Factores pronósticos de síndrome cardio-pulmonar y muerte por hantavirus Andes Sur: estudio de cohorte en San Carlos de Bariloche y su zona de influencia sanitaria / Prognostic factors for cardio-pulmonary syndrome and death by hantavirus Andes Sur: cohort study in San Carlos de Bariloche and health influence área

Resumen Las infecciones por hantavirus, ocurren a través de la inhalación de aerosoles provenientes de excretas de roedores infectados. Estos virus causan síndrome cardiopulmonar en el caso de la variante Andes Sur, con una mortalidad que puede alcanzar el 50%. Se presenta como casos esporádicos o en pequeños conglomerados, en los que predomina el contagio interhumano. En este estudio observacional de tipo cohorte histórica, en personas infectadas con hantavirus Andes Sur durante los años 2009 a 2019 que fueron asistidas en el subsector público de salud de San Carlos de Bariloche(Argentina), se buscó identificar factores que pudieran predecir mala evolución (síndrome cardiopulmonar y muerte). Para ello se caracterizó el riesgo para cada una de las variables y, para obtener información clave sobre las relaciones entre las mismas, se aplicó además un análisis de correspondencias múltiples. Durante el período de estudio, 38 personas fueron incluidas. La edad media fue de 35 años. Se sospechó contagio de persona a persona en 10/38 (26.8%) casos. El 21.1% (8/28) tuvo al momento del diagnóstico un síndrome pulmonar por hantavirus. Mientras que, 55.3% (21/38) lo desarrolló durante su evolución y 44.7% (17/38) de los infectados fallecieron durante la internación. La edad mayor a 15 años y la plaquetopenia, se asociaron con un mayor riesgo de progresión clínica, mientras que las formas de leves o las personas asintomáticas, el contagio persona a persona o durante un brote epidemiológico, se asociaron con un menor riesgo de muerte.

Abstract Hantavirus infections occur through the inhalation of aerosols from the excreta of infected rodents. These viruses cause a cardiopulmonary syn drome in the case of the Andes Sur variant, with a mortality that can reach 50%. It occurs in sporadic cases or in small clusters, in which interhuman contagion predominates. In this historical cohort-type observational study, in people infected with Andes Sur hantavirus during the years 2009 to 2019 who was assisted in the public health subsector of San Carlos de Bariloche (Argentina), it was sought to identify factors that could predict poor evolution (cardiopulmonary syndrome and death). For this, the risk for each of the variables was characterized and, to obtain key information about the relationships between them, a multiple correspondence analysis was also applied. During the study period, 38 people were included. The mean age was 35 years. Person-to-person contagion was suspected in 10/38 (26.8%) cases. 21.1% (8/28) presented a hantavirus pulmonary syndrome at the time of diagnosis, while 55.3% (21/38) developed it during their evolution, and 44.7% (17/38) of those infected died during hospitalization. Age over 15 years and thrombocytopenia were associated with a higher risk of clinical progression, while mild forms or asymptomatic people, person-to-person transmission, or during an epidemiological outbreak, were associated with a lower risk of death.

Expanded distribution of orthohantavirus Pergamino genotype: First record in Entre Rios province, Argentina / Ampliación de la distribución del Orthohantavirus genotipo Pergamino: Primer registro en la Provincia de Entre Ríos, Argentina

Abstract Hantavirus Pulmonary Syndrome (HPS) is an emerging infectious disease of the Americas. Eight native rodent species have been identified as HPS virus reservoirs in Argentina. The aim of this work was to detect the orthohantavirus genotypes present in a rodent commu-nity that inhabits a zone where a fatal HPS case occurred within an endemic locality of Central Argentina. We captured 27 rodents with a trapping effort of 723 trap nights. We detected 14.3% of infected Akodon azarae with the Pergamino genotype. This result expands the known distribution of this orthohantavirus. Although the Pergamino genotype has not been associated with human cases, the information about its distribution is relevant for risk assessment against potential changes in the virus infectivity.

Resumen El síndrome pulmonar por hantavirus (SPH) es una enfermedad infecciosa emergente en América. Ocho especies de roedores nativos han sido identificadas como reservorios del virus causante del SPH en la Argentina. El objetivo de este trabajo fue detectar los genotipos de orthohantavirus presentes en una comunidad de roedores que habita en una zona donde ocurrió un caso fatal de SPH, en una localidad endémica de Argentina central. Se capturaron 27 individuos con un esfuerzo de 723 trampas-noche. Se detectó un 14,3% de Akodon azarae infectados con el genotipo pergamino. Este resultado amplía el conocido rango de distribución de este orthohantavirus. A pesar de que el genotipo pergamino no ha sido asociado con casos humanos hasta el momento, la información sobre su distribución es relevante para analizar el riesgo ante un potencial cambio en la infectividad del virus.

