Aplicación de la Teoría del Cuidado Cultural a la investigación: prácticas de cuidado preventivas de hantavirus / Applying Cultural Care Theory to research: hantavirus preventive care practices

INTRODUCCIÓN: La investigación en enfermería surge de las necesidades y experiencias en la práctica y debe contribuir a generar, redefinir y actualizar el conocimiento de enfermería a través de comprobación o generación de nuevas teorías de enfermería. El conocimiento nuevo generado o actualizado debe retornar y mejorar la práctica del cuidado de enfermería dirigido las personas, familia y comunidad. Sin embargo en ocasiones la interrelación investigación y teoría no es clara, afectando de esta manera la relevancia de la aplicación de las teorías de enfermería en la práctica del cuidado de enfermería. OBJETIVO: La presente reflexión responde al objetivo de ejemplificar cómo se aplicó la Teoría del Cuidado Cultural Universalidad y Diversidad de Leininger al estudio del fenómeno de las prácticas de cuidado preventivas de hantavirus. DESARROLLO: Sistematización crítica de la experiencia investigativa a través de una propuesta metodológica, que describe cómo la Teoría del Cuidado Cultural Universalidad y Diversidad de Leininger guio el proceso de investigación sobre las prácticas de cuidado preventivas de hantavirus, factores personales, sociales, modos de vida y creencias culturales. CONCLUSIONES: Un elemento fundamental en toda investigación de enfermería es mostrar de manera clara y explícita cómo la teoría se interconecta con todas las fases de la investigación y en consecuencia genera conocimiento de enfermería para la práctica del cuidado.

INTRODUCTION: Nursing research arises from needs and experiences in practice and should contribute to generate, redefine and update nursing knowledge by testing or developing new nursing theories. Such new or updated knowledge should lead to improvements in the practice of nursing care applied to persons, family, and community. However, sometimes the interrelationship between research and theory is unclear, affecting the relevance of such theories to nursing care practice. OBJECTIVE: The present reflection aims to exemplify how Leininger's Theory of Cultural Care Universality and Diversity was applied to the study of hantavirus preventive care practices. DEVELOPMENT: Critical systematization of the research experience through a proposed methodology that describes how Leininger's Theory of Cultural Care Universality and Diversity guided research related to hantavirus preventive practices, personal and social factors, lifestyles, and cultural beliefs. CONCLUSIONS: A fundamental element in all nursing research is to clearly and explicitly show how theory interfaces with all phases of research and consequently generates nursing knowledge for caring practice.

Frecuencia de anticuerpos contra Hantavirus en agricultores de arroz de una región tropical en el noreste del Perú / Hantavirus antibody frequency in rice farmers from a tropical region in northeast Peru

RESUMEN Introducción. Existe limitada evidencia acerca de la exposición al hantavirus en el Perú. Los casos sintomáticos y estudios de seroprevalencia en febriles y población asintomática provienen de la región Loreto; sin embargo, existen grupos ocupacionales expuestos a los reservorios en regiones sin circulación conocida del virus. Objetivo. Determinar la frecuencia de anticuerpos contra el hantavirus en arroceros de un valle ubicado en una zona subtropical del Perú. Métodos. Estudio transversal en una muestra aleatoria de 250 agricultores de arroz obtenida en 2010 en el valle Alto Mayo (región San Martín), que incluyó la obtención de una muestra de sangre en cuyo suero se determinó la presencia de anticuerpos inmunoglobulinas G (IgG) mediante ELISA indirecto, y anticuerpos inmunoglobulinas M (IgM) mediante ELISA de captura. Resultados. Identificamos un caso con anticuerpos IgM (0,40%, IC95%: 0,01 a 2,21), pero no encontramos agricultores con anticuerpos IgG. El caso tenía contacto frecuente con ratas y roedores en la vivienda y campo de cultivo. Conclusión. Mostramos la primera evidencia serológica de infección por hantavirus en la región San Martín.

ABSTRACT Introduction. There is little evidence of hantavirus exposition in Peru. Cases and seroprevalence studies in febrile and asymptomatic persons are from Loreto region; however, there are occupational groups exposure to reservoirs in areas without know virus circulation. Objectives. To determinate the frequency of antibodies against hantavirus in rice farmers of a valley in a subtropical area of Peru. Methods. Cross-sectional study in a random sample of 250 rice farmers enrolled in 2010 in Alto Mayo Valley (San Martin region) that included blood sample obtention, in whose serum the presence of IgG antibodies was determined by indirect ELISA, and IgM antibodies by capture ELISA. Results. We identified a case with IgM antibodies (0,40%, 95% CI: 0,01 to 2,21), we did not find farmers with IgG antibodies. The case had frequent contact with rats and rodents in the home and crop field. Conclusion. We show the first serological evidence of hantavirus infection in the San Martin region.

