Vigilancia de fiebre hemorrágica argentina: FHA / Argentine hemorrhagic fever surveillance

Características generales de la Fiebre Hemorrágica Argentina (FHA): Transmisión, presentación clínica, definición de caso sospechoso, tratamiento, medidas de prevención, y situación regional. Se describe el caso confirmado en la Ciudad de Buenos Aires.

[Bolivian hemorrhagic fever].

Analysis of data of the available literature on epidemiology of Bolivian hemorrhagic fever, manifestations of human disease, biological properties of the causative agent and development carried out abroad of means and methods of diagnostics, prophylaxis and therapy of this infection that presents a potential threat for the population and economy of the Russian Federation in case of introduction of the causative agent is presented.

Junín virus. A XXI century update.

Junín virus of the Arenaviridae family is the etiological agent of Argentine hemorrhagic fever, a febrile syndrome causing hematological and neurological symptoms. We review historical perspectives of current knowledge on the disease, and update information related to the virion and its potential pathogenic mechanisms.

Genetic diversity of the Junin virus in Argentina: geographic and temporal patterns.

RNA was purified from 39 strains of cell-cultured Junin virus (JUN) from central Argentina, which included both human- and rodent-derived isolates (a total of 26 and 13, respectively), as well as from 2 laboratory JUN strains, XJ Cl3 and XJ #44. JUN-specific primers were used to amplify a 511-nucleotide (nt) fragment of the nucleocapsid protein gene and a 495-nt fragment of the glycoprotein 1 (GP1) gene. Genetic diversity among JUN strains studied was up to 13% at the nt level and up to 9% at the amino acid (aa) level for the GP1 gene and up to 9% (nt) and 4% (aa) for the NP gene. Phylogenetic analyses of both genes revealed three distinct clades. The first clade was composed of the JUN strains from the center of the endemic area and included the majority of JUN strains analyzed in the current study. The second clade contained 4 JUN strains isolated between 1963 and 1971 from Cordoba Province, the western-most edge of the known endemic area. The third clade contained 4 JUN strains that originated from Calomys musculinus trapped in Zarate, the northeastern edge of the known endemic area. Certain JUN sequences, which were obtained from GenBank and identified as XJ, XJ #44, and Candid #1 strains, appeared to form a separate clade. Over 400 nt of the GP1 and GP2 genes were additionally sequenced for 7 JUN strains derived from patients with different clinical presentations and outcomes of Argentine hemorrhagic fever. Analysis of the corresponding aa sequences did not allow us to attribute any particular genetic marker to the changing severity or clinical form of the human disease.

Experimental infection of the cane mouse Zygodontomys brevicauda (family Muridae) with guanarito virus (Arenaviridae), the etiologic agent of Venezuelan hemorrhagic fever.

Chronic infections in specific rodents appear to be crucial to the long-term persistence of arenaviruses in nature. The cane mouse, Zygodontomys brevicauda, is a natural host of Guanarito virus (family Arenaviridae), the etiologic agent of Venezuelan hemorrhagic fever. The purpose of this study was to elucidate the natural history of Guanarito virus infection in Z. brevicauda. Thirty-nine laboratory-reared cane mice each were inoculated subcutaneously with 3.0 log10 plaque-forming units of the Guanarito virus prototype strain INH-95551. No lethality was associated with infection in any animal, regardless of age at inoculation. The 13 newborn, 14 weanling, and 8 of the 12 adult animals developed chronic viremic infections characterized by persistent shedding of infectious virus in oropharyngeal secretions and urine. These findings indicate that Guanarito virus infection in Z. brevicauda can be chronic and thus support the concept that this rodent species is the natural reservoir of Guanarito virus.

Treatment of Bolivian hemorrhagic fever with intravenous ribavirin.

Bolivian hemorrhagic fever (BHF) is a potentially severe febrile illness caused by Machupo virus (family Arenaviridae). Initial symptoms include headache, fever, arthralgia, and myalgia. In the later stages of this illness, patients may develop hemorrhagic manifestations including subconjunctival hemorrhage, epistaxis, hematemesis, melena, and hematuria, as well as neurological signs including tremor, seizures, and coma. During the BHF epidemics of the 1960s, convalescent-phase immune plasma from survivors of BHF was administered to selected patients infected with Machupo virus. However, there is currently a paucity of survivors of BHF who can donate immune plasma, and there is no active program for collection and storage of BHF immune plasma; therefore, we had the opportunity to offer intravenous ribavirin to two of three patients with this potentially life-threatening infection. One patient with laboratory-confirmed Machupo virus infection who received ribavirin recovered without sequelae, as did a second patient with suspected BHF whose epidemiological and clinical features were similar to those of the first patient. This report describes the first use of intravenous ribavirin therapy for BHF in humans, and the results suggest the need for more extensive clinical studies to assess the usefulness of ribavirin for treating BHF.

