RESUMO
Hantaviruses, members of the Bunyaviridae family, can cause two patterns of disease in humans, hantavirus hemorrhagic fever with renal syndrome (HFRS) and cardiopulmonary syndrome (HCPS), being the latter hegemonic on the American continent. Andesvirus is one of the strains that can cause HCPS and is endemic in Chile. Its transmission occurs through direct or indirect contact with infected rodents' urine, saliva, or feces and inhalation of aerosol particles containing the virus. HCPS rapidly evolves into acute but reversible multiorgan dysfunction. The hemodynamic pattern of HCPS is not identical to that of cardiogenic or septic shock, being characterized by hypovolemia, systolic dysfunction, and pulmonary edema secondary to increased permeability. Given the lack of specific effective therapies to treat this viral infection, the focus of treatment lies in the timely provision of intensive care, specifically hemodynamic and respiratory support, which often requires veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This narrative review aims to provide insights into specific ICU management of HCPS based on the available evidence and gathered experience in Chile and South America including perspectives of pathophysiology, organ dysfunction kinetics, timely life support provision, safe patient transportation, and key challenges for the future.
Assuntos
Cuidados Críticos , Síndrome Pulmonar por Hantavirus , Humanos , Cuidados Críticos/métodos , Síndrome Pulmonar por Hantavirus/terapia , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/fisiopatologia , Síndrome Pulmonar por Hantavirus/epidemiologia , Oxigenação por Membrana Extracorpórea/métodos , Chile/epidemiologia , Orthohantavírus/fisiologiaRESUMO
BACKGROUND: We report hereby a severe case of Hantavirus Pulmonary Syndrome" (HPS) induced by Maripa virus in French Guiana and describe the mechanism of severity of the human disease. CASE PRESENTATION: A 47-year- old patient started presenting a prodromic period with fever, dyspnea, cough and head ache. This clinical presentation was followed by a rapid respiratory, hemodynamic and renal failure leading to admission in the ICU. Biological exams revealed an increased haematocrit level with a paradoxical low protein level. Echocardiographic and hemodynamic monitoring showed a normal left ventricular function with low filling pressures, an elevated extravascular lung water index and pulmonary vascular permeability index. These findings were compatible with a capillary leak-syndrome (CLS). CONCLUSIONS: The severity of HPS caused by the virus Maripa in French Guiana can be explained by the tropism of hantavirus for the microvascular endothelial cell leading to a CLS.
Assuntos
Síndrome de Vazamento Capilar/etiologia , Síndrome de Vazamento Capilar/fisiopatologia , Síndrome Pulmonar por Hantavirus/complicações , Síndrome Pulmonar por Hantavirus/fisiopatologia , Orthohantavírus/patogenicidade , Síndrome de Vazamento Capilar/diagnóstico , Guiana Francesa , Orthohantavírus/isolamento & purificação , Síndrome Pulmonar por Hantavirus/diagnóstico , Humanos , Pessoa de Meia-IdadeRESUMO
Andes virus (ANDV) is the etiological agent of hantavirus cardiopulmonary syndrome in Chile. In this study, we evaluated the profile of the pro-inflammatory cytokines IL-1ß, IL-12p70, IL-21, TNF-α, IFN-γ, IL-10 and IL-6 in serum samples of ANDV-infected patients at the time of hospitalization. The mean levels of circulating cytokines were determined by a Bead-Based Multiplex assay coupled with Luminex detection technology, in order to compare 43 serum samples of healthy controls and 43 samples of ANDV-infected patients that had been categorized according to the severity of disease. When compared to the controls, no significant differences in IL-1ß concentration were observed in ANDV-infected patients (p = 0.9672), whereas levels of IL-12p70 and IL-21 were significantly lower in infected cases (p = <0.0001). Significantly elevated levels of TNF-α, IFN-γ, IL-10, and IL-6 were detected in ANDV-infected individuals (p = <0.0001, 0.0036, <0.0001, <0.0001, respectively). Notably, IL-6 levels were significantly higher (40-fold) in the 22 patients with severe symptoms compared to the 21 individuals with mild symptoms (p = <0.0001). Using multivariate regression models, we show that IL-6 levels has a crude OR of 14.4 (CI: 3.3-63.1). In conclusion, the serum level of IL-6 is a significant predictor of the severity of the clinical outcome of ANDV-induced disease.