Sobrevida de pessoas com hantavirose diagnosticadas no Estado do Paraná, Brasil / Survival of persons with hantavirus infection diagnosed in Paraná State, Brazil / Supervivencia de personas con hantavirus diagnosticadas en el estado de Paraná, Brasil

Resumo: Hantavirose é uma doença emergente e com impacto na saúde pública. Por apresentar sinais e sintomas inespecíficos e facilmente confundidos com outras doenças, seu prognóstico poderia ser melhorado por meio do conhecimento de fatores que pudessem contribuir para seu desfecho. O estudo objetivou identificar os fatores associados ao tempo de sobrevivência em pessoas com hantavirose. Trata-se de um estudo com casos confirmados de hantavirose de janeiro/1992 a junho/2016 do Estado do Paraná, Brasil. Cada caso apresentou dois desfechos competitivos possíveis: óbito ou cura. Para a análise de sobrevivência foi utilizado um modelo de riscos competitivos e as probabilidades dos desfechos estimadas pelo estimador de Aalen-Johansen. A medida de associação foi a razão de riscos (RzRiscos), com respectivos intervalos de 95% de confiança (IC95%). Dos 280 indivíduos com hantavirose, 107 (38,21%) evoluíram para o óbito, 161 (57,5%) para a cura e 12 (4,29%) foram censurados. O modelo final de sobrevivência foi composto por uso de respirador mecânico para o óbito (RzRiscos = 2,86; IC95%: 1,76-4,64; p = 0,00002), sinais hemorrágicos para o óbito (RzRiscos = 2,86; IC95%: 1,69-4,84; p = 0,00009) e para a cura (RzRiscos = 0,66; IC95%: 0,45-0,95; p = 0,03), cefaleia para a cura (RzRiscos = 1,99; IC95%: 1,12-3,54; p = 0,02) e menor de 20 anos para a cura (RzRiscos = 1,73; IC95%: 1,05-2,84; p = 0,03). Sinais hemorrágicos e uso de respirador mecânico são fatores relacionados com a gravidade dos casos e não oportunizam tempo suficiente para reverter o desfecho. No entanto, esses sinais de gravidade corroboram o argumento da importância da suspeição oportuna, permitindo um manejo clínico adequado a fim de reduzir a letalidade.

Abstract: Hantavirus infection is an emerging disease with public health impact. Since the signs and symptoms are nonspecific and easily confused with those of other diseases, the prognosis could be improved by knowledge of the factors potentially contributing to the outcome. The study aimed to identify the factors associated with survival time in persons with hantavirus infection. This was a study of confirmed cases of hantavirus infection from January 1992 to June 2016 in Paraná State, Brazil. Each case presented two possible competitive outcomes: death or cure. Survival analysis used a competitive risks model and outcome probabilities estimated by the Aalen-Johansen estimator. The measure of association was the hazards ratio (HR) with 95% confidence interval (95%CI). Of the 280 individuals with hantavirus infection, 107 (38.21%) evolved to death, 161 (57.5%) to cure, and 12 (4.29%) were censored. The final survival model consisted of the use of mechanical ventilation for death (HR = 2.86; 95%CI: 1.76-4.64; p = 0.00002), hemorrhagic signs for death (HR = 2.86; 95%CI: 1.69-4.84; p = 0.00009) and for cure (HR = 0.66; 95%CI: 0.45-0.95; p = 0.03), headache for cure (HR = 1.99; 95%CI: 1.12-3.54; p = 0.02), and age under 20 years for cure (HR = 1.73; 95%CI: 1.05-2.84; p = 0.03). Hemorrhagic signs and use of mechanical ventilation are factors associated with the severity of cases and do not allow sufficient time to reverse the outcome. However, these signs of severity corroborate the argument of the importance of timely suspicion, allowing adequate clinical management to reduce case-fatality.