Successful repair of infantile scimitar syndrome with contralateral pulmonary vein stenosis in an infant

Abstract Infantile scimitar syndrome (SS) is a rare congenital heart disease and has high mortality. Guidelines have not been established, but surgery is indicated in symptomatic patients. Despite the various surgical approaches, outcomes continue to be disappointing. We present our surgical experience with an infantile SS patient who had stenotic pulmonary veins contralateral to the hypoplastic lung with complicated anatomy. There are few cases with this complex pathology in the literature. Moreover, our patient was the first transplant-free survivor with this complexity in the literature.

Factores ambientales y síndrome cardiopulmonar por virus hanta en Chile / Environmental factors and cardiopulmonary syndrome due to hanta virus in Chile

RESUMEN Objetivo Evaluar la relación entre la temperatura ambiente, humedad relativa y el material particulado ambiental 2,5 con el número de casos de síndrome cardiopulmonar por virus hanta en Chile durante el periodo 2015-2017. Métodos Estudio observacional transversal en 197 casos de síndrome cardiopulmonar por virus hanta notificados y confirmados, ocurridos entre los años 2015 y 2017 en Chile. Se realizó análisis bi- y multivariado entre variables de estudio. Resultados Se determinó una relación positiva y significativa entre temperatura ambiente y número de casos de Síndrome Cardiopulmonar por virus Hanta y una relación negativa y significativa entre el número de casos de Síndrome Cardiopulmonar por virus Hanta y la humedad relativa. Además se observó que la temperatura ambiental junto con material particulado 2,5 aumentan significativamente el número de casos de Síndrome Cardiopulmonar por virus Hanta. Conclusiones Los factores ambientales están relacionados con el número de casos de síndrome cardiopulmonar por virus Hanta en Chile entre los años 2015 y 2017.(AU)

ABSTRACT Objective Evaluate the relationship between ambient temperature, relative humidity and particulate matter 2,5 with the number of cases Hantavirus Cardiopulmonary Syndrome in Chile between 2015 and 2017. Methods Observational, cross-sectional study in 197 cases of Hantavirus Cardiopulmonary Syndrome reported and confirmed, occurring between 2015 and 2017 in Chile. Results Positive and significant relationship was identified between ambient temperature and number of cases of Hantavirus Cardiopulmonary Syndrome and a negative and significant relationship between the number of cases Hantavirus Cardiopulmonary Syndrome and the relative humidity. Also, ambient temperature together with particulate matter 2,5 was observed to increase significantly the number of cases of Hantavirus Cardiopulmonary Syndrome. Conclusions Environmental factors are related to the number of cases Hantavirus Pulmonary Syndrome in Chile between the years 2015 to 2017.(AU)

Surgical closure of large splenorenal shunt may accelerate recovery from hepato-pulmonary syndrome in liver transplant patients / 世界急诊医学杂志（英文）

BACKGROUND@#Hepatopulmonary syndrome (HPS) is not uncommon in the setting of liver disease, especially in liver cirrhosis patients. The prevalence of HPS in liver cirrhosis patients varies from 4% to 47%.[1-3] About the definition of HPS, it is a pulmonary vascular disorder with evidence of intrapulmonary arterial venous shunt.[4] Pulmonary dyspnea and polycythemia are common presentations of HPS. Dyspnea, cyanosis and clubbed fingers were present in most of all cases. Spider nevi is another common clinical feature of patients with HPS.

A retrospective study of Xiaoyan Decoction combined with symptomatic maintenance in treatment of advanced non-small cell lung cancer / 中草药

Objective: To investigate the efficacy of Xiaoyan Decoction in the treatment of non-small cell lung cancer (NSCLC) by retrospective study. Methods: Patients with NSCLC treated in the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 1, 2013 to December 30, 2017 were collected. The patients were divided into two groups: Xiaoyan Decoction plus subtractive prescription combined with symptomatic treatment group (46) and symptomatic treatment group (50). Analyze the survival of the two groups of patients, compare the Karnofsky scores of the two groups, and analyze the sex, age, smoking history, drinking history, histological grade, chemotherapy regimen, pathological type, TCM syndrome type, vascular invasion, and soft tissue invasion Correlation with patient prognosis. Results: There was a significant difference in median progression-free survival (mPFS) between the two groups (P 0.05).The quality of life of patients in Xiaoyan Decoction plus subtractive prescription combined with symptomatic treatment group was significantly improved (P < 0.05), among which, lung squamous cell carcinoma, no vascular, no soft tissue invasion, and patients with phlegm heat obstruction of lung syndrome had the best efficacy (P < 0.05). Conclusion: Xiaoyan Decoction combined with symptomatic maintenance therapy can prolong median progression-free survival (mPFS) and improve the quality of life of patients with advanced NSCLC. The best beneficiaries are patients with lung squamous cell carcinoma, phlegm-heat obstructive pulmonary syndrome without vascular or soft tissue invasion.

