RESUMEN
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.
Asunto(s)
Infecciones por Hantavirus , Síndrome Pulmonar por Hantavirus , Orthohantavirus , Adulto , Humanos , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/terapia , Síndrome Pulmonar por Hantavirus/complicaciones , Infecciones por Hantavirus/diagnóstico , Infecciones por Hantavirus/terapia , Infecciones por Hantavirus/complicaciones , Muerte , Cuidados CríticosRESUMEN
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.
Asunto(s)
Síndrome Pulmonar por Hantavirus/diagnóstico , Orthohantavirus/aislamiento & purificación , Insuficiencia Renal/diagnóstico , Colorado , Diagnóstico Diferencial , Síndrome Pulmonar por Hantavirus/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Proteinuria/etiología , Insuficiencia Renal/complicacionesRESUMEN
BACKGROUND: We report hereby a severe case of Hantavirus Pulmonary Syndrome" (HPS) induced by Maripa virus in French Guiana and describe the mechanism of severity of the human disease. CASE PRESENTATION: A 47-year- old patient started presenting a prodromic period with fever, dyspnea, cough and head ache. This clinical presentation was followed by a rapid respiratory, hemodynamic and renal failure leading to admission in the ICU. Biological exams revealed an increased haematocrit level with a paradoxical low protein level. Echocardiographic and hemodynamic monitoring showed a normal left ventricular function with low filling pressures, an elevated extravascular lung water index and pulmonary vascular permeability index. These findings were compatible with a capillary leak-syndrome (CLS). CONCLUSIONS: The severity of HPS caused by the virus Maripa in French Guiana can be explained by the tropism of hantavirus for the microvascular endothelial cell leading to a CLS.
Asunto(s)
Síndrome de Fuga Capilar/etiología , Síndrome de Fuga Capilar/fisiopatología , Síndrome Pulmonar por Hantavirus/complicaciones , Síndrome Pulmonar por Hantavirus/fisiopatología , Orthohantavirus/patogenicidad , Síndrome de Fuga Capilar/diagnóstico , Guyana Francesa , Orthohantavirus/aislamiento & purificación , Síndrome Pulmonar por Hantavirus/diagnóstico , Humanos , Persona de Mediana EdadAsunto(s)
Mordeduras y Picaduras/complicaciones , Disnea/etiología , Síndrome Pulmonar por Hantavirus/diagnóstico , Virus Sin Nombre/aislamiento & purificación , Animales , Anticuerpos Antivirales/sangre , Broncoscopía , Tos/etiología , Diagnóstico Diferencial , Fiebre/etiología , Síndrome Pulmonar por Hantavirus/complicaciones , Síndrome Pulmonar por Hantavirus/transmisión , Humanos , Recuento de Leucocitos , Leucocitosis/diagnóstico , Leucocitosis/etiología , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Ratones , Peromyscus , Neumonía/diagnóstico , Virus Sin Nombre/inmunología , Trombocitopenia/diagnóstico , Trombocitopenia/etiología , Tomografía Computarizada por Rayos X , Vapeo/efectos adversos , Adulto JovenRESUMEN
Hantaviruses are a group of single-stranded RNA viruses of the Bunyaviridae family. "New World" hantaviruses cause hantavirus cardiopulmonary syndrome (HCPS) in North America. HCPS carries with it significant mortality and those patients who survive the disease are often left with substantial morbidity. Neurologic complications of hantavirus infections are rare, with only sparse cases of central nervous system involvement having been documented in the literature. To our knowledge, there are no reports of hantavirus infection contributing to peripheral nervous system dysfunction. Here we report a case of possible small fiber neuropathy associated with hantavirus infection, in a patient who survived HCPS. Persistent and treatment-resistant neuropathic pain may be a prominent feature in hantavirus-associated peripheral neuropathy.