Resumen: El hantavirus es una enfermedad emergente y con impacto en la salud pública. Por presentar señales y síntomas inespecíficos, y fácilmente confundidos con otras enfermedades, su pronóstico podría ser mejor gracias al conocimiento de factores que pudiesen contribuir a su resultado. El estudio tuvo como objetivo identificar los factores asociados al tiempo de supervivencia en personas con hantavirus. Se trata de un estudio con casos confirmados de hantavirus de enero/1992 a junio/2016 del estado de Paraná, Brasil. Cada caso presentó dos desenlaces competitivos posibles: óbito o cura. Para el análisis de supervivencia se utilizó un modelo de riesgos competitivos y las probabilidades de los resultados se estimaron mediante el estimador de Aalen-Johansen. La medida de asociación fue la razón de riesgos (RzRiscos), con sus respectivos intervalos de 95% de confianza (IC95%). De los 280 individuos con hantavirus, 107 (38,21%) evolucionaron hacia el óbito, 161 (57,5%) hacia la cura y 12 (4,29%) fueron censurados. El modelo final de supervivencia estuvo compuesto por el uso de respirador mecánico para el óbito (RzRiscos = 2,86; IC95%: 1,76-4,64; p = 0,00002), señales hemorrágicas para el óbito (RzRiscos = 2,86; IC95%: 1,69-4,84; p = 0,00009) y para la cura (RzRiscos = 0,66; IC95%: 0,45-0,95; p = 0,03), cefalea para la cura (RzRiscos = 1,99; IC95%: 1,12-3,54; p = 0,02) y menor de 20 años para la cura (RzRiscos = 1,73; IC95%: 1,05-2,84; p = 0,03). Las señales hemorrágicas y uso de respirador mecánico son factores relacionados con la gravedad de los casos y no destinar tiempo suficiente para revertir el desenlace. No obstante, estas señales de gravedad corroboran el argumento de la importancia de la sospecha oportuna, permitiendo un manejo clínico adecuado, con el fin de reducir la letalidad.

Magnitude e distribuição dos óbitos por hantavirose no Brasil, 2007-2015 / Magnitud y distribución de las muertes por hantavirose no Brasil, 2007-2015 / Magnitude and distribution of deaths due to hantavirus in Brazil, 2007-2015

Objetivo: descrever a magnitude e a distribuição temporal e espacial dos casos e óbitos por hantavirose no Brasil, de 2007 a 2015. Métodos: estudo descritivo, com dados do Sistema de Informação de Agravos de Notificação (Sinan). Resultados: foram notificados 1.060 casos e 410 óbitos no período; a letalidade por hantavirose foi de 39,0%, variando segundo mês (de 28,6% em novembro a 50,7% em dezembro), sexo (37,4% no masculino e 42,6% no feminino), idade (maior letalidade em idosos e crianças) e regiões nacionais (46,2% no Norte, 32,9% no Sul); a maioria dos indivíduos que morreram morava em zona urbana (58,3%) e foi infectada na zona rural (70,2%). Conclusão: a alta letalidade em certos grupos populacionais, meses do ano e regiões do Brasil aponta para baixa suspeição clínica da doença em grupos pouco expostos, o que pode comprometer seu manejo adequado.

Objetivo: describir la magnitud y la distribución temporal y espacial de los casos y muertes por hantavirus en Brasil, de 2007 a 2015. Métodos: estudio descriptivo, con datos del Sistema de Información de Agravios de Notificación (Sinan). Resultados: se notificaron 1.060 casos y 410 muertes en este período; la mortalidad por hantavirus fue 39,0%, variando por mes (28,6% en noviembre a 50,7% en diciembre), sexo (37,4% en el masculino y 42,6% en el femenino), edad (mayor letalidad en ancianos y niños) y regiones nacionales (46,2% en el Norte, 32,9% en el Sur); la mayoría de los individuos que murieron vivían en zona urbana (58,3%) y se infectaron en la zona rural (70,2%). Conclusión: la alta letalidad en ciertos grupos poblacionales, meses del año y regiones de Brasil apuntan a baja sospecha clínica de la enfermedad en grupos poco expuestos, lo que puede comprometer su manejo adecuado.

Objective: to describe the magnitude and temporal and spatial distribution of hantavirus cases and deaths in Brazil between 2007 and 2015. Methods: descriptive study with data from the Notifiable Diseases Information System (SINAN). Results: 1,060 cases and 410 deaths were reported in the period; hantavirus lethality was 39.0%, varying according to month (from 28.6% in November to 50.7% in December), sex (37.4% in males and 42.6% in females), age (higher lethality in the elderly and children) and Brazilian regions (46.2% in the North, 32.9% in the South); most of the individuals who died lived in urban areas (58.3%) and were infected in rural area (70.2%). Conclusion: high lethality in certain population groups, months of the year and regions of Brazil point to low clinical suspicion of the disease in groups with low exposure, which may compromise proper case management.

