Clinical and anatomopathological aspects of patients with hantavirus cardiopulmonary syndrome in Uberaba, Minas Gerais, Brazil

Abstract

The hantavirus cardiopulmonary syndrome is considered an emerging disease in the Americas. Since 1993, thousands of cases have been reported from different countries, but mainly from Brazil. This study aims to describe some epidemiological, clinical and anatomopathological aspects of patients with hantavirus who presented poor outcome and were autopsied in a teaching hospital in Brazil, from 2000 to 2014. Of the 10 patients included, nine were male (mean age 43.5 years) and seven reported previous contact with rodents. Fever was present in eight of ten patients, dyspnea in nine of ten and myalgia in seven of ten patients; hemoconcentration, leukocytosis, thrombocytopenia and renal involvement were evidenced in all the 10 cases. At autopsy, the main alterations were seen in the lungs: pleural effusion (8/10 cases), increased weight 2.5 to 3 times, congestion/edema (10/10), interstitial mononuclear inflammation (10/10), alveolar hemorrhage (7/10), pulmonary collapse (7/10), hyaline membranes (7/10) and alveolar neutrophilic infiltrate (2/10). Pericardial effusion (2/10), mild myocardium inflammation (4/10), right ventricle dilation (1/10), polyploidy nuclei (3/10) and pericardial diffuse petechial (1/10) were also observed. The other organs exhibited discrete and non-specific alterations. Currently, this syndrome continues to be associated with high mortality directly linked to a late diagnosis and/or a misdiagnosis in the medical centers where these patients were seen for the first time. The anatomopathological findings at autopsy revealed the final phase of the process with pulmonary alterations, allowing a direct correlation with the severity of respiratory distress observed in these patients at admission.

Doenças infecciosas: inovações e aprendizados para área médica

“…Após três a seis dias, o paciente evolui com edema pulmonar, desconforto respiratório e choque. Os que sobrevivem seguem com diurese e posteriormente entram no período de convalescença (SANTOS et al, 2019).…”

“…Terças-Trettel et al (2019) relataram que a sintomatologia mais comumente descrita abrangia febre (75%), dispneia (59,4), tosse (46,9%), cefaleia (43,7%) e dor abdominal (43,7%). Em consonância, Santos et al (2019) concluíram que febre (80%), dispneia (90%) e mialgia (70%) estiveram presentes na análise dos pacientes em estudo. Esta inespecificidade de sinais e sintomas pode gerar erros diagnósticos e tratamentos inadequados.…”

“…A paciente evoluiu para óbito devido à persistência de choque séptico refratário. Santos et al (2019) observaram, na necropsia, congestão e edema pulmonar (100%), hemorragia alveolar (70%) e colapso associado a derrame pleural maciço (70%).…”

Proteinuria in Hantavirus Cardiopulmonary Syndrome: A Frequent Finding Linked To Mortality

“…"New World" orthohantaviruses cause a different syndrome, affecting mainly lungs and heart. Renal involvement is less frequent, with tubular necrosis in the more severe cases (Santos JP et al, 2019). Increased lung permeability is a mayor finding, due, at least in part, to endothelial dysfunction (Maningold T et al, 2014;López et al, 2019).…”

The kidney in hantavirus infection—epidemiology, virology, pathophysiology, clinical presentation, diagnosis and management

“…A recent but small Brazilian autopsy study reported marked acute tubular necrosis. This notwithstanding, more pathological characterization of kidney phenotype in HCPS is needed [ 205 ]. Long-term kidney outcome in HCPS has been scarcely examined, mainly due to the low incidence and high mortality of the disease (Table 2 ).…”