Role of atrial natriuretic peptide in disturbed water and electrolyte metabolism of guinea pigs infected with Pichinde virus.

Daily intake and output of water and electrolytes (Na+, K+, and Cl-) were determined for 14 days in control and Pichinde virus-infected strain-13 guinea pigs. Although water intake began to decrease 7 days after virus inoculation, total daily water output (insensible water loss, urine excretion, plus fecal water loss) had little change. However, insensible water loss alone increased markedly in the virus-infected animals. Both intake and excretions of urinary and fecal electrolytes decreased at the middle (days 7 to 10) and late (days 11 to 14) stages of viral infection. Differences between intake and output of water and electrolytes were reduced significantly during these periods. To determine a possible relationship between atrial natriuretic peptide (ANP) and urinary Na+ and water excretion over intake, we measured plasma ANP concentrations. The mean control value of plasma ANP was 24 +/- 1.0 pg/ml, and plasma ANP concentrations of infected animals increased significantly (P < 0.01) to 49.5 +/- 3.9 and 51.3 +/- 8.8 pg/ml on postinoculation days 7 and 12. Because the overall physiologic responses to Pichinde virus infection are complicated, it is difficult to postulate a single central theme concerning the pathogenesis. Nevertheless, we hypothesize that the virus-induced invisible tissue "biochemical lesions" and the consequential release of mediators and hormones were possible causes of death. Among other pathophysiologic mechanisms, the increased plasma ANP concentration may have played a role in the development of disturbed water and electrolytes metabolism during Pichinde virus infection.

Persistent infection of mice with Pichinde virus associated with failure to thrive.

Intracranial inoculation of neonatal mice of certain inbred strains with Pichinde virus has been found to be fatal, but Balb/c neonates survive such infection. Survival of Balb/c mice after neonatal inoculation was not linked to the major histocompatability complex. Virus was gradually cleared in surviving Balb/c mice but could be detected in the brain and kidneys for up to 9 months after infection. These animals were not immunologically tolerant but exhibited high antibody titers to viral antigens. MHC restricted cytotoxic T cell activity was also demonstrable in persistently infected mice following challenge with high titered virus. Pathological changes consistent with glomerulonephritis were observed in the kidneys and surviving mice were runted compared to normals. This model differs from the widely studied persistent infection of mice with lymphocytic choriomeningitis virus (LCMV) and provides a unique model for the study of the genetics of resistance to viral infection, mechanisms of persistence and pathological processes in chronic viral infections.

Cardiovascular and pulmonary responses to Pichinde virus infection in strain 13 guinea pigs.

In fatal human Lassa fever, severe hypotension, circulatory shock, and pulmonary edema develop as terminal events. We examined cardiovascular and respiratory functions in strain 13 guinea pigs infected with Pichinde virus, an animal model for studying human Lassa fever. Cardiovascular functions were studied in anesthetized and conscious guinea pigs, whereas pulmonary functions were measured only on animals under anesthesia. In anesthetized animals, cardiovascular disturbances were severe and progressive from postinoculation day (PID) 10. Cardiac output, measured by thermodilution, decreased 28 to 53% below baseline values from PID 10 to 12 and was accompanied by a gradual reduction of mean arterial blood pressure and heart rate. Although left ventricular systolic pressure decreased significantly, the left ventricular +dp/dtmax and -dp/dtmax decreased only slightly on PID 12. Similar depressed cardiovascular responses were observed in conscious animals infected with Pichinde virus. Changes included decreased cardiac output, heart rate, cardiac work, cardiac power, and stroke volume, as well as increased total peripheral resistance and prolonged mean transit time. We postulate that a global cardiovascular dysfunction with the involvement of right and left sides of the heart may be the main cause of irreversible circulatory deterioration and death during Pichinde virus infection in strain 13 guinea pigs.

A triple staining procedure to evaluate phagocytic role of differentiated astrocytes.

To determine whether phagocytic activity is affected by a viral infection known to induce astrocyte differentiation, a triple procedure (PAP labeling for GFAP, PAS reaction for added baker's yeast cells and hematoxylin for nuclear staining of the whole monolayer) was applied to Junin virus-inoculated cultures, as well as matched controls. The three-step staining simplified yeast cell count for subsequent statistical analysis, which discerned preferential uptake by differentiated rather than immature astrocytes. Accordingly, greater cell maturation induced by Junin virus was concomitant with early enhancement of phagocytic activity.

Arenaviral haemorrhagic fevers.