Factores de riesgo socio-demográficos del síndrome cardiopulmonar por hantavirus / Sociodemographic risk factors of hantavirus cardiopulmonary syndrome

Resumen Introducción: El síndrome cardiopulmonar por hantavirus (SCPH) es causado en Chile y en el sur de Argentina por el Andes hantavirus (ANDV), el que es endémico en esta zona. La enfermedad causada por ANDV produce un aumento de permeabilidad vascular y filtración de plasma con una alta tasa de letalidad (35%), debido principalmente a insuficiencia respiratoria por edema pulmonar y al desarrollo en los casos graves de compromiso miocárdico, hipoperfusión y shock. Aunque se sabe que los factores socio-demográficos del hospedero pueden influir en el curso y el resultado de la enfermedad, estos no se han caracterizado previamente en la población chilena. Objetivo: Evaluar la relación entre los factores socio-demográficos y la gravedad del SCPH. Pacientes y Métodos: Período de análisis 2004-20013, pacientes atendidos en ocho centros colaboradores, diagnóstico etiológico serológico o por biología molecular, se comparan SCPH leve y grave. Se analizaron 139 pacientes chilenos, 64 (46%) con enfermedad grave, entre los cuales 12 murieron (19%). Resultados: La etnia europea tuvo un riesgo 5,1 veces mayor de desarrollar un SCPH grave que la etnia amerindia, gravedad mayor que también se asoció a una residencia urbana. Conclusiones: Se observó una asociación estadísticamente significativa entre etnia, lugar de residencia y evolución de SCPH. Se discuten hipótesis que expliquen estos hallazgos.

Background: Hantavirus cardiopulmonary syndrome (HCPS) is caused by new world hantaviruses, among which Andes hantavirus (ANDV) is endemic to Chile and Southern Argentina. The disease caused by ANDV produces plasma leakage leading to enhanced vascular permeability and has a high case fatality rate (35%), mainly due to respiratory failure, pulmonary edema and myocardial dysfunction, hypoperfusion and shock. Host sociodemographic and genetic factors might influence the course and outcome of the disease. Yet, they have not been thoroughly characterized. Aim: To evaluate sociodemographic factors as risk factors in severity of HCPS. Patients and Methods: Study period: 2004-20013, attending in eight collaborative centers, etiological diagnosis was performed by serology or molecular biology, mild and severe HCPS were compared.139 Chilean patients were analyzed, 64 (46%) with severe disease among which 12 (19 %) died. Results: European ethnicity had 5,1 times higher risk than Amerindian ethnic group to develop a severe HCPS, greater seriousness that was also associated with an urban residence. Conclusion: It was observed that ethnicity and type of residence were significant risk factors for HCPS severity. Hypotheses explaining these findings are discussed.

Síndrome cardiopulmonar por hantavirus / Hanta syndromevirus cardiopulmonary

Introducción: En el ámbito mundial las enfermedades infecciosas son la segunda causa de muerte en el presente siglo. La epidemiología de las enfermedades infecciosas emergentes y reemergentes plantean desafíos a la clínica y a la salud pública en general, tal es el caso del síndrome cardiopulmonar por hantavirus. Objetivo: Actualizar los conocimientos sobre la vigilancia epidemiológica del microorganismo responsable y documentar a los profesionales de la salud. Métodos: Revisión de artículos de investigación referentes al síndrome cardiopulmonar por hantavirus en el presente siglo. Se realizaron búsquedas en las fuentes de indexación Scopus, SciELO, Medline, Latindex, Bireme, Google. Lilacs, PubMed sobre el microorganismo, patogenia, manifestaciones clínicas, diagnóstico y tratamiento. Conclusiones: La emergencia y reemergencia de este síndrome con alta letalidad debe ser de dominio de clínicos, pediatras, intensivistas, epidemiólogos y los médicos de la atención primaria para su prevención, diagnóstico precoz y conducta oportuna. La vigilancia epidemiológica es fundamental(AU)

Introduction: Infectious diseases are globally the second cause of death in this century. The epidemiology of emerging and reemerging infectious diseases poses clinical and public health challenges in general; such is the home of Hantavirus cardiopulmonary syndrome. Objective: Updating information on the epidemiological surveillance of the causing microorganism and provide said knowledge to health professionals. Methods: Reviewing research articles related to cardiopulmonary syndrome by Hantavirus conducted in the present century. Researches were carried out about the microorganism, pathogenesis, clinical manifestations, diagnosis and treatment in the indexing sources Scopus, SciELO, Medline, Latindex, Bireme, Google, Lilacs and PubMed. Conclusions: The emergence and reemergence of this highly lethal syndrome should be known by clinicians, pediatricians, intensive care staff, epidemiologists and primary care physicians for prevention, early diagnosis and timely treatment. Epidemiological surveillance is essential(AU)

