Tratamiento con metilprednisolona en pacientes con síndrome cardio pulmonar por hantavirus, XI Región de Aysén / Methylprednisolone treatment in patients with hantavirus cardio pulmonary syndrome, XI Aysén Region

The Hantavirus Cardio Pulmonary Syndrome (HCPS) was observed for first time in the Región of Aysén in December of 1996. The recommended treatment is guided to manage the shock and the Adult Respiratory Distress Syndrome(ARDS) with a 50 per cent of outcome in 1988, This illnes is produced as consequence of the guest's exaggerated immune answer before the presence of the virus. Many papers report clear benefits of the corticosteroids use in patient with severe sepsis and ARDS in bacterial meningitis, serious typhoid fever, in acute medullary lesion and P. carinii pneumonia. Theoretically, the guest's inflammatory answer in the systemic inflammatory response syndrome (SIRS) and ARDS is possible of being modified with the antiinflamatorios, inmuno-supresores or corticosteroids employment. Supposing that the corticosteroids use in early stages of the illnes could reduce the severity and to prevent the death of these patients, it took us to begin a protocol of the patients treatment with HCPS, using Methylprednisolone (MP) in high dose. A retrospective and prospective study of patients was admitted in the ICU of the Coyhaique Hospital with these inclusion approach: 1) fever, migraine, mialgias, diarrhea y/o vomits and lives in endemic area; 2) front chest film with bilateral interstitial edema; 3) blood count with deviation to left of the white series, trombocytophenia (<150,000/ml) and inmunoblasts greater than 10 per cent of the linfocyts. Dose of MP 1.000 mg/day EV x 3 days + 16 mg PO x 5 days. Since december 1996 the MP has been used in 27 patients with SPCH, half age 32,7 years old range 2 to 60 years. Since september 1997 the MP has been used in 15 patients, 2 women and 13 men, half age 36.3 years old and range among 19 to 57 years. All the cases were confirmed with presence of positive IgM. The general mortality is 37 per cent (10/27), of the group control 50 per cent (6/12) and of the group that use MP 26,6 per cent (4/15). 14.3 per cent of the group MP that make moderate shock (1/7) it dies, versus 50 per cent (3/6) of the group control. The patients that make ARDS 75 per cent die (6/8) in the group control and 33.3 per cent (4/12) in the group MP (p=0.08). According to the day of beginning of the MP, used the day 5° the patients don't make shock neither ARDS.

Síndrome pulmonar por hantavirus: experiencia clínica en diagnóstico y tratamiento: Hospital Coyhaique Chile / Hantavirus pulmonary syndrome: clinical experience in diagnosis and treatment: Hospital Coyhaique Chile

Entre diciembre de 1996 y diciembre de 1999, se ingresaron a la unidad de cuidados intensivos del Hospital Coyhaique, 24 pacientes con síndrome pulmonar por hantavirus (SPH), con un rango de edad entre 2 y 60 años, (media 31,8), de los cuales 19 (79,2 por ciento) eran de sexo masculino. El SPH se manifestó con fiebre, mialgias, molestias digestivas, dolor lumbar y cefalea. El diagnóstico se basó en los siguientes tres criterios: cuadro clínico: fiebre, mialgias, diarrea y/o vómitos, en residente de zona endémica: radiografía de tórax: infiltrado intersticial bilateral; hemograma: desviación a izquierda de serie blanca, trombocitopenia (< 150.000/ml) e inmunoblastos (> 10 por ciento de los linfocitos). La severidad clínica del SPH se pudo estratificar en tres grupos: SPH leve; no evolucionaron con shock y requirieron sólo oxigenoterapia (n:7); SPH moderado: desarrollaron shock moderado, requirieron soporte hemodinámico, ventilación mecánica (VM) y sobrevivieron (n:8); SPH severo: desarrollaron shock severo, requirieron de soporte hemodinámico, VM y fallecieron (n:9). La letalidad general fue de 37,5 por ciento (9/24)