Conocimientos y prácticas asociadas a transmisión de triquinelosis, hanta y equinococosis quística / Knowledge and practices associated with transmission of trichinellosis, hanta and cystic equinococcosis

RESUMEN Objetivo: Asociar el nivel de conocimiento y prácticas (hábitos y costumbres) responsables de la transmisión de Triquinelosis, Síndrome Cardiopulmonar por Hantavirus y Equinococosis quística (Hidatidosis), en habitantes de los sectores rurales. Material y método: Estudio descriptivo correlacional de corte transversal en el que se aplicó una encuesta a 149 habitantes residentes en el área rural de las localidades de Curacautín, Lonquimay y Melipeuco, a través de muestreo no probabilístico por conveniencia, durante los meses de diciembre 2013 a enero 2014. Resultados: La población posee mejores conocimientos de Triquinelosis y Hanta que Hidatidosis, 64,9, 72,8 y 39,3%, respectivamente; los hábitos y costumbres para Hanta e Hidatidosis alcanzan mejores prácticas (84% cada una) que para Triquinelosis (69,5%); la población reconoce correctamente reservorio, fuente de infección y mecanismos de transmisión en Triquinelosis y Hanta, pero en menor grado Hidatidosis; respecto de los hábitos y costumbres, aun desconociendo los fundamentos teóricos, reportan buenas prácticas, aunque mantienen algunas que favorecen la transmisión de infecciones predominantemente en Triquinelosis. Conclusión: El nivel de conocimiento no asegura buenas prácticas, además los conocimientos y prácticas siguen un patrón empírico más que cognitivo, respaldados por aspectos culturales y del entorno. Esto sugiere mayor participación de los equipos interdisciplinarios en comunidades aisladas para fortalecer la promoción, educación y refuerzo de las buenas prácticas de acuerdo con sus condiciones sociales e incentivar la adherencia a conductas que reduzcan el riesgo de la transmisión de zoonosis.

ABSTRACT Objective: To associate the level of knowledge and practices (habits and customs) responsible for the transmission of trichinellosis, Hanta and cystic echinococcosis (hydatidosis), among rural population. Material and method: Cross-sectional correlational descriptive study in which 149 residents of the rural areas of Curacautín, Lonquimay and Melipeuco were surveyed, using non-probability convenience sampling from December 2013 to January 2014. Results: The population has better knowledge of trichinellosis and Hanta than hydatidosis, 64.9%, 72.8 and 39.3% respectively; they also have better practices regarding Hanta and hydatidosis (84% each) than regarding trichinellosis (69.5%). The population recognizes correctly the reservoir, source of infection and transmission mechanisms of trichinellosis and Hanta, and to a lesser degree hydatidosis; they report good practices regarding habits and customs, even ignoring theoretical foundations, but maintain some practices that favor the transmission of infections related to trichinellosis. Conclusion: The level of knowledge does not ensure good practices. Additionally, knowledge and practices follow an empirical rather than cognitive pattern, rooted on cultural and environmental aspects. This suggests greater participation of interdisciplinary teams in isolated communities to strengthen the promotion, education and reinforcement of good practices in accordance with their social conditions and to encourage adherence to behaviors that reduce the risk of the transmission of zoonoses.

Estudo transversal da letalidade da hantavirose no estado de Goiás, 2007-2013 / Estudio transversal de la letalidad de la infección por hantavirus en el estado de Goiás, Brasil, 2007-2013 / Cross-sectional study on case fatality rate due to hantavirus infection in Goiás State, Brazil, 2007-2013