Assuntos
Progressão da Doença , Síndrome Pulmonar por Hantavirus/sangue , Síndrome Pulmonar por Hantavirus/epidemiologia , Interleucina-6/sangue , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Pré-Escolar , Chile/epidemiologia , Citocinas/sangue , Feminino , Orthohantavírus , Síndrome Pulmonar por Hantavirus/fisiopatologia , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Adulto JovemRESUMO
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.
Assuntos
Síndrome Pulmonar por Hantavirus/terapia , Hemofiltração/métodos , Respiração Artificial/métodos , Adulto , Feminino , Síndrome Pulmonar por Hantavirus/fisiopatologia , Humanos , Resultado do TratamentoRESUMO
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.
Assuntos
Humanos , Feminino , Adulto , Respiração Artificial/métodos , Hemofiltração/métodos , Síndrome Pulmonar por Hantavirus/terapia , Resultado do Tratamento , Síndrome Pulmonar por Hantavirus/fisiopatologiaRESUMO
Hantavirus (Bunyaviridae) cardiopulmonary syndrome (HCPS) is an emerging health problem in South America due to urban growth and to the expansion of agriculture and cattle-raising areas into ecosystems containing most of the species of Sigmodontinae rodents that act as hantavirus reservoirs. About 4000 HCPS cases have been reported in South America up to 2013, associated with the following hantaviruses: Andes, Anajatuba, Araraquara (ARQV), Paranoá, Bermejo, Castelo dos Sonhos, Juquitiba, Araucária, Laguna Negra, Lechiguanas, Maripa, Oran, Rio Mamore and Tunari. The transmission of hantavirus to man occurs by contact with or through aerosols of excreta and secretions of infected rodents. Person-to-person transmission of hantavirus has also been reported in Argentina and Chile. HCPS courses with a capillary leaking syndrome produced by the hantavirus infecting lung endothelial cells and mostly with a severe inflammatory process associated with a cytokine storm. HCPS starts as a dengue-like acute febrile illness but after about 3 days progresses to respiratory failure and cardiogenic shock, leading to a high fatality rate that reaches 50% for patients infected with ARQV.
Assuntos
Reservatórios de Doenças , Síndrome Pulmonar por Hantavirus/epidemiologia , Orthohantavírus/patogenicidade , Doenças dos Roedores/epidemiologia , Sigmodontinae/virologia , Animais , Orthohantavírus/classificação , Orthohantavírus/fisiologia , Síndrome Pulmonar por Hantavirus/mortalidade , Síndrome Pulmonar por Hantavirus/fisiopatologia , Síndrome Pulmonar por Hantavirus/transmissão , Coração/fisiopatologia , Coração/virologia , Humanos , Pulmão/fisiopatologia , Pulmão/ultraestrutura , Pulmão/virologia , Filogenia , Doenças dos Roedores/transmissão , América do Sul/epidemiologia , Análise de SobrevidaRESUMO
Hantavirus pulmonary syndrome (HPS) was described for the first time in Brazil in 1993 and has occurred endemically throughout the country. This study analysed clinical and laboratory aspects as well as death-related factors for HPS cases in Brazil from 1993 to 2006. The investigation comprised a descriptive and exploratory study of the history of cases as well as an analytical retrospective cohort survey to identify prognostic factors for death due to HPS. A total of 855 Brazilian HPS cases were assessed. The majority of cases occurred during spring (33.5%) and winter (27.6%), mainly among young male adults working in rural areas. The global case fatality rate was 39.3%. The mean interval between the onset of symptoms and hospitalisation was 4 days and that between hospitalisation and death was 1 day. In the multiple regression analysis, adult respiratory distress syndrome and mechanical respiratory support were associated with risk of death; when these two variables were excluded from the model, dyspnoea and haemoconcentration were associated with a higher risk of death.