Aspectos clínico-epidemiológico dos pacientes convalescentes após infecção por hantavírus em Mato Grosso / Clinical-epidemiological aspects of convalescent patients after hantavirus infection in Mato Grosso / Aspectos clínico-epidemiológicos de los pacientes convalecientes después de la infección por hantavirus en Mato Grosso

Justificativa e Objetivos: As hantaviroses são zoonoses que nas américas são caracterizadas pela Síndrome Pulmonar por Hantavírus SPH), caracterizada pela alta letalidade. Dessa forma, objetivou-se, identificar o perfil dos pacientes em convalescência após a infecção por hantavírus em Mato Grosso. Métodos: Foi realizado um estudo epidemiológico descritivo de uma série de dados secundários, referente aos casos confirmados de SPH em Mato Grosso, registrados entre os anos de 1999 a 2016. A coleta de dados foi realizada através de consulta às fichas de notificação e posteriormente realizada a análise estatística descritiva dos dados, sendo respeitados os preceitos éticos em pesquisa envolvendo seres humanos. Resultados: Utilizou-se 160 fichas de notificação de pacientes convalescentes. Nessa população predominou o sexo masculino, faixa etária de 25 a 34 anos, raça/cor branca, ensino fundamental incompleto e atividade profissional voltadas à área agrícola. As situações de risco envolveram desmatamento, aragem de terra, plantio ou colheita agrícola. Os principais sinais e sintomas descritos foram febre (86,9%), cefaleia (74,4%) e dispneia (72,5%). Do total de pacientes, 77,5% realizaram exames laboratoriais e 79,4% exame de imagem por raio X, destes a maioria com infiltrado pulmonar difuso (66,9%). Além disso, 87,5% foram hospitalizados, com utilização de assistência respiratória mecânica (46,5%), uso de antibioticoterapia (50,5%) e drogas vasoativas (35,5%). Conclusão: Conhecer o perfil dos pacientes que evoluíram para cura possibilita instrumentalizar os profissionais para a adoção de medidas adequadas tanto no diagnóstico precoce, como na terapêutica eficaz, com o intuito de reduzir a letalidade.(AU)

Background and Objectives: Hantaviruses are zoonoses that in the Americas are characterized by Hantavirus Pulmonary Syndrome (HPS), characterized by high lethality. Thus, it is aimed to identify the profile of patients in convalescence after hantavirus infection in Mato Grosso. Methods: A descriptive epidemiological study was performed on a series of secondary data referring to the confirmed cases of HPS in Mato Grosso recorded between 1999 and 2016. The data collection was done through consultation of the notification sheets and subsequently performed the descriptive statistical analysis of the data, respecting the ethical precepts in research involving human beings. Results: A total of 160 patient notification cards were used. In this population, males, aged between 25 and 34 years old, white race / color, incomplete elementary school and professional activity focused on the agricultural area predominated. The risk situations involved deforestation, land plowing, planting or agricultural harvesting. The main signs and symptoms described were fever (86.9%), headache (74.4%) and dyspnea (72.5%). Of the total number of patients, 77.5% performed laboratory tests and 79.4% had X-ray imaging, of which the majority had diffuse pulmonary infiltrate (66.9%). In addition, 87.5% were hospitalized, using mechanical respiratory assistance (46.5%), antibiotic therapy (50.5%) and vasoactive drugs (35.5%). Conclusion: Knowing the profile of the patients that evolve to cure makes it possible to instrumentalize the professionals for the adoption of adequate measures both in the early diagnosis and in the effective therapy that can contribute to the reduction of the lethality.(AU)