Asunto(s)
Síndrome Pulmonar por Hantavirus/fisiopatología , Neuralgia/fisiopatología , Orthohantavirus/patogenicidad , Neuropatía de Fibras Pequeñas/fisiopatología , Adulto , Aminas/uso terapéutico , Analgésicos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Ácidos Ciclohexanocarboxílicos/uso terapéutico , Gabapentina , Orthohantavirus/fisiología , Síndrome Pulmonar por Hantavirus/complicaciones , Síndrome Pulmonar por Hantavirus/tratamiento farmacológico , Síndrome Pulmonar por Hantavirus/virología , Humanos , Masculino , Naproxeno/uso terapéutico , Neuralgia/tratamiento farmacológico , Neuralgia/etiología , Neuralgia/virología , Sistema Nervioso Periférico/efectos de los fármacos , Sistema Nervioso Periférico/fisiopatología , Sistema Nervioso Periférico/virología , Neuropatía de Fibras Pequeñas/tratamiento farmacológico , Neuropatía de Fibras Pequeñas/etiología , Neuropatía de Fibras Pequeñas/virología , Síndrome , Ácido gamma-Aminobutírico/uso terapéuticoRESUMEN
Puumala virus (PUUV) is considered a classic Old World etiologic agent of nephropathia epidemica (NE), or hemorrhagic fever with renal syndrome (HFRS). HFRS is considered to be distinct from hantavirus (cardio-)pulmonary syndrome (HPS or HCPS), described in the New World. Here, we report a severe case, which fulfilled most, if not all, Centers for Disease Control and Prevention (CDC) criteria for HPS, needing non-invasive ventilation and subsequent acute hemodialysis. However, the etiological agent was PUUV, as proved by serological testing, real-time polymerase chain reaction (PCR), and sequencing. Viral antigen was detected by specific anti-PUUV immunostaining, showing, for the first time, greenish intracytoplasmic inclusions in bronchoalveolar lavage (BAL) macrophages. This case definitely confirms that HPS can be encountered during PUUV infections. Interestingly, special findings could render the diagnosis easier, such as greenish homogeneous cytoplasmic inclusions, surrounded by a fine clear halo in BAL macrophages. Therefore, although the diagnosis remains difficult before the onset of renal involvement, the occurrence of severe respiratory failure mimicking community-acquired pneumonia must alert the clinician for possible HPS, especially in endemic areas.
Asunto(s)
Síndrome Pulmonar por Hantavirus/complicaciones , Síndrome Pulmonar por Hantavirus/diagnóstico , Fiebre Hemorrágica con Síndrome Renal/diagnóstico , Cuerpos de Inclusión Viral , Pulmón/virología , Macrófagos Alveolares/virología , Virus Puumala/aislamiento & purificación , Adulto , Líquido del Lavado Bronquioalveolar/citología , Líquido del Lavado Bronquioalveolar/virología , Análisis por Conglomerados , Femenino , Humanos , Filogenia , Virus Puumala/clasificación , Virus Puumala/genética , Radiografía Torácica , Reacción en Cadena en Tiempo Real de la Polimerasa , Análisis de Secuencia de ADN , Serotipificación , Tomografía Computarizada por Rayos XRESUMEN
Sochi virus, a novel genetic variant of Dobrava-Belgrade virus, was isolated in cell culture from a fulminant lethal case of hantavirus disease presenting with shock and combined kidney and lung failure. Sochi virus is transmitted to humans from host reservoir Apodemus ponticus and must be considered a life-threatening emerging agent.
Asunto(s)
Síndrome Pulmonar por Hantavirus/complicaciones , Síndrome Pulmonar por Hantavirus/virología , Fiebre Hemorrágica con Síndrome Renal/complicaciones , Fiebre Hemorrágica con Síndrome Renal/virología , Orthohantavirus/aislamiento & purificación , Análisis por Conglomerados , Resultado Fatal , Femenino , Orthohantavirus/clasificación , Orthohantavirus/genética , Síndrome Pulmonar por Hantavirus/mortalidad , Síndrome Pulmonar por Hantavirus/patología , Fiebre Hemorrágica con Síndrome Renal/mortalidad , Fiebre Hemorrágica con Síndrome Renal/patología , Humanos , Persona de Mediana Edad , Datos de Secuencia Molecular , Filogenia , ARN Viral/genética , Análisis de Secuencia de ADN , Cultivo de VirusRESUMEN
Features of hantavirus pulmonary syndrome are considered in the review - zoonosis natural focal polyetiological viral infection, that is characterized by lung injury. Etiology of the disease, main characteristics of the agents, epidemiology, contagiousness, pathogenesis, clinical presentation of this pathology are examined. Laboratory diagnostics, therapy and prophylaxis ofhantavirus pulmonary syndrome are described.