OBJETIVO: descrever o perfil epidemiológico e clínico da hantavirose e analisar fatores associados à letalidade em Goiás, Brasil. MÉTODOS: foi conduzido um estudo transversal com dados do Sistema de Informação de Agravos de Notificação (Sinan), referentes ao período de 2007 a 2013, no estado de Goiás. Regressão logística foi empregada para estimar razões de chances (OR) com intervalos de confiança de 95% (IC95%). RESULTADOS: foram notificados 1.171 casos suspeitos de hantavirose e 73 (6,2%) confirmados. Entre os confirmados, observou-se maior frequência entre homens (n=50), febre como sintoma mais frequente (n=70) e elevada proporção de hospitalizações (n=68). A taxa de letalidade foi de 57,5%. Foram fatores associados ao óbito: insuficiência respiratória aguda (IRpA) (OR=3,6; IC95%1,2;10,6), hemoconcentração (OR=3,3; IC95%1,1;7,9) e não uso do respirador mecânico (OR=3,4; IC95%1,3;9,1). Após ajuste, a IRpA permaneceu associada ao óbito (OR=3,4; IC95%1,0;11,6). CONCLUSÃO: foi identificada alta taxa de letalidade, associada principalmente com insuficiência respiratória.

OBJETIVO: evaluar el perfil clínico y epidemiológico del hantavirus y los factores asociados con su letalidad en Goiás, Brasil. MÉTODOS: estudio transversal usando datos del Sistema de Información de Enfermedades de Declaración Obligatoria (Sinan), referentes al periodo 2007-2013, en el estado de Goias. Usamos regresión logística para calcular odds ratio (OR) con intervalos de confianza al 95%. RESULTADOS: fueron reportados 1.171 casos sospechosos de hantavirus 73 fueron confirmados (6,2%). Entre los confirmados la frecuencia fue mayor entre hombres (n=50), fiebre fue síntoma más común (n=70), 68 fueron hospitalizados, la tasa de letalidad fue 57,5%. Variables asociadas con letalidad: insuficiencia respiratoria aguda (IRpA) (OR=3,6 IC95% 1,2; 10,6), hemoconcentración (OR=3.3 IC95% 1,1; 7,9) y no usar respirador mecánico (OR=3,4 IC95% 1,3; 9,1). Sólo IRpA se mantuvo asociado en modelos multivariados (OR=3,4 IC95% 1,0; 11,6). CONCLUSIÓN: identificamos una alta tasa de letalidad asociada principalmente con insuficiencia respiratoria.

OBJECTIVE: to describe the epidemiological and clinical profile of hantavirus infection and to analyze factors associated with case-fatality in Goiás, Brazil. METHODS: this was a cross-sectional study on case fatality due to hantavirus infection from 2007 to 2013 using data from the Notifiable Diseases Information System (SINAN) for Goiás State. Logistic regression analysis was performed to estimate odds ratios (OR) with 95% confidence intervals (95%CI). RESULTS: 1,171 suspected cases were reported, of which 73 (6.2%) were confirmed. Among the confirmed cases, greater frequency was found among males (n=50), fever was the most common symptom (n=70), and there was a high proportion of hospitalization (n=68). The case-fatality rate was 57.5% . The following factors were associated with death: acute respiratory failure (ARF) (OR=3.6; 95%CI 1.2;10.6), hemoconcentration (OR=3.3; 95%CI 1.1;7.9) and not using a mechanical ventilator (OR=3.4; 95%CI 1.3;9.1). After adjustment, the ARF was still associated with death (OR=3.4; 95%CI 1.0;11.6). CONCLUSION: the case-fatality rate was high, primarily associated with respiratory failure.

Risk factors associated with hantavirosis fatality: a regional analysis from a case-control study in Brazil

Introduction: In Brazil, hantavirus cardiopulmonary syndrome (HCPS) has a high lethality rate that varies by region. This study aimed to identify the risk factors associated with fatal hantavirosis. Methods: This study was a case-control study that included all laboratory confirmed cases of hantavirosis. The cases were stratified by the different Brazilian regions using data from the Notifiable Diseases Information System. “Cases” were patients who progressed to death, whereas “controls” were patients who were cured. The odds ratio (OR) and the adjusted OR were calculated. Results: Overall, 158 cases and 281 controls were included in this study. In the Midwest region, the cases were 60% less likely to present with flank pain, and the time between the beginning of symptoms and death was shorter than the time between the beginning of symptoms and a cure. In the Southeast region, the cases were 60% less likely to present with thrombocytopenia or reside in rural areas compared to those who progressed to a cure. Additionally, the cases sought medical assistance, notification and investigation more quickly than the controls. In the Southern region, the cases that died were 70% less likely to be male compared to the controls. Conclusions: HCPS manifests with nonspecific symptoms, and there are few published studies related to the condition, so determining a patient's therapeutic strategy is difficult. This study presents findings from different Brazilian regions and highlights the need for further investigations to improve comprehension about regional risk factors associated with hantavirosis and to reduce morbimortality. .