Three arenaviruses--Lassa, Junin and Machupo--cause severe haemorrhagic disease in humans: Lassa fever, Argentine haemorrhagic fever and Bolivian haemorrhagic fever, respectively. These conditions are a source of considerable economic hardship in endemic areas and remain a worldwide concern for public-health officials. They are characterised by an insidious onset of influenza-like symptoms followed, in severe cases, by a generalised bleeding diathesis, encephalopathy and death. Central to studies of their pathogenesis is evidence for cellular dysfunction disproportionate to overt histopathology. Recent studies of patients with Lassa fever indicate that platelet and possibly endothelial-cell dysfunction play an important role in the bleeding tendency. The platelet defect appears to be mediated by an inhibitory factor in plasma; the nature of this is uncertain but it seems to be neither viral protein nor virus antibody. A similar inhibitor has since been demonstrated in patients with Argentine haemorrhagic fever. Plasma from patients with Lassa fever also profoundly modulates the amount of superoxide generated by normal neutrophils in response to the chemotactic peptide f-met-leu-phe, suggesting the inhibitor(s) has global effects on cellular function. These findings may have important implications for future therapeutic strategies.

Ribavirin effect on experimental Junin virus-induced encephalitis.

Junin virus, the etiological agent of Argentine hemorrhagic fever, produces in man a disease mainly characterized by hemorrhagic alterations, commonly accompanied by neurological symptoms, and leading to 10% mortality. Intracerebral inoculation in 10-day-old rats or intraperitoneal inoculation in 2-day-old rats leads to high mortality due to severe encephalitis. Here, the effect of Ribavirin on these experimental models was tested in order to evaluate the degree of protection achieved against neuropathological manifestations. In intracerebrally infected 10-day-old rats the drug was administered 2 hr before virus inoculation. Doses ranged from 30 to 90 mg/kg body weight. Protection reached 40% for the 60 and 90 mg doses. Intraperitoneally infected 2-day-old rats received the drug in five 30-mg daily doses, starting the same day as virus inoculation. Survival was 73%. Viral replication within peritoneal macrophages dropped markedly, leading to much lower CNS viral titres. Together with results reported in primates, our findings support further studies on Ribavirin, with a view to eventual trials in humans.

Experimental Argentine hemorrhagic fever: myocardial involvement in Cebus monkey.

Four Cebus apella monkeys, to test a recently proposed model for testing neurovirulence of Junín virus (JV) strains, were intracerebrally infected with 10(5) LD50 of the XJ clone 3 strain of JV. There were no significant electrocardiographic abnormalities or gross lesions, but all infected monkeys exhibited a varying degree of histologic myocardial lesions including focal lymphoblastic infiltrates, vascular ruptures, and mild interstitial reactive change. One Cebus showed lymphocytic infiltrates in the caudal portion of the A-V node without specific cell involvement. These preliminary results demonstrate cardiac involvement in experimental infection of the Cebus monkey with Junín virus.

[Infection of New World primates with Junín virus. IV. Aotus trivirgatus]. / Infección de primates del nuevo mundo con virus Junín. IV. Aotus trivirgatus.

Owl monkeys (Aotus trivirgatus) were inoculated with XJ, a pathogenic strain of Junin virus, seeking new animal models for Argentine Hemorrhagic Fever. Nine monkeys were inoculated intramuscularly with 30 or 300,000 TCID50 of junin virus. Hematological and virological studies showed no alteration in blood elements such as red cell, reticular cell and platelets, up to 28 days after inoculation. Hemoglobin and hematocrit determinations also remained constant. However, significant neutropenia was seen at day 11 and minimal viremia was detected in some animals during the second and third week post-inoculation. No clinical or behavioral modifications were observed during the eighty-days observation period. Non-specific necropsy findings included pyelonephritis, pneumonitis, liver abscess and eosinophilic spleen infiltrate. All of these findings seem to be unrelated to Junin virus inoculation. No virus was present in organs of animals killed 29, 57 or 85 days post-inoculation. All nine owl monkeys developed serum neutralizing antibodies by day 22. It is concluded that the owl monkey suffers a subclinical infection when inoculated with Junin virus, similar to that seen in other primate species (Saimiri sciureus and Alouatta caraya).

[Infection in rats by the intraperitoneal route with Junín virus]. / Infección en ratas por vía intraperitoneal con virus Junín.

The susceptibility of the rat, infected at various ages by intraperitoneal route with the XJ prototype strain of Junin virus was studied two day-old animals showed maximum mortality, being the most suitable dose 10(3) LD50. Antiviral humoral response at 35 days pi was tested in survivors of all ages. Highest neutralizing antibody titers were found in those infected up to 4 days of age. This host behaves quite differently when infected by intracerebral route with the same XJ strain.