynamic instability found in hantavirus cardiopulmonary syndrome. Anticipation of significant pressor use and fluid administration could likely mean the difference in patient mortality during transport.
Assuntos
Infecções por Hantavirus , Síndrome Pulmonar por Hantavirus , Orthohantavírus , Adulto , Humanos , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/terapia , Síndrome Pulmonar por Hantavirus/complicações , Infecções por Hantavirus/diagnóstico , Infecções por Hantavirus/terapia , Infecções por Hantavirus/complicações , Morte , Cuidados CríticosRESUMO
Hantavirus cardiopulmonary syndrome (HCPS) is a severe respiratory illness primarily associated with microvascular endothelial changes, particularly in the lungs. However, the role of the pulmonary epithelium in HCPS pathogenesis remains unclear. This study explores the potential of soluble Receptors for Advanced Glycation End-products (sRAGE) as a biomarker for assessing pulmonary epithelial damage in severe HCPS, challenging the prevailing view that endothelial dysfunction is the sole driver of this syndrome. We conducted a cross-sectional study on critically ill HCPS patients, categorizing them into mild HCPS, severe HCPS, and negative control groups. Plasma sRAGE levels were measured, revealing significant differences between the severe HCPS group and controls. Our findings suggest that sRAGE holds promise as an indicator of pulmonary epithelial injury in HCPS and may aid in tracking disease progression and guiding therapeutic strategies. This study brings clarity on the importance of investigating the pulmonary epithelium's role in HCPS pathogenesis, offering potential avenues for enhanced diagnostic precision and support in this critical public health concern.
Assuntos
Doenças Transmissíveis , Infecções por Hantavirus , Síndrome Pulmonar por Hantavirus , Lesão Pulmonar , Orthohantavírus , Humanos , Receptor para Produtos Finais de Glicação Avançada , Endotélio Vascular , Estudos Transversais , Pulmão/patologia , Biomarcadores , Lesão Pulmonar/patologia , Síndrome Pulmonar por Hantavirus/diagnósticoRESUMO
Hantavirus infections are part of the broad group of viral haemorrhagic fevers. They are also recognised as a distinct model of an emergent zoonotic infection with a global distribution. Many factors influence their epidemiology and transmission, such as climate, environment, social development, ecology of rodent hosts, and human behaviour in endemic regions. Transmission to humans occurs by exposure to infected rodents in endemic areas; however, Andes hantavirus is unique in that it can be transmitted from person to person. As hantaviruses target endothelial cells, they can affect diverse organ systems; increased vascular permeability is central to pathogenesis. The main clinical syndromes associated with hantaviruses are haemorrhagic fever with renal syndrome (HFRS), which is endemic in Europe and Asia, and hantavirus cardiopulmonary syndrome (HCPS), which is endemic in the Americas. HCPS and HFRS are separate clinical entities, but they share several features and have many overlapping symptoms, signs, and pathogenic alterations. For HCPS in particular, clinical outcomes are highly associated with early clinical suspicion, access to rapid diagnostic testing or algorithms for presumptive diagnosis, and prompt transfer to a facility with critical care units. No specific effective antiviral treatment is available.
Assuntos
Doenças Transmissíveis , Infecções por Hantavirus , Síndrome Pulmonar por Hantavirus , Febre Hemorrágica com Síndrome Renal , Orthohantavírus , Humanos , Febre Hemorrágica com Síndrome Renal/diagnóstico , Febre Hemorrágica com Síndrome Renal/epidemiologia , Febre Hemorrágica com Síndrome Renal/terapia , Células Endoteliais/patologia , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/tratamento farmacológico , Síndrome Pulmonar por Hantavirus/epidemiologia , Infecções por Hantavirus/diagnóstico , Infecções por Hantavirus/epidemiologia , Infecções por Hantavirus/terapiaRESUMO
We describe the clinical parameters and management of nine confirmed cases of hantavirus pulmonary syndrome reported in French Guiana since 2008. All patients were admitted to Cayenne Hospital. Seven patients were men and the mean age was 48 years (range, 19-71 years). Two phases characterized the disease. The prodromal phase was characterized by fever (77.8%), myalgia (66.7%), and gastrointestinal symptoms (vomiting and diarrhea; 55.6%) starting, on average, 5 days before the illness phase, which was characterized by respiratory failure in all patients. Five patients died (55.6%) and the length of stay in the intensive care unit was 19 days (range, 11-28 days) for survivors. Detection of two back-to-back recent cases highlights the reason to screen for hantavirus infection during the nonspecific phase of the disease, in particular when concomitant pulmonary infection and digestive disorders are observed. Specific longitudinal serological surveys must also be used to identify other potential clinical forms of the disease in French Guiana.
