A Fatal Hantavirus Pulmonary Syndrome Misdiagnosed as Dengue: An Investigation into the First Reported Case in Rio de Janeiro State, Brazil.

We report the results of an investigation into a fatal case of hantavirus pulmonary syndrome (HPS) in Rio de Janeiro State, Brazil, where the disease had not been reported previous to 2015. Following the notification of an HPS case, serum samples were collected from the household members and work contacts of the HPS patient and tested for antibody to hantaviruses. Seroprevalence of 22% (10/45) was indicated for hantavirus out of 45 human samples tested. Blood and tissue samples were collected from 72 rodents during fieldwork to evaluate the prevalence of hantavirus infection, by using enzyme-linked immunosorbent assay IgG, and to characterize the rodent hantavirus reservoir(s), by reverse transcription polymerase chain reaction and sequencing. Antibody prevalence was 6.9%. The circulation of a single genotype, the Juquitiba hantavirus, carried by two rodent species, black-footed pigmy rice rat (Oligoryzomys nigripes) and cursor grass mouse (Akodon cursor), was shown by analysis of the nucleotide sequences of the S segment. Juquitiba hantavirus circulates in rodents of various species, but mainly in the black-footed pigmy rice rat. HPS is a newly recognized clinical entity in Rio de Janeiro State and should be considered in patients with febrile illness and acute respiratory distress.

Avaliação da infecção por Hantavirus em amostras humanas e de roedores silvestres e sinantrópicos no Estado do Rio de Janeiro / Assessment for hantavirus infection in human specimens and wild and synanthropic rodents in Rio de Janeiro

A síndrome pulmonar por hantavírus (SPH) tem sido registrada no Brasil desde1993 e a transmissão para o homem ocorre através da inalação de partículas viraispresentes em aerossóis de excretas de roedores infectados. No Brasil, nove genótiposvirais caracterizados a partir de roedores e/ou humanos foram descritos, sendo seiscomprovadamente patogênicos. Desde os primeiros registros, mais de 1600 casoshumanos foram confirmados, com ampla distribuição entre a maioria dos estadosbrasileiros e alta taxa de letalidade. A SPH apresenta-se como doença febril agudacaracterizada pelo grave comprometimento cardiovascular e respiratório. Os pacientespodem exibir uma ampla variedade de manifestações clínicas, onde os sinais e sintomaspodem ser confundidos com os de outras doenças. Assim é necessário o diagnósticodiferencial separando casos de SPH de outros agravos com manifestações clínicassemelhantes, como é o caso da dengue. Embora não existam relatos de casos humanosno estado do Rio de Janeiro, foram encontradas evidências sorológicas em humanos econfirmação de circulação de hantavírus patogênico entre roedores silvestres, maisespecificamente, na espécie Oligoryzomys nigripes, no Parque Nacional da Serra dosÓrgãos, em Teresópolis. Neste cenário, este estudo teve como objetivos avaliar ainfecção por hantavírus em amostras humanas e em amostras de roedores silvestres esinantrópicos provenientes de diversos municípios fluminenses. Um total de 497amostras de soro de pacientes negativos para dengue pelos testes sorológicos, cedidaspelo LACEN/RJ, provenientes de 25 municípios, e de 235 amostras de roedoresprovenientes de sete municípios, foram analisadas através do ensaio imunoenzimáticopara detecção de anticorpos anti-hantavírus da classe IgM e IgG (ELISA IgM e IgG) ede testes moleculares...

Hantavirus pulmonary syndrome (HPS) has been registered in Brazil since 1993and transmission to humans occurs through inhalation of viral particles present inaerosols from excreta of infected rodents. In Brazil, nine viral genotypes characterizedfrom rodents and/or humans have been described, six of them pathogenic. Over 1.600human cases were confirmed, with wide distribution among most Brazilian states andhigh lethality. Hantavirus pulmonary syndrome presents as an acute febrile illnesscharacterized by severe cardiovascular and respiratory compromise. Patients mayexhibit a wide variety of clinical manifestations, where signs and symptoms can beconfused with other diseases. Thus the differential diagnosis of HPS is necessary fromother illnesses with similar clinical manifestations, such as dengue. There are no reportsof human cases in Rio de Janeiro state, until now, but serologic evidence in humans andconfirmation of circulating pathogenic hantavirus among wild rodents in ParqueNacional da Serra dos Órgãos in Teresopolis, related to the rodent Oligoryzomysnigripes were found. In this scenario, this study aimed to evaluate hantavirus infectionin human, wild and synanthropic rodents samples from different municipalities in Riode Janeiro state. Serum samples from 497 dengue fever seronegative patients, from 25municipalities provided by the LACEN/RJ, and 235 serum samples from rodents, fromseven municipalities, were analyzed by enzyme-linked immunosorbent assay fordetection of anti-hantavirus antibodies of IgM and IgG (IgM and IgG ELISA) andmolecular tests. Five human samples, from Valença, Vassouras and Nova Friburgomunicipalities, presented IgM antibodies against hantavirus...