Hantavirus cardiopulmonary syndrome: a report of two cases / Síndrome cardiopulmonar por hantavírus: relato de dois casos

Infection with hantavirus, from the family Bunyaviridae, causes hantavirus cardiopulmonary syndrome (HCPS) in the Americas. This highly lethal anthropozoonosis afflicts preferentially individuals in rural areas and is transmitted by aerosol of excreta from infected wild rodents. The aim of this study is to report the almost simultaneous occurrence of two cases of HCPS in the municipality of Jataí, state of Goiás, Brazil.

A infecção por hantavírus, família Bunyaviridae, provoca a síndrome cardiopulmonar por hantavírus (SCPH) nos países da América. Ela é uma antropozoonose, de elevada letalidade, que tem acometido preferencialmente indivíduos em contato com o meio rural, sendo transmitida por aerossóis a partir das excretas dos roedores silvestres infectados. O objetivo deste estudo foi relatar a ocorrência, quase que simultânea, de dois casos de SCPH ocorridos no município de Jataí, Estado de Goiás, Brasil.

Detection of the specific antigens and viral RNA in the tissues of the BALB/c mice infected with hantavirus / 中国医师杂志

Objective To establish an evaluation system about animals infected with hantavirus,an observation of the BALB/c mice infected with hantavirus was made.Methods BALB/c mice were infected with hantavirus by intramuscular injection with stock solution.The specific antigen from BALB/c mice tissues after 3 days was detected with enzyme-linked immunosorbent assay (ELISA) and viral RNA with real-time polymerase chain reaction (RT-PCR).Results Within a short term,the specific antigen and viral RNA were detected from the brain and liver at day 3 after infection,but not be detected from the heart,spleen,lung,and kidney samples.Conclusions The results provided ones with some information on animals infected with hantavirus.

Vigilancia epidemiológica de la enfermedad por hantavirus en los años 2009 y 2010 / Epidemiologic surveillance of hantaviral disease between 2009 and 2010

En Chile es la variedad Andes del hantavirus la que provoca el síndrome cardiopulmonar. El reservorio es el roedor silvestre Oligoryzomys longicaudatus y su hábitat se extiende desde el sur de la Región de Atacama a la Región de Magallanes. Durante los años 2009 y 2010 se confirmaron 35 y 61 casos de síndrome cardiopulmonar por hantavirus, cifra sobre lo esperado para el año 2010, en relación al quinquenio anterior. La letalidad alcanzó en el período a un 32 por ciento. La incidencia en el 2010 fue de 0,35 por 100.000 habitantes. El mayor el riesgo se mantiene en las regiones del sur del país. Sin embargo, se observó un número de casos sobre lo esperado en 2 regiones del centro-sur del país, las que fueron afectadas por el terremoto de 2010. La alta letalidad de esta enfermedad requiere mantener la detección y hospitalización precoz en los casos sospechosos de hantavirus a través de la capacitación a los equipos de salud y realizar campañas de prevención periódica dirigidas a la población y grupos de mayor riesgo.

In Chile, Andes strain causes hantavirus cardiopulmonary syndrome. The reservoir is the wild rodent Oligoryzomys longicaudatus and its habitat extends from south of Atacama region to Magallanes region. During 2009 and 2010, 35 and 61 cases of hantavirus cardiopulmonary syndrome were confirmed, a figure above the expected for 2010 compared to theprevious five years. Lethality reached 32 percent in this period. Incidence in 2010 was 0.35 per 100,000 inhabitants. The greater risk remains in the southern regions of the country. However, a number of cases more than expected were observed in 2 regions in south-central portion of the country, which were affected by the earthquake of 2010. High lethality level of thisdisease requires maintaining early detection and hospitalization in suspected cases of hantavirus through health teams training and conducting periodic prevention campaigns focused at the population and risk groups.

Síndrome cardiopulmonar por hantavirus / Hantavirus cardiopulmonary syndrome

A hantavirose é doença emergente e amplamente distribuída em todo o mundo. A transmissão ocorre principalmente através da inalação de aerossóis formados a partir das excretas e secreções de roedores silvestres contaminados. Acomete especialmente indivíduos que têm contato com o meio rural e com esses animais. São conhecidas duas formas distintas da doença em humanos, a febre hemorrágica com síndrome renal, na Ásia e Europa, e a síndrome pulmonar e cardiovascular, nas Américas. O relato deste caso justifica-se pela complexidade da doença e importância do diagnóstico precoce por se tratar de afecção grave com altas taxas de letalidade.