Assuntos
Síndrome Pulmonar por Hantavirus , Orthohantavírus , Vírus de RNA , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , Guiana Francesa/epidemiologia , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/epidemiologia , HospitaisRESUMO
OBJECTIVES: From 1993 to 2018, hantavirus infections were reported in 39 states, with hantavirus pulmonary syndrome (HPS) as the most common and fatal manifestation. To identify differences in the presentation of HPS between children and adults, we hypothesized that children with HPS would be diagnosed later in their illness course given the nonspecific clinical features of HPS. METHODS: This was an evaluation of the clinical and demographic characteristics of national HPS cases from 1993 to 2018. Data were from the Centers for Disease Control and Prevention database and 1 state department of health, comprising 97% of US cases. We compared children (0 to 12 years), adolescents (13 to 18 years), and adults using nonparametric and parametric analyses, with additional exploratory analyses to identify clinical variables associated with mortality. RESULTS: Among 719 HPS patients, 22 (3.0%) were aged ≤12 years, 47 (6.5%) were 13 to 18 years old, and the remaining 650 (90.4%) were adults. Overall mortality was 35.4% and did not differ between age groups (P = .8). The time between symptom onset and death differed by age group, with children living a median of 2 days (interquartile range [IQR] 2 to 3), adolescents 4 days (IQR 3 to 5), and adults 5 days (IQR 4 to 8; P = .001). The mean highest hematocrit and median highest creatinine level were significantly associated with mortality in those 0 to 18 years old but not adults. CONCLUSIONS: In our dataset representing the largest study of HPS in the United States, we found that children with HPS died more quickly than adults and that highest hematocrit and creatinine levels were associated with death only among those <19 years old.
Assuntos
Síndrome Pulmonar por Hantavirus , Criança , Adolescente , Humanos , Estados Unidos/epidemiologia , Recém-Nascido , Lactente , Pré-Escolar , Adulto Jovem , Adulto , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/epidemiologia , CreatininaRESUMO
Hantavirus infections occur through the inhalation of aerosols from the excreta of infected rodents. These viruses cause a cardiopulmonary syndrome in the case of the Andes Sur variant, with a mortality that can reach 50%. It occurs in sporadic cases or in small clusters, in which interhuman contagion predominates. In this historical cohort-type observational study, in people infected with Andes Sur hantavirus during the years 2009 to 2019 who was assisted in the public health subsector of San Carlos de Bariloche (Argentina), it was sought to identify factors that could predict poor evolution (cardiopulmonary syndrome and death). For this, the risk for each of the variables was characterized and, to obtain key information about the relationships between them, a multiple correspondence analysis was also applied. During the study period, 38 people were included. The mean age was 35 years. Person-to-person contagion was suspected in 10/38 (26.8%) cases. 21.1% (8/28) presented a hantavirus pulmonary syndrome at the time of diagnosis, while 55.3% (21/38) developed it during their evolution, and 44.7% (17/38) of those infected died during hospitalization. Age over 15 years and thrombocytopenia were associated with a higher risk of clinical progression, while mild forms or asymptomatic people, person-to-person transmission, or during an epidemiological outbreak, were associated with a lower risk of death.