Justificación y objetivos: Las hantavirosis son zoonosis que en las américas se caracterizan por el Síndrome Pulmonar por Hantavirus (SPH), caracterizada por la alta letalidad. De esta forma, se objetiva, identificar el perfil de los pacientes en convalecencia después de la infección por hantavirus en Mato Grosso. Métodos: Se realizó un estudio epidemiológico descriptivo de una serie de datos secundarios, referentes a los casos confirmados de SPH en Mato Grosso, registrados entre los años 1999 a 2016. La recolección de datos fue realizada a través de consulta a las fichas de notificación y posteriormente realizada el análisis estadístico descriptivo de los datos, siendo respetados los preceptos éticos en investigación envolviendo seres humanos. Resultados: Se utilizaron 160 fichas de notificación de pacientes convalecientes. En esta población predominó el sexo masculino, grupo de edad de 25 a 34 años, raza / color blanco, enseñanza fundamental incompleta y actividad profesional orientadas al área agrícola. Las situaciones de riesgo involucraron deforestación, ajo de tierra, siembra o cosecha agrícola. Los principales signos y síntomas descritos fueron fiebre (86,9%), cefalea (74,4%) y disnea (72,5%). Del total de pacientes, el 77,5% realizaron exámenes de laboratorio y el 79,4% examen de imagen por radiografía, de éstos la mayoría con infiltrado pulmonar difuso (66,9%). Además, 87,5% fueron hospitalizados, con utilización de asistencia respiratoria mecánica (46,5%), uso de antibioticoterapia (50,5%) y drogas vasoactivas (35,5%). Conclusiones: Conocer el perfil de los pacientes que evolucionan a curación posibilita instrumentalizar a los profesionales para la adopción de medidas adecuadas tanto en el diagnóstico precoz, como en la terapéutica eficaz que puedan contribuir con la reducción de la letalidad.(AU)

Soporte vital extracorpóreo en adultos con insuficiencia respiratoria aguda refractaria / Extra-corporeal life support for adults with refractory severe respiratory failure / Suporte vital extracorpóreo em adultos com insuficiência respiratória aguda refratária

Resumen: Introducción: El soporte vital extracorpóreo (ECLS - por sus siglas en inglés extra-corporeal life support) se aplica exitosamente en neonatos con insuficiencia respiratoria aguda (IRA). Las dificultades técnicas, los costos y los resultados desalentadores confinaron a esta técnica como última estrategia en adultos. Nuestro objetivo es reportar nuestra experiencia con ECLS en adultos. Material y métodos: Se analizaron pacientes adultos tratados con ECLS entre febrero de 2002 y enero de 2012. Se recolectaron variables demográficas y cardiopulmonares. Los datos son expresados como mediana (rango). Se analizaron las diferencias entre los pacientes afectados con IRA aislada y con síndrome cardiopulmonar por Hantavirus (SCPH) con test U de Mann Whitney y se consideró estadísticamente significativo un valor de p < 0.05. Resultados: Se aplicó ECLS a15 pacientes. Cinco venoarteriales (VA), siete venovenoso (V-V) y tres asistencias pulmonares extracorpóreas sin bomba (P-ELA). Se describen variables demográficas, cardiopulmonares, diagnóstico, tiempo en ECLS y los desenlaces. Los días en ventilación mecánica (VM), la estadía en UCI y hospital fueron: 17 (4-49), 38 (4-93) y 46 (4-102) días respectivamente. Siete de los 15 pacientes fallecieron (47%). Dos pacientes murieron por shock séptico por bacilos Gram negativos después de un ECLS exitoso. La única diferencia estadísticamente significativa entre los pacientes con IRA aislada (ECLS-VV venovenosa o P-ELA) y los pacientes con SCPH (ECLS-VA venoarterial) fue el lactato al ingreso (p < 0.05). Conclusión: ECLS es una estrategia útil como rescate de adultos con IRA refractaria a estrategias de VM avanzada. El progreso en los equipos y el uso de algoritmos en la toma de decisiones han contribuido a reducir la morbimortalidad.

Abstract: Introduction: Extra-corporeal life support (ECLS) is an established technique for neonates with acute respiratory failure (ARF). Technical difficulties, expense and discouraging outcomes explains its confinement to a last resource tool for adults with ARF. Our objective is report the experience with adult ECLS in two hospitals. Material and methods: All consecutive adult patients treated with different ECLS techniques from 2002 to 2012 were analyzed. Demographic and cardiopulmonary variables were collected. Data are expressed as median (range). The differences between patients affected with ARF isolated and patients with hantavirus cardiopulmonary syndrome was obtained with Mann Whitney U test and a value of p < 0.05 was considered statistically significant. Results: Fifteen patients received ECLS. Five were veno-arterial (VA), 7 veno-venous (VV), and 3 pumpless extracorporeal lung assist (P-ELA). Demographic, cardiopulmonary variables, diagnosis, time on ECLS and outcome are described. Mechanical ventilation (MV), ICU and hospital stay were 17 (4-49), 38 (4-93) and 46 (4-102) days respectively. All patients who required VA-ECLS were affected for Hanta cardiopulmonary syndrome. Seven of fifteen patients died. Two out of five VA-ECLS suffered some degree of lower extremity (arterial cannulation) compartmental syndrome and a mild abnormal gait sequel affected them. Vascular accesses and bleeding were not a concern. Two patients died due to septic shock from gram negative bacilli after leaving ECLS. Conclusion: ECLS for catastrophic ARF in adults is useful therapeutic option to rescue patients who do not respond to conventional MV strategies. The progress in technical devices, use an algorithm to medical decision making contribute to reducing morbidity and mortality.