Asunto(s)
Reservorios de Enfermedades/veterinaria , Síndrome Pulmonar por Hantavirus/fisiopatología , Lesión Pulmonar/virología , Orthohantavirus/genética , Enfermedades de los Roedores/virología , Zoonosis/virología , Animales , Antivirales/administración & dosificación , Reservorios de Enfermedades/virología , Orthohantavirus/clasificación , Orthohantavirus/aislamiento & purificación , Orthohantavirus/patogenicidad , Síndrome Pulmonar por Hantavirus/complicaciones , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/mortalidad , Síndrome Pulmonar por Hantavirus/prevención & control , Síndrome Pulmonar por Hantavirus/terapia , Síndrome Pulmonar por Hantavirus/transmisión , Humanos , Inmunohistoquímica , Incidencia , Lesión Pulmonar/etiología , Lesión Pulmonar/fisiopatología , América del Norte/epidemiología , Reacción en Cadena de la Polimerasa , Enfermedades de los Roedores/epidemiología , Enfermedades de los Roedores/transmisión , Roedores , América del Sur/epidemiología , Tasa de Supervivencia , Zoonosis/epidemiología , Zoonosis/transmisiónRESUMEN
Hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome (HPS) are rodent-borne emerging diseases caused by members of the genus Hantavirus, family Bunyaviridae. Some species of hantavirus may cause encephalitis, but this is the first report in Andes virus associated to HPS.
Asunto(s)
Encefalitis/fisiopatología , Síndrome Pulmonar por Hantavirus/fisiopatología , Orthohantavirus/aislamiento & purificación , Animales , Argentina , Encefalitis/etiología , Encefalitis/virología , Orthohantavirus/patogenicidad , Síndrome Pulmonar por Hantavirus/complicaciones , Síndrome Pulmonar por Hantavirus/virología , Humanos , Masculino , Enfermedades de los Roedores/transmisión , Enfermedades de los Roedores/virología , Roedores/virologíaRESUMEN
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.
Asunto(s)
Enfermedades Transmisibles , Infecciones por Hantavirus , Síndrome Pulmonar por Hantavirus , Orthohantavirus , Adulto , Síndrome Pulmonar por Hantavirus/complicaciones , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/epidemiología , Humanos , Masculino , Proteinuria/epidemiologíaAsunto(s)
Síndrome Pulmonar por Hantavirus/diagnóstico , Bloqueo de Rama/diagnóstico , Diagnóstico Diferencial , Disnea/etiología , Síndrome Pulmonar por Hantavirus/complicaciones , Pruebas Hematológicas , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía , Fiebre Maculosa de las Montañas Rocosas/diagnóstico , ViajeRESUMEN
Dengue is an arthropod-borne disease caused by viruses of Flaviviridae family. It poses a major public health burden in tropical and sub-tropical regions. Clinical features of dengue vary from a mild flu-like disease and rash, to a potentially lethal haemorrhagic fever or shock syndrome. Hantavirus pulmonary syndrome is a rodent-born disease emerging in the American continent and is caused by viruses of the Bunyaviridae family. Potential reservoirs of these agents were described in Brazilian Central Plateau. Dengue infection is transmitted by mosquitoes, while hantaviruses are acquired by contact or inhalation of aerosolised excreta of infected rodents. Dengue and hantavirus infections have also been considered as emerging public health problems in some Indian areas; moreover, other infections mixed with dengue have been documented. The case of a Brazilian patient with hantavirus pulmonary syndrome and serologic evidence of dengue infection is described.
Asunto(s)
Dengue/complicaciones , Síndrome Pulmonar por Hantavirus/complicaciones , Brasil , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Hantavirus pulmonary syndrome (HPS) is a reportable infectious disease with a high case-fatality rate, transmitted to humans by exposure to rodents. Each year, 20--40 cases of HPS occur in the United States; cases in persons aged <17 years make up fewer than 7% of those cases, and cases in children aged <10 years are exceptionally rare. CDC received reports of five pediatric cases of HPS occurring during May 16--November 25, 2009, among children aged 6--14 years from Arizona, California, Colorado, and Washington. Three of the children were aged <10 years, and all five had exposure to rodents. This report summarizes the five cases, including the clinical findings and likely means of transmission of a hantavirus. Thrombocytopenia, elevated white blood cell (WBC) count, and pulmonary infiltrates were observed in all five children; elevated hematocrit was observed in three. One child died, and three of the four children who recovered required mechanical ventilation during hospitalization. Clinicians should consider HPS in the differential diagnosis for children with unexplained acute respiratory distress, especially if recent rodent exposure is noted. Public health agencies should promote preventive measures, including rodent control in housing and play areas, and children should be advised to avoid contact with rodents and areas of infestation.