Las infecciones por hantavirus, ocurren a través de la inhalación de aerosoles provenientes de excretas de roedores infectados. Estos virus causan síndrome cardiopulmonar en el caso de la variante Andes Sur, con una mortalidad que puede alcanzar el 50%. Se presenta como casos esporádicos o en pequeños conglomerados, en los que predomina el contagio interhumano. En este estudio observacional de tipo cohorte histórica, en personas infectadas con hantavirus Andes Sur durante los años 2009 a 2019 que fueron asistidas en el subsector público de salud de San Carlos de Bariloche(Argentina), se buscó identificar factores que pudieran predecir mala evolución (síndrome cardiopulmonar y muerte). Para ello se caracterizó el riesgo para cada una de las variables y, para obtener información clave sobre las relaciones entre las mismas, se aplicó además un análisis de correspondencias múltiples. Durante el período de estudio, 38 personas fueron incluidas. La edad media fue de 35 años. Se sospechó contagio de persona a persona en 10/38 (26.8%) casos. El 21.1% (8/28) tuvo al momento del diagnóstico un síndrome pulmonar por hantavirus. Mientras que, 55.3% (21/38) lo desarrolló durante su evolución y 44.7% (17/38) de los infectados fallecieron durante la internación. La edad mayor a 15 años y la plaquetopenia, se asociaron con un mayor riesgo de progresión clínica, mientras que las formas de leves o las personas asintomáticas, el contagio persona a persona o durante un brote epidemiológico, se asociaron con un menor riesgo de muerte.
Assuntos
Doenças Transmissíveis , Infecções por Hantavirus , Síndrome Pulmonar por Hantavirus , Orthohantavírus , Estudos de Coortes , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/epidemiologia , Humanos , PrognósticoRESUMO
We describe a patient in Argentina with severe acute respiratory syndrome coronavirus 2 infection and hantavirus pulmonary syndrome (HPS). Although both coronavirus disease and HPS can be fatal when not diagnosed and treated promptly, HPS is much more lethal. This case report may contribute to improved detection of co-infections in HPS-endemic regions.
Assuntos
COVID-19 , Coinfecção , Síndrome Pulmonar por Hantavirus , Orthohantavírus , Argentina/epidemiologia , COVID-19/diagnóstico , Síndrome Pulmonar por Hantavirus/diagnóstico , HumanosRESUMO
Hantavirus cardiopulmonary syndrome (HCPS) is an emerging rodent-borne disease in the Americas. The most common initial symptoms of HCPS are similar to those of COVID-19 and other respiratory infections that evolve rapidly to respiratory failure, resulting from pulmonary edema and shock in about 40% of cases. We describe a fatal case of HCPS in a 24-year-old man who was hospitalized with fever, hemoconcentration, thrombocytopenia, leukocytosis, dry cough and a bilateral diffuse alveolar pulmonary infiltrate during the emergence of the COVID-19 pandemic in Brazil. HCPS needs to be ruled out in patients with clinical manifestations compatible with respiratory infections such as influenza and COVID-19.
Assuntos
COVID-19 , Infecções por Hantavirus , Síndrome Pulmonar por Hantavirus , Orthohantavírus , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/epidemiologia , Humanos , Pandemias , SARS-CoV-2RESUMO
OBJECTIVES: Navajo Nation is disproportionately affected by hantavirus cardiopulmonary syndrome (HCPS), a severe respiratory disease that can quickly progress to respiratory failure and cardiogenic shock. The initial signs and symptoms of HCPS are indistinguishable from coronavirus disease 2019 (COVID-19). However, this distinction is critical, as the disease course differs greatly, with most patients with COVID-19 experiencing mild to moderate illness. We set out to determine if the evaluation of peripheral blood smears for five hematopathologic criteria previously identified as hallmarks of hantavirus infection, or "the hantavirus 5-point screen," could distinguish between COVID-19 and HCPS. METHODS: The hantavirus 5-point screen was performed on peripheral blood smears from 139 patients positive for COVID-19 seeking treatment from Tséhootsooí Medical Center and two Emory University hospitals. RESULTS: Of these 139 individuals, 136 (98%) received a score of 3/5 or below, indicating low suspicion for HCPS. While thrombocytopenia, one of the key signs of HCPS, was seen in the patients with COVID-19, it was generally mild and remained stable on repeat specimens collected 12 to 24 hours later. CONCLUSIONS: Given these findings, the 5-point screen remains a useful rapid screening tool for potential HCPS cases and may be useful to distinguish early HCPS from COVID-19 in HCPS endemic regions.