Resumo: Introdução: O suporte de vida extracorpórea (ECLS) é usado com sucesso em neonatos com insuficiência respiratória aguda (IRA). As dificuldades técnicas, custos e resultados decepcionantes confinaram a esta técnica como última estratégia em adultos. Nosso objetivo é relatar nossa experiência com ECLS em adultos. Métodos: Foram analisados pacientes adultos tratados com ECLS entre 2002 e 2012. Foram recolhidas as variáveis demográficas e cardiopulmonares. Os dados são expressos em mediana (desvio padrão). As diferenças entre os pacientes com IRA isolada e com síndrome cardiopulmonar por Hantavírus foi analisada com o teste U de Mann Whitney e foi considerou um valor estatisticamente significativo p < 0.05. Resultados: Quinze pacientes receberam ECLS. Cinco veno-arteriais (VA), 7 veno-venosas (V-V) e trêis asssistências pulmonares extracorpóreas sem bomba (P-ELA). Se descrevem variáveis demográficas, cardiopulmonar, diagnóstico, tempo no ECLS e os resultados. Os dias de ventilação mecânica (VM), tempo de UTI e hospitalar foram: 17 (4-49), 38 (4-93) e 46 (4-102) dias respectivamente. Sete dos quinze pacientes morreram (47%). Dois pacientes morreram com choque séptico por bacilos gram negativos depois de um ECLS exitoso. A única diferença estatisticamente significativa entre os pacientes com IRA isolada (ECLS-VV ou P-ELA) e pacientes com SCPH (ECLS-VA) foi o lactato na admissão (p < 0.05). Conclusão: O ECLS é uma estratégia útil como resgate de adultos com IRA refractária a estratégias de VM avançada. O progresso dos equipamentos e o uso de algoritmos na tomada de decisões têm ajudado a reduzir a morbimortalidade.

Tratamento bem-sucedido da síndrome cardiopulmonar por hantavírus com uso de hemofiltração de alto volume / Hantavirus cardiopulmonary syndrome successfully treated with high-volume hemofiltration

RESUMO A síndrome cardiopulmonar por hantavírus tem elevada taxa de mortalidade. Sugere-se que uma conexão precoce com oxigenação por membrana extracorpórea melhore os resultados. Relatamos o caso de uma paciente que apresentou síndrome cardiopulmonar por hantavírus e choque refratário, que preenchia os critérios para oxigenação por membrana extracorpórea e que teve resposta satisfatória com uso de hemofiltração contínua de alto volume. A implantação de hemofiltração contínua de alto volume, juntamente da ventilação protetora, reverteu o choque dentro de poucas horas e pode ter levado à recuperação. Em pacientes com síndrome cardiopulmonar por hantavírus, um curso rápido de hemofiltração contínua de alto volume pode ajudar a diferenciar pacientes que podem ser tratados com cuidados convencionais da unidade de terapia intensiva dos que necessitarão de terapias mais complexas, como oxigenação por membrana extracorpórea.

ABSTRACT Hantavirus cardiopulmonary syndrome has a high mortality rate, and early connection to extracorporeal membrane oxygenation has been suggested to improve outcomes. We report the case of a patient with demonstrated Hantavirus cardiopulmonary syndrome and refractory shock who fulfilled the criteria for extracorporeal membrane oxygenation and responded successfully to high volume continuous hemofiltration. The implementation of high volume continuous hemofiltration along with protective ventilation reversed the shock within a few hours and may have prompted recovery. In patients with Hantavirus cardiopulmonary syndrome, a short course of high volume continuous hemofiltration may help differentiate patients who can be treated with conventional intensive care unit management from those who will require more complex therapies, such as extracorporeal membrane oxygenation.

Síndrome hepatopulmonar: poco común, pero mortal / Hepatopulmonary syndrome: uncommon, but deadly

Patients with cirrhosis may present with portal hypertension (PHT), which can lead to various complications. The most common areas cites, variceal bleeding, and hepatic encephalopathy. However, there is another entity o flow prevalence but high morbidity and mortality: the hepato pulmonary syndrome (HPS). We report the case of a 25 year-old woman with cirrhosis secondary to autoimmunehepatitis. She was admitted with respiratory symptoms suggestive of viral etiology, but evolved unfavorably. Various diagnoses of cardiovascular and respiratory conditions were successively ruled out, persisting with severe hypoxemia. Concomitantly, she developed progressive pain in the left hypochondrium area, and imaging studies show edsplenic and perisplenic form of manifestation of PHT. In context fHTP and hypoxemia, the diagnosis of HPS vs portopulmonary syndrome was considered, with the bubble test echocardiogramas a key study for such dilemma.