Asunto(s)
Síndrome Pulmonar por Hantavirus/complicaciones , Síndrome Pulmonar por Hantavirus/diagnóstico , Adolescente , Animales , Arizona , California , Niño , Colorado , Resultado Fatal , Femenino , Síndrome Pulmonar por Hantavirus/tratamiento farmacológico , Síndrome Pulmonar por Hantavirus/patología , Síndrome Pulmonar por Hantavirus/transmisión , Humanos , Masculino , Roedores , WashingtónRESUMEN
: Simultaneous infections with multiple pathogens can alter the function of the host's immune system, often resulting in additive or synergistic morbidity. We examined how coinfection with the common pathogens Sin Nombre virus (SNV) and Bartonella sp. affected aspects of the adaptive and innate immune responses of wild deer mice ( Peromyscus maniculatus). Adaptive immunity was assessed by measuring SNV antibody production; innate immunity was determined by measuring levels of C-reactive protein (CRP) in blood and the complement activity of plasma. Coinfected mice had reduced plasma complement activity and higher levels of CRP compared to mice infected with either SNV or Bartonella. However, antibody titers of deer mice infected with SNV were more than double those of coinfected mice. Plasma complement activity and CRP levels did not differ between uninfected deer mice and those infected with only Bartonella, suggesting that comorbid SNV and Bartonella infections act synergistically, altering the innate immune response. Collectively, our results indicated that the immune response of deer mice coinfected with both SNV and Bartonella differed substantially from individuals infected with only one of these pathogens. Results of our study provided unique, albeit preliminary, insight into the impacts of coinfection on immune system function in wild animal hosts and underscore the complexity of the immune pathways that exist in coinfected hosts.
Asunto(s)
Infecciones por Bartonella/veterinaria , Síndrome Pulmonar por Hantavirus/veterinaria , Peromyscus , Enfermedades de los Roedores/patología , Virus Sin Nombre , Inmunidad Adaptativa , Animales , Animales Salvajes , Anticuerpos Antivirales/sangre , Infecciones por Bartonella/complicaciones , Infecciones por Bartonella/microbiología , Infecciones por Bartonella/virología , Proteína C-Reactiva , Síndrome Pulmonar por Hantavirus/complicaciones , Síndrome Pulmonar por Hantavirus/microbiología , Síndrome Pulmonar por Hantavirus/virología , Inmunidad Innata , Enfermedades de los Roedores/microbiología , Enfermedades de los Roedores/virologíaRESUMEN
A previously healthy 29-year-old male presented to the emergency department with pleuritic chest pain, nonproductive cough, and dyspnea. He was treated empirically for community acquired pneumonia and discharged to home. Two days later, the patient presented with respiratory distress along with neutrophilia, thrombocytopenia, elevated liver function tests, and hemoconcentration. Radiographs of his chest showed bilateral lung infiltrates and pleural effusions. He was admitted to the hospital and developed cardiopulmonary failure and died the following day. Serologic tests for hantavirus pulmonary syndrome confirmed the diagnosis.
Asunto(s)
Infecciones por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome de Dificultad Respiratoria/diagnóstico , Adulto , Resultado Fatal , Infecciones por Hantavirus/complicaciones , Síndrome Pulmonar por Hantavirus/complicaciones , Humanos , Masculino , Síndrome de Dificultad Respiratoria/etiologíaRESUMEN
A 44-year-old man from Connecticut with no significant past medical history presented to the ED with a 2-week history of sore throat and fatigue, subsequently developing cough, dyspnea, fevers, and chills. The patient reported buying an old camper van and noticed a large infestation of rodent droppings, which he had cleaned thoroughly from the cabin. He used the camper van on several camping trips in Vermont, and symptoms started on his return.
