RESUMO
BACKGROUND: In June 2019, the Bolivian Ministry of Health reported a cluster of cases of hemorrhagic fever that started in the municipality of Caranavi and expanded to La Paz. The cause of these cases was unknown. METHODS: We obtained samples for next-generation sequencing and virus isolation. Human and rodent specimens were tested by means of virus-specific real-time quantitative reverse-transcriptase-polymerase-chain-reaction assays, next-generation sequencing, and virus isolation. RESULTS: Nine cases of hemorrhagic fever were identified; four of the patients with this illness died. The etiologic agent was identified as Mammarenavirus Chapare mammarenavirus, or Chapare virus (CHAPV), which causes Chapare hemorrhagic fever (CHHF). Probable nosocomial transmission among health care workers was identified. Some patients with CHHF had neurologic manifestations, and those who survived had a prolonged recovery period. CHAPV RNA was detected in a variety of human body fluids (including blood; urine; nasopharyngeal, oropharyngeal, and bronchoalveolar-lavage fluid; conjunctiva; and semen) and in specimens obtained from captured small-eared pygmy rice rats (Oligoryzomys microtis). In survivors of CHHF, viral RNA was detected up to 170 days after symptom onset; CHAPV was isolated from a semen sample obtained 86 days after symptom onset. CONCLUSIONS: M. Chapare mammarenavirus was identified as the etiologic agent of CHHF. Both spillover from a zoonotic reservoir and possible person-to-person transmission were identified. This virus was detected in a rodent species, O. microtis. (Funded by the Bolivian Ministry of Health and others.).
Assuntos
Arenavirus do Novo Mundo , Febre Hemorrágica Americana , RNA Viral , Roedores , Animais , Arenavirus do Novo Mundo/genética , Arenavirus do Novo Mundo/isolamento & purificação , Bolívia/epidemiologia , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Transmissão de Doença Infecciosa , Febre Hemorrágica Americana/complicações , Febre Hemorrágica Americana/genética , Febre Hemorrágica Americana/transmissão , Febre Hemorrágica Americana/virologia , Febres Hemorrágicas Virais/genética , Febres Hemorrágicas Virais/transmissão , Febres Hemorrágicas Virais/virologia , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Reação em Cadeia da Polimerase , RNA Viral/genética , RNA Viral/isolamento & purificação , Ratos/virologia , Roedores/virologia , Zoonoses Virais/transmissão , Zoonoses Virais/virologiaRESUMO
The present study is aimed to assess the risk factors for mortality in the first 107 rRT-PCR confirmed cases of SARS-CoV-2 infections in Bolivia. For this observational, retrospective and cross-sectional study, the epidemiological data records were collected from the Hospitals and the Ministry of Health of Bolivia, obtaining the clinical and epidemiological data of the COVID-19 cases that were laboratory-diagnosed during March 2-29, 2020. Samples were tested by rRT-PCR to SARS-CoV-2 at the Laboratory of the National Center of Tropical Diseases (CENETROP), following the protocol Charite, Berlin, Germany. The odds ratio (OR) with respective 95% confidence interval (95%CI) for mortality as dependent variable was calculated. When we comparatively analyzed survivors and non-survivors in this first group of 107 cases in Bolivia, we found that at bivariate analyses, age (±60 years old), hypertension, chronic heart failure, diabetes, and obesity, as well as the requirement of ICU, were significantly exposure variables associated with death. At the multivariate analysis (logistic regression), two variables remained significantly associated, age, ±60 years-old (OR=9.4, 95%CI 1.8-104.1) and hypertension (OR=3.3, 95%CI 1.3-6.3). As expected, age and comorbidities, particularly hypertension, were independent risk factors for mortality in Bolivia in the first 107 cases group. More further studies are required to better define risk factors and preventive measures related to COVID-19 in this and other Latin American countries.
Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bolívia/epidemiologia , COVID-19 , Criança , Intervalos de Confiança , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Complicações do Diabetes/mortalidade , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Obesidade/mortalidade , Razão de Chances , Pandemias , Pneumonia Viral/epidemiologia , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2 , Distribuição por Sexo , Adulto JovemRESUMO
INTRODUCTION: In March 2020, Coronavirus Disease 2019 (COVID-19) arrived in Bolivia. Here, we report the main clinical findings, and epidemiological features of the first series of cases, and a cluster, confirmed in Bolivia. METHODS: For this observational, retrospective and cross-sectional study, information was obtained from the Hospitals and the Ministry of Health for the cases that were laboratory-diagnosed and related, during March 2020. rRT-PCR was used for the detection of the RNA of SARS-CoV-2 following the protocol Charité, Berlin, Germany, from nasopharyngeal swabs. RESULTS: Among 152 suspected cases investigated, 12 (7.9%) were confirmed with SARS-CoV-2 infected by rRT-PCR. The median age was 39 years (IQR 25-43), six of them male. Two cases proceed from Italy and three from Spain. Nine patients presented fever, and cough, five sore throat, and myalgia, among other symptoms. Only a 60 y-old woman with hypertension was hospitalized. None of the patients required ICU nor fatalities occurred in this group. CONCLUSIONS: This is the first report of surveillance of COVID-19 in Bolivia, with patients managed mainly with home isolation. Preparedness for a significant epidemic, as is going on in other countries, and the deployment of response plans for it, in the country is now taking place to mitigate the impact of the COVID-19 pandemic in the population.