Los pacientes con daño hepático crónico (DHC) pueden cursar con hipertensión portal (HTP), que puede generar diversas complicaciones. Las más frecuentes son la ascitis, hemorragia variceal y encefalopatía hepática. Sin embargo, existe otra entidad de baja prevalencia, pero elevada morbimortalidad: el síndrome hepatopulmonar (SHP). Reportamos el caso de una mujer de 25 años con DHC secundario a hepatitis autoinmune. Ella ingresó con un cuadro sugerente de infección respiratoria alta de etiología viral, pero evolucionó tórpidamente. Se descartaron sucesivamente diversos diagnósticos de la esfera cardiovascular y respiratoria, persistiendo con hipoxemia grave. En forma concomitante desarrolló dolor en hipocondrio izquierdo de carácter progresivo, y las imágenes evidenciaron manifestaciones de HTP de predominio esplénico y periesplénico. En contexto de HTP e hipoxemia se consideró el diagnóstico de síndrome hepatopulmonar vs síndrome porto pulmonar, siendo el ecocardiograma con test de burbujas un estudio clave para el diagnóstico definitivo.

Hantavirus Pulmonary Syndrome (HPS): A Concise Review based on Current Knowledge and Emerging Concept.

Hantaviruses are rodent-borne bunyaviruses transmitted from the rodents. Today numerous rodent species are carrying hantaviruses throughout the world. These group of viruses can cause one of two types of viral hemorrhagic fever (VHF) in human beings namely hemorrhagic fever with renal syndrome (HFRS), and hantavirus pulmonary syndrome (HPS). In the spring of 1993, an unknown group of hantaviruses emerged in the United States as the cause of an acute respiratory disease currently termed as Hantavirus pulmonary symdrome (HPS), also referred to as hantavirus cardiopulmonary syndrome (HCPS). HPS is characterized by an acute onset of headache, fever, hypovolemic hypotension, myalgia and respiratory failure. This review covers the distribution, virology, epidemiology, pathophysiology, symptoms, treatment and prevention of hantavirus causing HPS/HCPS.

Serologic surve on hantavirus in blood donors from the state of santa Catarina, Braiil / Inquérito sorológico para hantavírus em doadores de sangue no Estado de Santa Catarina, Brasil

Emergent diseases such as Hantavirus Cardio-pulmonary Syndrome (HCPS) are able to create a significant impact on human populations due to their seriousness and high fatality rate. Santa Catarina, located in the South of Brazil, is the leading state for HCPS with 267 reported cases from 1999 to 2011. We present here a serological survey on hantavirus in blood donors from different cities of the state of Santa Catarina, with an IgG-ELISA using a recombinant nucleocapsid protein from Araraquara hantavirus as an antigen. In total, 314 donors from blood banks participated in the study, geographically covering the whole state. Among these, 14 individuals (4.4%) had antibodies to hantavirus: four of 50 (8% positivity) from Blumenau, four of 52 (7.6%) from Joinville, three of 50 (6%) from Florianópolis, two of 50 (4%) from Chapecó and one of 35 (2.8%) from Joaçaba. It is possible that hantaviruses are circulating across almost the whole state, with important epidemiological implications. Considering that the seropositive blood donors are healthy individuals, it is possible that hantaviruses may be causing unrecognized infections, which are either asymptomatic or clinically nonspecific, in addition to HCPS. It is also possible that more than one hantavirus type could be circulating in this region, causing mostly benign infections.

Doenças emergentes como a Síndrome Cárdio-Pulmonar por Hantavírus (SCPH) são capazes de promover um grande impacto nas populações humanas devido a sua severidade e alta letalidade. Santa Catarina, localizada ao Sul do Brasil, é o estado com o maior número de relatos de SCPH, com 267 casos desde 1999 a 2011. Apresentamos aqui um inquérito sorológico para hantavírus em doadores de sangue de diferentes cidades do Estado de Santa Catarina, usando um teste IgG-ELISA com proteína recombinante de nucleocapsídeo do hantavírus Araraquara como antígeno. No total, 314 doadores de banco de sangue participaram do estudo, cobrindo geograficamente todo o Estado. Dentre estes, 14 indivíduos (4,4%) apresentaram anticorpos para hantavírus: quatro de 50 (8% de positividade) provenientes de Blumenau, quatro de 52 (7,6%) de Joinville, três de 50 (6%) de Florianópolis, dois de 50 (4%) de Chapecó e um de 35 (2,8%) de Joaçaba. É possível que hantavírus estejam circulando praticamente em todo o Estado, com implicações epidemiológicas importantes. Considerando que os doadores de sangue soropositivos são indivíduos saudáveis, é possível que hantavírus possam estar causando infecções não diagnosticadas, sejam elas assintomáticas ou clinicamente inespecíficas, além da SCPH. É possível ainda que mais de um tipo de hantavírus possa estar circulando na região, causando infecções mais benignas.