Hantavirosis is an emerging disease widely spread over the world. It is acquired specially by inhalation of aerosols produced from secretion and excreta of infected wild rodents. It affects mostly individuals that have contact with such animals, especially in rural areas. Two distinct forms of the disease have been reported among humans, namely: hemorrhagic fever with renal syndrome in Asia and Europe, and cardiopulmonary syndrome in the Americas. This case report is relevant because of both the disease complexity and the importance of early diagnosis to treat this severe infection that has high lethality rates.

Diagnosis of hantavirus infection in humans and rodents in Ribeirão Preto, State of São Paulo, Brazil / Diagnóstico de infecção por hantavírus em humanos e roedores em Ribeirão Preto, Estado de São Paulo

INTRODUCTION: Hantavirus pulmonary and cardiovascular syndrome (HPCS) is an emerging serious disease in the Americas. Hantaviruses (Bunyaviridae) are the causative agents of this syndrome and are mainly transmitted through inhalation of aerosols containing the excreta of wild rodents. In the Ribeirão Preto region (state of São Paulo, Brazil), HPCS has been reported since 1998, caused by the Araraquara virus (ARAV), for which Necromys lasiurus is the rodent reservoir. This study aimed to show diagnostic results relating to infection in humans and rodents, obtained at the Virology Research Center of the Ribeirão Preto School of Medicine, University of São Paulo, between 2005 and 2008. METHODS: HPCS was diagnosed by means of ELISA and/or RT-PCR in 11 (21.2 percent) out of 52 suspected cases, and 54.4 percent of these were fatal. Furthermore, 595 wild rodents (Necromys lasiurus, Akodon sp, Calomys tener and Oligoryzomys sp) were caught between 2005 and 2008. RESULTS: Fifteen (2.5 percent) of these rodents presented antibodies for hantavirus, as follows: Necromys lasiurus (4 percent), Calomys tener (1.9 percent) and Akodon sp (1.5 percent). Nucleotide sequences obtained through RT-PCR from one HPCS patient and one Calomys tener rodent were compared with hantavirus sequences from GenBank, which showed that both were homologous with ARAV. CONCLUSIONS: This work corroborates previous studies showing that ARAV is the hantavirus causing HPCS in the Ribeirão Preto region. It also shows that rodents infected with hantavirus represent a constant risk of transmission of this virus to man.

INTRODUÇÃO: A síndrome pulmonar e cardiovascular por hantavírus é uma doença grave emergente nas Américas. Os hantavírus, Bunyaviridae, são os agentes causadores desta síndrome, causadas, principalmente, pela inalação de aerossóis dos dejetos de roedores silvestres. Na região de Ribeirão Preto, a SPCVH, causada pelo vírus Araraquara, tem sido diagnosticada, desde 1998. O roedor-reservatório do ARAV é o Necromys lasiurus. Este tem como objetivo mostrar os resultados de diagnósticos da infecção de humanos e roedores obtidos no Centro de Pesquisa em Virologia da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, durante o período de 2005 a 2008. MÉTODOS: A síndrome pulmonar e cardiovascular por hantavírus foi diagnosticada, por ELISA e/ou RT-PCR, em 11 (21,2 por cento) dos 52 casos suspeitos e destes, 54,4 por cento foram casos fatais. Além disso, também, de 2005 a 2008, foram capturados 595 roedores silvestres, Necromys lasiurus, Akodon sp, Calomys tener e Oligoryzomys sp. RESULTADOS: Quinze (2,5 por cento) destes roedores apresentaram anticorpos para hantavírus. As soropositividades intraespécie ou gênero foram 4 por cento para Necromys lasiurus, 1,9 por cento para Calomys tener e 1,5 por cento para Akodon sp. Sequências nucleotídicas, obtidas pela RT-PCR de um paciente com SPCVH e de um roedor Calomys tener, foram comparadas com sequências de hantavírus do GenBank, o que mostrou que ambas tinham homologia com o ARAV. CONCLUSÕES: Este trabalho corrobora outros estudos que mostram que o ARAV é o hantavírus causador da SPCVH, na região de Ribeirão Preto, além de mostrar que roedores infectados por hantavírus representam um risco constante de transmissão desses vírus para o homem.