RESUMO
Andes virus was identified in 1995 as the etiologic agent of Hantavirus Pulmonary Syndrome (HPS) in Southern Argentina. We describe herein the main clinical characteristics of 25 HPS confirmed cases acquired in this area between 1993 and September 1999. The mean age was 34 years (range 11-70), with 72% males. Clinical characteristics were similar to those previously reported for Sin Nombre virus (SNV) cases. However, in this group of patients we also observed conjuntival injection in 10/25 (42%), facial flushing in 8/25 (33%), pharyngeal congestion in 7/25 (29%) and petechiae in 3/25 (12%). On the other hand, BUN was increased in 83% of cases (mean 0.77 g/l range 0.31-2.01). Mean serum creatinine concentration was 26.8 mg/l (range: 8.1-110 mg/l) with serum creatinine being higher than 20 mg/l in 8/15 patients (53%). Urinalysis was abnormal in 12/12 cases and was characterized by presence of proteins, red blood cells and granular casts. Aminotransferases were increased in 90% of cases with levels 5-10 times over normal values in 50% of cases. Serum creatine kinase concentration was elevated in 11/14 cases. Two patients required hemodialysis. Case fatality rate was 44% (11/25) and 10 of these cases died among the first 10 days of illness. Mononuclear myocarditis was observed in two cases, a finding that has not been reported for SNV cases. During the 1996 HPS outbreak in Southern Argentina due to Andes virus, there were epidemiological and molecular evidences of person-to-person transmission, a feature not previously shown for other members of the hantavirus genus. These data would also be indicative of some distinctive clinical characteristics of HPS caused by Andes virus, with more frequent renal involvement than in SNV cases.
Assuntos
Síndrome Pulmonar por Hantavirus/complicações , Adolescente , Adulto , Idoso , Argentina/epidemiologia , Criança , Surtos de Doenças , Ensaio de Imunoadsorção Enzimática , Feminino , Orthohantavírus/genética , Síndrome Pulmonar por Hantavirus/mortalidade , Síndrome Pulmonar por Hantavirus/patologia , Humanos , Masculino , Pessoa de Meia-Idade , RNA Viral/análise , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
Andes virus was identified in 1995 as the etiologic agent of Hantavirus Pulmonary Syndrome (HPS) in Southern Argentina. We describe herein the main clinical characteristics of 25 HPS confirmed cases acquired in this area between 1993 and September 1999. The mean age was 34 years (range 11-70), with 72
males. Clinical characteristics were similar to those previously reported for Sin Nombre virus (SNV) cases. However, in this group of patients we also observed conjuntival injection in 10/25 (42
), facial flushing in 8/25 (33
), pharyngeal congestion in 7/25 (29
) and petechiae in 3/25 (12
). On the other hand, BUN was increased in 83
of cases (mean 0.77 g/l range 0.31-2.01). Mean serum creatinine concentration was 26.8 mg/l (range: 8.1-110 mg/l) with serum creatinine being higher than 20 mg/l in 8/15 patients (53
). Urinalysis was abnormal in 12/12 cases and was characterized by presence of proteins, red blood cells and granular casts. Aminotransferases were increased in 90
of cases with levels 5-10 times over normal values in 50
of cases. Serum creatine kinase concentration was elevated in 11/14 cases. Two patients required hemodialysis. Case fatality rate was 44
(11/25) and 10 of these cases died among the first 10 days of illness. Mononuclear myocarditis was observed in two cases, a finding that has not been reported for SNV cases. During the 1996 HPS outbreak in Southern Argentina due to Andes virus, there were epidemiological and molecular evidences of person-to-person transmission, a feature not previously shown for other members of the hantavirus genus. These data would also be indicative of some distinctive clinical characteristics of HPS caused by Andes virus, with more frequent renal involvement than in SNV cases.
RESUMO
A fatal case of serologically confirmed hantavirus pulmonary syndrome (HPS) was recently reported in southwestern Argentina. Nucleotide sequence analysis of PCR fragments from conserved regions of the S and M genomic segments of the virus, amplified from RNA extracted from autopsy lung and liver tissues, showed the virus (referred as Andes virus) to be novel. Comparisons between Andes virus genome sequences with the corresponding sequences of the more closely related hantaviruses revealed differences at the amino acid level from 13.6 to 23.9% for G2 protein regions and from 8.5 to 12.5% for the amino terminal region of the nucleocapsid protein. Phylogenetic analysis using the maximum parsimony and maximum likelihood methods showed that Andes virus maps within the clade containing the HPS-associated viruses from North America. Within this group, Andes virus represents a unique lineage. This is, to our knowledge, the first report on the genetic characterization of a hantavirus from South America.
Assuntos
Síndrome Pulmonar por Hantavirus/virologia , Orthohantavírus/genética , Argentina , Sequência de Bases , Capsídeo/genética , DNA Viral , Orthohantavírus/isolamento & purificação , Humanos , Dados de Sequência Molecular , Filogenia , Proteínas do Core Viral/genéticaRESUMO
El 18 de junio de 1986 se efectuó en el Hospital de Clínicas José de San Martín un estudio para evaluar el uso de los antibióticos en pacientes internados y los gastos que surgen de su empleo inadecuado. El 28% de los internados recibían antibióticos, el 69% de las indicaciones con finalidad terapéutica y el 35% de las profilaxisis fueron correctas. El error más frecuente en el tratamiento fue el uso del antibiótico no electivo y en la profilaxis, la utilización innecesaria. El gasto por uso inadecuado fue de u$s 494.17 en un día, u$s 14.825 en un mes y u$s 180.372 por año
Assuntos
Humanos , Masculino , Feminino , Antibacterianos/uso terapêutico , Custos de Medicamentos , Uso de Medicamentos/economia , ArgentinaRESUMO
El 18 de junio de 1986 se efectuó en el Hospital de Clínicas José de San Martín un estudio para evaluar el uso de los antibióticos en pacientes internados y los gastos que surgen de su empleo inadecuado. El 28% de los internados recibían antibióticos, el 69% de las indicaciones con finalidad terapéutica y el 35% de las profilaxisis fueron correctas. El error más frecuente en el tratamiento fue el uso del antibiótico no electivo y en la profilaxis, la utilización innecesaria. El gasto por uso inadecuado fue de u$s 494.17 en un día, u$s 14.825 en un mes y u$s 180.372 por año (AU)