Assuntos
COVID-19 , Infecções por Hantavirus , Síndrome Pulmonar por Hantavirus , Orthohantavírus , Infecções por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/epidemiologia , Síndrome Pulmonar por Hantavirus/patologia , Humanos , SARS-CoV-2RESUMO
Hantaviruses are tri-segmented lipid-enveloped RNA viruses belonging to the Bunyaviridae family. Human infection corresponds to a zoonosis associated with two different clinical syndromes: hemorrhagic fever with renal syndrome that occurs in Asia and Europe and hantavirus cardiopulmonary syndrome (HCPS) that occurs in the North America, Central America and South America. The major pathogenic mechanisms in HCPS include (1) direct microvascular endothelial injury leading to increased capillary permeability and the development of noncardiogenic pulmonary edema and acute respiratory distress syndrome, and (2) exaggerated host immune response leading to secondary organ damage. The incubation period for this disease is quite long (6-39 days, median: 18 days); however, rapid progression to respiratory failure and shock can occur highlighting the importance of high index of clinical suspicion. Management revolves around high-quality supportive care. Various management and preventative strategies are currently being explored and warrant further examination to improve the overall outlook following infection with hantavirus.
Assuntos
Infecções por Hantavirus , Síndrome Pulmonar por Hantavirus , Orthohantavírus , Animais , Orthohantavírus/fisiologia , Infecções por Hantavirus/diagnóstico , Infecções por Hantavirus/epidemiologia , Infecções por Hantavirus/terapia , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/epidemiologia , Síndrome Pulmonar por Hantavirus/terapia , Humanos , Pulmão , ZoonosesRESUMO
OBJECTIVES: To determine the relative frequency and prognosis value of proteinuria in hantavirus cardiopulmonary syndrome (HCPS) due to Andes virus. METHODS: This observational analytical study prospectively obtained data from patients admitted to 12 health centers in nine Chilean cities between 2001 and 2018. Only patients with confirmed Andes virus HCPS and laboratory characterization that included qualitative proteinuria determination at admission were considered. RESULTS: The database involved 175 patients, 95 of them had a measurement of urine protein at the time of hospital admission. They were mainly male (71%) and the median age was 35 [22-47] years. Median duration of the febrile prodromal time was 5 [4-7] days. Hospital length of stay and hospital mortality rate were 10 [7-14] days and 21.1%, respectively. Seventy-three patients (77%) were identified with proteinuria at admission, which was associated with increased mortality rate (26% versus 5%, p=0.036) and the relative risk was 1.3 [1.1-1.6], p=0.002. CONCLUSIONS: Proteinuria is a frequent finding in patients with HCPS, which is associated with a higher mortality rate.
Assuntos
Doenças Transmissíveis , Infecções por Hantavirus , Síndrome Pulmonar por Hantavirus , Orthohantavírus , Adulto , Síndrome Pulmonar por Hantavirus/complicações , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/epidemiologia , Humanos , Masculino , Proteinúria/epidemiologiaRESUMO
Hantavirus cardiopulmonary syndrome (HCPS) is a severe respiratory disease caused by Sin Nombre virus in North America (SNV). As of January 1, 2020, SNV has caused 143 laboratory-confirmed cases of HCPS in Canada. We review critical aspects of SNV virus epidemiology and the ecology, biology, and genetics of HCPS in Canada.