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.

Síndrome pulmonar por Hantavirus (Virus Río Mamoré) en la Amazonía Peruana / Hantavirus pulmonary syndrome (Rio Mamore Virus) in the Peruvian Amazon region

La hantavirosis es una infección viral zoonótica transmitida por roedores cuya forma clínica más letal es el síndrome pulmonar por Hantavirus (SPH). La variante río Mamoré es autóctona de Sudamérica y fue descrita en roedores sin asociarla a enfermedad en humanos. Se presenta dos casos de SPH causados por hantavirus río Mamoré en la Amazonía peruana en noviembre de 2011. En ambos casos, el diagnóstico confirmatorio fue molecular, efectuados en el Instituto Nacional de Salud de Perú. Se realizó análisis filogenético del fragmento de genoma viral y la evaluación histopatológica. Ambos pacientes evolucionaron a síndrome de distrés respiratorio del adulto y estado de choque refractario. Un paciente falleció y el otro se recuperó a los doce días.

Hantavirus infection is a viral zoonotic infection borne by rodents which most letal form clinical is the Hantavirus Pulmonary Syndrome (SPH, Spanish abbreviation). The Mamore River variant originates in South America and was found in rodents without any association to human diseases. Two cases of SPH were identified in the Peruvian Amazon region in November 2011. In both cases, a molecular diagnostic testing was conducted by the Instituto Nacional de Salud from Peru. A phylogenetic analysis of a viral genome fragment and a histopathological evaluation were conducted. Both patients developed adult respiratory distress syndrome and refractory shock. A patient died and another one recovered 12 days later.

Prevalence of serum antibodies to hantavirus in a rural population from the southern state of Santa Catarina, Brazil / Prevalência de anticorpos séricos para hantavírus em população rural do extremo sul do estado de Santa Catarina, Brasil

INTRODUCTION: Rodent-borne hantaviruses cause severe human diseases. We completed a serological survey of hantavirus infection in rural inhabitants of Turvo County, in the southern State of Santa Catarina, Brazil, in which seropositivity for hantavirus was correlated to previous disease in the participants. METHODS: The levels of IgG antibodies to hantavirus Araraquara in the sera of 257 individuals were determined using an immunoenzymatic assay. RESULTS: IgG antibodies to hantavirus were found in 2.3 percent of the participants. All seropositive participants reported previous disease with symptoms suggestive of hantavirus cardiopulmonary syndrome. CONCLUSIONS: Human infections causing unreported cardiopulmonary syndrome probably occur in the southern State of Santa Catarina.

INTRODUÇÃO: Hantaviroses são zoonoses de roedores silvestres que causam doenças graves em seres humanos. Este trabalho mostra inquérito sorológico para hantavírus em população rural e periurbana do município de Turvo, Estado de Santa Catarina e a correlação da presença de anticorpos anti-hantavírus com a história mórbida pregressa dos indivíduos. MÉTODOS: Investigaram-se os 257 participantes do estudo quanto à presença de anticorpos IgG séricos anti-hantavírus Araraquara, por método imunoenzimático. RESULTADOS: A prevalência de anticorpos anti-hantavírus na população foi de 2,3 por cento. Os soropositivos possuíam antecedente nosológico sugestivo de hantavirose pregressa. CONCLUSÕES: Os achados mostram a ocorrência de infecções por hantavírus no extremo sul de Santa Catarina.

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.

Hemorrhagic fever with renal syndrome and coexisting hantavirus pulmonary syndrome

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease with fever, hemorrhage and renal failure caused by hantavirus infection. Hantavirus induces HFRS or hantavirus pulmonary syndrome (HPS). HPS progression to a life-threatening pulmonary disease is found primarily in the USA and very rarely in South Korea. Here, we report a case of HFRS and coexisting HPS.

Hantavirus pulmonary syndrome coexistent with dengue.

Dengue is an arthropod-borne disease caused by viruses of Flaviviridae family. It poses a major public health burden in tropical and sub-tropical regions. Clinical features of dengue vary from a mild flu-like disease and rash, to a potentially lethal haemorrhagic fever or shock syndrome. Hantavirus pulmonary syndrome is a rodent-born disease emerging in the American continent and is caused by viruses of the Bunyaviridae family. Potential reservoirs of these agents were described in Brazilian Central Plateau. Dengue infection is transmitted by mosquitoes, while hantaviruses are acquired by contact or inhalation of aerosolised excreta of infected rodents. Dengue and hantavirus infections have also been considered as emerging public health problems in some Indian areas; moreover, other infections mixed with dengue have been documented. The case of a Brazilian patient with hantavirus pulmonary syndrome and serologic evidence of dengue infection is described.