A Fatal Hantavirus Pulmonary Syndrome Misdiagnosed as Dengue: An Investigation into the First Reported Case in Rio de Janeiro State, Brazil

Abstract

We report the results of an investigation into a fatal case of hantavirus pulmonary syndrome (HPS) in Rio de Janeiro State, Brazil, where the disease had not been reported previous to 2015. Following the notification of an HPS case, serum samples were collected from the household members and work contacts of the HPS patient and tested for antibody to hantaviruses. Seroprevalence of 22% (10/45) was indicated for hantavirus out of 45 human samples tested. Blood and tissue samples were collected from 72 rodents during fieldwork to evaluate the prevalence of hantavirus infection, by using enzyme-linked immunosorbent assay IgG, and to characterize the rodent hantavirus reservoir(s), by reverse transcription polymerase chain reaction and sequencing. Antibody prevalence was 6.9%. The circulation of a single genotype, the Juquitiba hantavirus, carried by two rodent species, black-footed pigmy rice rat () and cursor grass mouse (), was shown by analysis of the nucleotide sequences of the S segment. Juquitiba hantavirus circulates in rodents of various species, but mainly in the black-footed pigmy rice rat. HPS is a newly recognized clinical entity in Rio de Janeiro State and should be considered in patients with febrile illness and acute respiratory distress.

Rodent-borne viruses survey in rural settlers from Central Brazil

“… 7 , 8 , 15 Two hantaviruses have been detected in the state, Araraquara and Juquitiba virus in N. lasiurus and O. nigripis rodents, respectively. 16 The prevalence of anti-hantavirus IgG antibodies detected in this study is in accordance with prevalence found in different studies conducted in rural populations from Brazil (0.4% to 22.0%), 17 , 18 , 19 , 20 , 21 , 22 , 23 but is lower than the one found for Jataí municipality 3.9% (95% CI: 2.3-5.7). 24 According to Guzmán et al, 11 this difference could be explained by the lower sensitivity found in the serological testes using Maciel orthohantavirus when compared to those obtained using Araraquara orthohantavirus.…”

Malaria and Hantavirus Pulmonary Syndrome in Gold Mining in the Amazon Region, Brazil

“…The clinical manifestations of acute febrile diseases are nonspecific and may hinder diagnosis and clinical management, especially in relation to infectious diseases such as HPS and malaria that can often coexist in endemic areas, as well as dengue, chikungunya, zika, and leptospirosis, among others. Both malaria and HPS, in the prodromal phase, have fever, myalgia, malaise, headache, abdominal discomfort, chills, nausea, and vomiting as clinical manifestations, which reinforces the need to consider differential diagnosis in areas with eco-epidemiological conditions suitable for vector and rodent transmissions as in the mining areas of this study [26,29,39].…”

“…In HPS, hemoconcentration, leukocytosis, atypical lymphocytes and thrombocytopenia, and elevated serum levels of liver enzymes are generally observed [27,40,41,42,43]; laboratory findings are similar to those observed in malaria and dengue [44,45,46,47,48]. In relation to chest radiographs in HPS, frequently observed findings include bilateral diffuse interstitial infiltrates, pulmonary edema, and pleural effusion during the cardiorespiratory phase [29,49]. Respiratory involvements in malaria are rare, but well-documented; they can be confused, however, with the severe phase of HPS [31,32,34,35].…”

“…It is noteworthy that the characteristic signs and symptoms of the prodromal phase of HPS are nonspecific, including fever, myalgia, malaise, headache, chills, nausea, and vomiting; thus, the differential diagnosis method is essential to distinguish HPS from other diseases that have similar initial characteristics [26,27,28,29,30]. In fact, although infrequent, the appearance of respiratory complications related to malaria can simulate HPS in the cardiopulmonary stage when the patient has dry cough, accompanied by tachycardia, dyspnea, and hypoxemia, followed by rapid progression to pulmonary edema, hypotension, and circulatory collapse [29,31,32,33,34,35].…”

PathogenicLeptospiraspecies are widely disseminated among small mammals in Atlantic Forest biome

“…in Didelphis aurita (Lopes, Menna-Barreto, Pavan, Pereira, & Roque, 2018) and in Trinomys sp. (Trüeb et al, 2018); Hantavirus (Juquitiba viral genotype) in Akodon cursor and Oligoryzomys nigripes (De Oliveira et al, 2017); and Toxoplasma gondii in Akodon spp., O. nigripes and D. aurita (Gennari et al, 2015), their role in the maintenance and shedding of leptospires remains to be elucidated. Some serosurveys for detecting Leptospira spp.…”