Assuntos
Infecções por Hantavirus , Síndrome Pulmonar por Hantavirus , Orthohantavírus , Vírus Sin Nombre , Canadá/epidemiologia , Orthohantavírus/genética , Infecções por Hantavirus/epidemiologia , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/epidemiologia , Humanos , América do NorteAssuntos
Mordeduras e Picadas/complicações , Dispneia/etiologia , Síndrome Pulmonar por Hantavirus/diagnóstico , Vírus Sin Nombre/isolamento & purificação , Animais , Anticorpos Antivirais/sangue , Broncoscopia , Tosse/etiologia , Diagnóstico Diferencial , Febre/etiologia , Síndrome Pulmonar por Hantavirus/complicações , Síndrome Pulmonar por Hantavirus/transmissão , Humanos , Contagem de Leucócitos , Leucocitose/diagnóstico , Leucocitose/etiologia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Camundongos , Peromyscus , Pneumonia/diagnóstico , Vírus Sin Nombre/imunologia , Trombocitopenia/diagnóstico , Trombocitopenia/etiologia , Tomografia Computadorizada por Raios X , Vaping/efeitos adversos , Adulto JovemRESUMO
In North America, hantaviruses commonly cause hantavirus pulmonary syndrome (HPS). Clinical descriptions of hantavirus-associated renal disease in the Americas are scarce. Herein, we discuss the case of a 61-year-old man whose predominant manifestations were acute kidney injury and proteinuria. Clinical recognition of renal signs in hantavirus infections can reduce risk for death.
Assuntos
Síndrome Pulmonar por Hantavirus/diagnóstico , Orthohantavírus/isolamento & purificação , Insuficiência Renal/diagnóstico , Colorado , Diagnóstico Diferencial , Síndrome Pulmonar por Hantavirus/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Proteinúria/etiologia , Insuficiência Renal/complicaçõesRESUMO
Most human hantavirus infections occur in Asia, but some cases have been described in Europe in travelers returning from Asia. We describe a case of hantavirus pulmonary syndrome in a previously healthy traveler occurring shortly after he returned to Spain from Nepal. Serologic tests suggested a Puumala virus-like infection.
Assuntos
Síndrome Pulmonar por Hantavirus/epidemiologia , Viagem , Adulto , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/etiologia , Síndrome Pulmonar por Hantavirus/virologia , Humanos , Masculino , Nepal/epidemiologia , Virus Puumala , Espanha/epidemiologiaRESUMO
Hantavirus Pulmonary Syndrome is an, often fatal, emerging zoonotic disease in the Americas caused by hantaviruses (family: Hantaviridae). In Brazil, hantavirus routine diagnosis is based on serology (IgM-ELISA) while RT-PCR is often used to confirm acute infection. A Semi-nested RT-PCR and an internally controlled RT-qPCR assays were developed for detection and quantification of four hantaviruses strains circulating in the Brazilian Amazon: Anajatuba (ANAJV) and Castelo dos Sonhos (CASV) strains of Andes virus (ANDV) species; and Rio Mamoré (RIOMV) and Laguna Negra (LNV) strains of LNV species. A consensus region in the N gene of these hantaviruses was used to design the primer sets and a hydrolysis probe. In vitro transcribed RNA was diluted in standards with known concentration. MS2 bacteriophage RNA was detected together with hantavirus RNA as an exogenous control in a duplex reaction. RT-qPCR efficiency was around 100% and the limit of detection was 0.9 copies/µL of RNA for RT-qPCR and 10 copies/µL of RNA for Semi-nested RT-PCR. There was no amplification of either negative samples or samples positive to other pathogens. To assess the protocol for clinical sensitivity, specificity and general accuracy values, both assays were used to test two groups of samples: one comprising patients with disease (n = 50) and other containing samples from healthy individuals (n = 50), according to IgM-ELISA results. A third group of samples (n = 27) infected with other pathogens were tested for specificity analysis. RT-qPCR was more sensitive than semi-nested RT-PCR, being able to detect three samples undetected by conventional RT-PCR. RT-qPCR clinical sensitivity, specificity and general accuracy values were 92.5%, 100% and 97.63%, respectively. Thus, the assays developed in this study were able to detect the four Brazilian Amazon hantaviruses with good specificity and sensitivity, and may become powerful tools in diagnostic, surveillance and research applications of these and possibly other hantaviruses.