Asunto(s)
Fatiga/etiología , Síndrome Pulmonar por Hantavirus/complicaciones , Faringitis/etiología , Adulto , Anticuerpos Antivirales/inmunología , Tos/etiología , Disnea/etiología , Fiebre/etiología , Síndrome Pulmonar por Hantavirus/diagnóstico por imagen , Síndrome Pulmonar por Hantavirus/inmunología , Humanos , Pulmón/diagnóstico por imagen , Masculino , Radiografía Torácica , Tomografía Computarizada por Rayos XAsunto(s)
Encefalomielitis Aguda Diseminada/etiología , Síndrome Pulmonar por Hantavirus/complicaciones , Mielitis Transversa/etiología , Adolescente , Encéfalo/patología , Resultado Fatal , Femenino , Orthohantavirus/genética , Síndrome Pulmonar por Hantavirus/líquido cefalorraquídeo , Síndrome Pulmonar por Hantavirus/patología , Humanos , Masculino , Persona de Mediana Edad , Paraplejía/etiología , ARN Viral/líquido cefalorraquídeo , Trombocitopenia/etiologíaRESUMEN
Hantavirus infection may cause diffuse air space disease, termed hantavirus pulmonary syndrome (HPS). The authors sought to determine if chest radiographs could differentiate HPS from typical acute respiratory distress syndrome (ARDS). The authors identified patients with either HPS (n = 11) or acute ARDS (n = 32) and selected the earliest chest radiograph showing diffuse airspace disease, and a chest radiograph taken 24 to 48 hours previously. Thoracic and general radiologists first viewed the chest radiograph showing diffuse air space disease, and ranked the likelihood that each case represented HPS versus ARDS. Afterward, readers viewed earlier chest radiographs and rescored each case. Receiver operating characteristic (ROC) curves from both scoring sessions were generated. The mean areas under the ROC curves for the entire group was 0.83 +/- 0.12 initially, and improved to 0.87 +/- 0.09 (p < 0.05) after viewing prior chest radiographs. Receiver operating characteristic curves of thoracic radiologists described greater areas than those of general radiologists both before and after viewing prior chest radiographs; 0.95 +/- 0.01 versus 0.78 +/- 0.08 (p < 0.05) and 96 +/- 0.02 versus 0.80 +/- 0.05 (p < 0.05). The mean sensitivity and specificity of chest radiograph interpretation for HPS was 86 +/- 13% and 74 +/- 11%, respectively. Chest radiographs can differentiate HPS from ARDS. Accuracy is improved by the use of serial radiographs and more highly trained readers. The chest radiograph findings may represent differences in the extent of alveolar epithelial damage seen in HPS and ARDS.
Asunto(s)
Síndrome Pulmonar por Hantavirus/diagnóstico por imagen , Síndrome de Dificultad Respiratoria/diagnóstico por imagen , Enfermedad Aguda , Diagnóstico Diferencial , Reacciones Falso Positivas , Síndrome Pulmonar por Hantavirus/complicaciones , Humanos , Edema Pulmonar/diagnóstico por imagen , Edema Pulmonar/etiología , Curva ROC , Radiografía Torácica , Síndrome de Dificultad Respiratoria/complicaciones , Sensibilidad y Especificidad , Estadísticas no ParamétricasRESUMEN
The Hantavirus pulmonary and cardiovascular syndrome (HPCVS) is an emerging disease in Brazil. In this study, eight confirmed cases of HPCVS were studied. All the patients presented fever and dyspnea as well as thrombocytopenia and hypoxemia. Tachycardia, malaise, hypotension and lung rales occurred in 75 to 87.5% of the cases. Hemoconcentration, blood cell count increased and immature neutrophils, and high levels of creatinine were observed in 75 to 87.5%. Intravenous liquid infusion, the use of drugs for increasing systemic vascular resistance and inotropism, and mechanic ventilation were used for the patients. Mechanical ventilation and volume administration should be started precociously, preferable in intensive care units employing recommended universal and respiratory precautions. Careful volume administration should be limited if signs of pulmonary edema develop. Mortality (50%) is high and probably related to the severity of the disease as well as to a delayed attending of the patients for intensive management. It is important to report hantaviruses and HPCVS to the Brazilian medical community considering that many cases could be undiagnosed.