Assuntos
Dispneia/mortalidade , Síndrome Pulmonar por Hantavirus/mortalidade , Hospitalização/estatística & dados numéricos , Orthohantavírus/patogenicidade , Respiração Artificial , Adulto , Brasil/epidemiologia , Estudos de Coortes , Dispneia/fisiopatologia , Feminino , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/fisiopatologia , Humanos , Masculino , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
Features of hantavirus pulmonary syndrome are considered in the review - zoonosis natural focal polyetiological viral infection, that is characterized by lung injury. Etiology of the disease, main characteristics of the agents, epidemiology, contagiousness, pathogenesis, clinical presentation of this pathology are examined. Laboratory diagnostics, therapy and prophylaxis ofhantavirus pulmonary syndrome are described.
Assuntos
Reservatórios de Doenças/veterinária , Síndrome Pulmonar por Hantavirus/fisiopatologia , Lesão Pulmonar/virologia , Orthohantavírus/genética , Doenças dos Roedores/virologia , Zoonoses/virologia , Animais , Antivirais/administração & dosagem , Reservatórios de Doenças/virologia , Orthohantavírus/classificação , Orthohantavírus/isolamento & purificação , Orthohantavírus/patogenicidade , Síndrome Pulmonar por Hantavirus/complicações , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/mortalidade , Síndrome Pulmonar por Hantavirus/prevenção & controle , Síndrome Pulmonar por Hantavirus/terapia , Síndrome Pulmonar por Hantavirus/transmissão , Humanos , Imuno-Histoquímica , Incidência , Lesão Pulmonar/etiologia , Lesão Pulmonar/fisiopatologia , América do Norte/epidemiologia , Reação em Cadeia da Polimerase , Doenças dos Roedores/epidemiologia , Doenças dos Roedores/transmissão , Roedores , América do Sul/epidemiologia , Taxa de Sobrevida , Zoonoses/epidemiologia , Zoonoses/transmissãoRESUMO
Hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome (HPS) are rodent-borne emerging diseases caused by members of the genus Hantavirus, family Bunyaviridae. Some species of hantavirus may cause encephalitis, but this is the first report in Andes virus associated to HPS.
Assuntos
Encefalite/fisiopatologia , Síndrome Pulmonar por Hantavirus/fisiopatologia , Orthohantavírus/isolamento & purificação , Animais , Argentina , Encefalite/etiologia , Encefalite/virologia , Orthohantavírus/patogenicidade , Síndrome Pulmonar por Hantavirus/complicações , Síndrome Pulmonar por Hantavirus/virologia , Humanos , Masculino , Doenças dos Roedores/transmissão , Doenças dos Roedores/virologia , Roedores/virologiaRESUMO
El Hantavirus es un patógeno de aparición relativamente nueva. El año 1996 fue publicado el primer en Chile y un año antes se habla establecido el primer diagnostico de síndrome cardiopulmonar (SCPH) en nuestro país. En Chile el tipo de Hantavirus es el Andes cuyo reservorio es el ratón de cola larga (Oligoryzomys longicaudatus). Se puede presentar como infección inaparente, como una enfermedad leve por Hantavirus o como su expresión más grave que es el SCPH. En general se manifiesta como un cuadro rápidamente progresivo, que tiene 3 etapas, la prodrómica, la cardiopulmonar y la de convalecencia. Comienza como si fuera un cuadro gripal, con fiebre y mialgias o como un cuadro gastrointestinal, seguido por aparición súbita de insuficiencia respiratoria con o sin aparición de inestabilidad hemodinámica que puede progresar en algunos casos hasta edema agudo de pulmón, shock y muerte. En Chile se han confirmado casos de SCPH desde la ciudad de Valparaíso hasta Aysén, siendo esta última la de mayor incidencia en el país. A la fecha, durante el 2010 se han confirmado 30 casos. La letalidad alcanza a un 33 por ciento El objetivo de este trabajo es comunicar un caso de SCPH de rápida regresión y revisar la literatura respecto al tema.