Assuntos
Testes Diagnósticos de Rotina/métodos , Síndrome Pulmonar por Hantavirus/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Adulto , Brasil , Testes Diagnósticos de Rotina/normas , Orthohantavírus/classificação , Orthohantavírus/isolamento & purificação , Humanos , Reação em Cadeia da Polimerase/métodos , Reação em Cadeia da Polimerase/normas , Reação em Cadeia da Polimerase em Tempo Real/normas , Padrões de Referência , Reação em Cadeia da Polimerase Via Transcriptase Reversa/normas , Sensibilidade e Especificidade , Adulto JovemRESUMO
BACKGROUND: The hantavirus infection is an emerging zoonotic disease, endemic in Chile, generating the hantavirus cardiopulmonary syndrome (HCPS), characterized by cardiopulmonary dysfunction with rapidly progressive respiratory failure and high lethality. For an early clinical orientation of HCPS, due to its non-specificity in symptoms and to help the differential diagnosis, some laboratory parameter that may be useful have been studied. AIM: To identify laboratory criteria as predictive factors of HCPS in patients with suspected hantavirus infection. METHODOLOGY: Retrospective cohort study of 71 patients admitted to the Hospital Guillermo Grant Benavente Emergency. We determined discriminative capacity of laboratory's parameters at the time of admission: platelets recount, hematocrit, inmunoblasts, activated partial thromboplastin time (aPTT) and aspartate aminotransferase (AST/GOT). RESULTS: Were found significant differences in all parameters studied between confirmed patients (22) with respect to unconfirmed (49). Hematocrit, inmunoblasts, AST/GOT and aPTT had a OR > 1 and platelets count had a OR < 1. The best combination for predict HCPS was hematocrit, platelets count and AST/GOT with 90,01% sensibility and 81,63% specificity. CONCLUSION: The five parameters studied are good predictors of HCS in suspicious patients and they would may be useful in low complexity hospitals for quick transfer a center with critical care units.
Assuntos
Técnicas de Laboratório Clínico/normas , Síndrome Pulmonar por Hantavirus/diagnóstico , Aspartato Aminotransferases/normas , Chile , Feminino , Síndrome Pulmonar por Hantavirus/sangue , Hematócrito/normas , Humanos , Masculino , Tempo de Tromboplastina Parcial/normas , Contagem de Plaquetas/normas , Valor Preditivo dos Testes , Estudos Retrospectivos , População Rural , Sensibilidade e EspecificidadeRESUMO
Hantavirus Cardiopulmonary Syndrome (HCPS) is an important emergent zoonosis associated with wild rodents in Brazil, where this viral infection in children is generally rare. We present HCPS in a child from the Pantanal Biome and a review of all reported pediatric cases in Mato Grosso State, an endemic area for HCPS in Brazil. The investigation used the Information System for Notifiable Diseases database (SINAN). A 12-year-old boy was hospitalized with fever and respiratory failure and hantavirus IgM and IgG antibodies were detected by ELISA in serum samples. During the period of 1999 to 2016, 32 HCPS pediatric cases confirmed by serology were reported to SINAN with a mortality rate of 34.4%. The possibility of hantavirus infection in children with acute febrile illness associated with respiratory failure should be considered mainly in recognized endemic areas as Mato Grosso State, contradicting a hypothesis that children are more protected from lung involvement.
