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1.
Clin Infect Dis ; 57(7): 943-51, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23784924

RESUMEN

BACKGROUND: Andes virus (ANDV)-related hantavirus cardiopulmonary syndrome (HCPS) has a 35% case fatality rate in Chile and no specific treatment. In an immunomodulatory approach, we evaluated the efficacy of intravenous methylprednisolone for HCPS treatment, through a parallel-group, placebo-controlled clinical trial. METHODS: Patients aged >2 years, with confirmed or suspected HCPS in cardiopulmonary stage, admitted to any of 13 study sites in Chile, were randomized by study center in blocks of 4 with a 1:1 allocation and assigned through sequentially numbered envelopes to receive placebo or methylprednisolone 16 mg/kg/day (≤1000 mg) for 3 days. All personnel remained blinded except the local pharmacist. Infection was confirmed by immunoglobulin M antibodies or ANDV RNA in blood. The composite primary endpoint was death, partial pressure of arterial oxygen/fraction of inspired oxygen ratio ≤55, cardiac index ≤2.2, or ventricular tachycardia or fibrillation within 28 days. Safety endpoints included the number of serious adverse events (SAEs) and quantification of viral RNA in blood. Analysis was by intention to treat. RESULTS: Infection was confirmed in 60 of 66 (91%) enrollees. Fifteen of 30 placebo-treated patients and 11 of 30 methylprednisolone-treated patients progressed to the primary endpoint (P = .43). We observed no significant difference in mortality between treatment groups (P = .41). There was a trend toward more severe disease in placebo recipients at entry. More subjects in the placebo group experienced SAEs (P = .02). There were no SAEs clearly related to methylprednisolone administration, and methylprednisolone did not increase viral load. CONCLUSIONS: Although methylprednisolone appears to be safe, it did not provide significant clinical benefit to patients. Our results do not support the use of methylprednisolone for HCPS. CLINICAL TRIALS REGISTRATION: NCT00128180.


Asunto(s)
Antiinflamatorios/administración & dosificación , Síndrome Pulmonar por Hantavirus/tratamiento farmacológico , Metilprednisolona/administración & dosificación , Administración Intravenosa , Adolescente , Adulto , Chile , Método Doble Ciego , Femenino , Orthohantavirus/genética , Orthohantavirus/aislamiento & purificación , Síndrome Pulmonar por Hantavirus/mortalidad , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , ARN Viral/sangre , Resultado del Tratamiento
2.
Emerg Infect Dis ; 17(10): 1936-9, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22000376

RESUMEN

During 2001-2007, to determine incidence of all hantavirus infections, including those without pulmonary syndrome, in western Panama, we conducted 11 communitywide surveys. Among 1,129 persons, antibody prevalence was 16.5%-60.4%. Repeat surveys of 476 found that patients who seroconverted outnumbered patients with hantavirus pulmonary syndrome by 14 to 1.


Asunto(s)
Infecciones por Hantavirus/epidemiología , Orthohantavirus/inmunología , Adulto , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/inmunología , Infecciones por Hantavirus/virología , Síndrome Pulmonar por Hantavirus/epidemiología , Síndrome Pulmonar por Hantavirus/virología , Humanos , Incidencia , Persona de Mediana Edad , Panamá/epidemiología , Adulto Joven
3.
Am J Trop Med Hyg ; 81(1): 59-66, 2009 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-19556568

RESUMEN

Hantavirus cardiopulmonary syndrome (HCPS), which is caused by infection with Choclo virus, is uncommon in Panama, yet seropositivity among rural residents is as high as 60%. To clarify the environmental risk factors favoring rodent-to-human transmission, we tested serum from 3,067 rodents captured over a five-year period for antibodies against recombinant N protein of hantavirus by enzyme immunoassay and strip immunoblot. Among 220 seropositive rodents, Oligoryzomys fulvescens, the reservoir of Choclo virus, had the highest overall seroprevalence (23.5%); more abundant rodents (Zygodontomys brevicauda and Sigmodon hirsutus) had lower seroprevalences. In the mixed (combined modern and traditional) productive agroecosystem, the highest seroprevalence was among O. fulvescens captured in residences and in crops grown within 40 meters of a residence, with significantly lower seroprevalence in adjacent pasture and non-productive vegetation. Thus, crop habitats may serve as refugia for invasion into adjacent human residences and suggests several interventions to reduce human infection.


Asunto(s)
Ecosistema , Infecciones por Hantavirus/veterinaria , Enfermedades de los Roedores/epidemiología , Roedores/virología , Zoonosis/virología , Animales , Anticuerpos Antivirales/sangre , Productos Agrícolas/virología , Femenino , Infecciones por Hantavirus/epidemiología , Infecciones por Hantavirus/transmisión , Humanos , Masculino , Panamá , Heridas y Lesiones/virología
4.
J Infect Dis ; 195(11): 1563-71, 2007 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-17471425

RESUMEN

BACKGROUND: Andes virus (ANDV) infection, which has a case fatality rate of 37% in Chile, often occurs in household clusters and may be transmitted from person to person. METHODS: To determine the incidence and risk factors for additional household cases, we conducted a prospective study among recent household contacts of persons with hantavirus cardiopulmonary syndrome (HCPS) in Chile, including testing of serum for anti-hantavirus antibodies and blood cells for ANDV RNA by reverse-transcription polymerase chain reaction (RT-PCR). RESULTS: We enrolled 76 index case patients and 476 household contacts, of whom 16 (3.4%) developed HCPS; 32.6% of 92 cases occurred in household clusters. The risk of HCPS was 17.6% among sex partners of index case patients, versus 1.2% among other household contacts (P<.001). Person-to-person transmission was definite in 3, probable in 9, and possible in 2 of the 16 additional household case patients. We detected ANDV RNA by RT-PCR in peripheral blood cells 5-15 days before the onset of symptoms or the appearance of anti-hantavirus antibodies. CONCLUSIONS: In recent household contacts of persons with HCPS in Chile, the risk of HCPS was greatest among sex partners. Among the household contacts who developed HCPS, viremia preceded the onset of symptoms and the appearance of anti-hantavirus antibodies by up to 2 weeks.


Asunto(s)
Trazado de Contacto , Composición Familiar , Síndrome Pulmonar por Hantavirus/transmisión , Orthohantavirus/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/sangre , Niño , Preescolar , Chile/epidemiología , Femenino , Orthohantavirus/genética , Orthohantavirus/inmunología , Síndrome Pulmonar por Hantavirus/epidemiología , Síndrome Pulmonar por Hantavirus/virología , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Estudios Prospectivos , ARN Viral/sangre , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factores de Riesgo , Viremia/epidemiología , Viremia/transmisión , Viremia/virología
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