Assuntos
Anticorpos Antivirais/sangue , Síndrome Pulmonar por Hantavirus/epidemiologia , Adolescente , Brasil/epidemiologia , Criança , Doenças Endêmicas , Ensaio de Imunoadsorção Enzimática , Feminino , Síndrome Pulmonar por Hantavirus/diagnóstico , Humanos , Imunoglobulina G/sangue , Masculino , Fatores de Risco , Estudos SoroepidemiológicosRESUMO
Los Hantavirus son virus con ARN de cadena simple pertenecientes a la familia Bunyaviridae. A diferencia de otros virus de la familia, no tienen artrópodos como vectores; sus hospederos en la naturaleza son roedores y algunos mamíferos pequeños. La transmisión al hombre ocurre por la inhalación de excretas de los animales infectados, rara vez por mordeduras y se ha documentado la posibilidad de transmisión persona a persona. Existen dos formas clínicas de la enfermedad: fiebre hemorrágica con síndrome renal (FHSR) distribuida en Europa y Asia, y síndrome cardiopulmonar por Hantavirus (SCPH), en las Américas. El SCPH se presenta clinicamente en cuatro fases: incubación, prodrómica, cardiopulmonar y convalescencia. En el laboratorio es frecuente el hallazgo de trombocitopenia, junto con otros cambios hematológicos y bioquímicos. El diagnóstico se realiza por la detección de anticuerpos o PCR. Recientemente en Epuyén, Provincia de Chubut, Argentina, ocurrió un brote que afectó a 34 personas con 12 muertes asociado a la transmisión interpersonal. Se revisa la situación actual con respecto al tratamiento y las posibilidades futuras de intervención. Aunque se trate de una enfermedad con una baja prevalencia, la alta tasa de letalidad y el alto impacto emocional y económico que sufren las localidades afectadas hacen necesario seguir investigando la búsqueda de nuevas alternativas de tratamiento.
Hantaviruses are single-stranded RNA viruses that belong to the Bunyaviridae family. Unlike other viruses in the family, they do not have arthropods as vectors; their hosts in the wild are rodents and some small mammals. Human transmission takes place through inhalation of excreta from infected animals, rarely from bites, and the possibility of person-to-person transmission has been documented. There are two clinical forms of the disease: hemorrhagic fever with renal syndrome (HFRS) distributed in Europe and Asia, and cardiopulmonary Hantavirus syndrome (HCPS) distributed in the Americas. The HCPS presents clinically in four phases: incubation, prodromal, cardiopulmonary and convalescence. In the laboratory, a thrombocytopenia is common, together with other hematological and biochemical changes. Diagnosis is made through the detection of antibodies or PCR. Recently, in Epuyén, Province of Chubut, Argentina, an outbreak occurred, affecting 34 people with 12 deaths associated with interpersonal transmission. The current situation is reviewed with respect to the treatment and the future possibilities of intervention. Although it is a disease with a low prevalence, the high rate of lethality and the high emotional and economic impact suffered by the affected areas make it necessary to continue investigating in search of new treatment alternatives.
Os Hantavírus são vírus RNA de cadeia simples pertencentes à família Bunyaviridae. Diferente de outros vírus da família, não têm artrópodes como vetores; seus anfitrões na natureza são roedores e alguns mamíferos pequenos. A transmissão para o homem acontece através da inalação de excrementos dos animais infectados, raras vezes por mordeduras e foi documentada a possibilidade de transmissão de pessoa para pessoa. Existem duas formas clínicas da doença: febre hemorrágica com síndrome renal (FHSR) distribuída na Europa e Ásia, e síndrome cardiopulmonar por Hantavírus (SCPH), nas Américas. O SCPH apresenta-se clinicamente em quatro fases: incubação, prodrômica, cardiopulmonar e convalescença. No laboratório é frequente o achado de trombocitopenia, junto a outras mudanças hematológicas e bioquímicas. O diagnóstico é realizado pela detecção de anticorpos ou PCR. Recentemente em Epuyén, Província de Chubut, Argentina, houve um surto que afetou 34 pessoas com 12 mortes associado à transmissão interpessoal. Revê-se a situação atual relativa ao tratamento e às possibilidades futuras de intervenção. Embora se trate de uma doença com uma baixa prevalência, a alta taxa de letalidade e o alto impacto emocional e econômico que sofrem as localidades afetadas tornam necessário continuar investigando em busca de novas alternativas de tratamento.