Twenty years of hantavirus pulmonary syndrome in Brazil: a review of epidemiological and clinical aspects

Abstract

Hantavirus infection is transmitted to humans by wild rodents and the most common clinical form in Brazil is the Hantavirus Pulmonary Syndrome (HPS). The first serological evidence of the disease was identified in 1990, in Recife, Pernambuco State, and later in 1993 in Juquitiba, State of São Paulo. Since then there has been a progressive increase in case notification in all regions of the country. The clinical aspects of the disease in Brazil are characterized by a prodromal phase, with nonspecific signs and symptoms of an acute febrile illness. After about three days, respiratory distress develops, accompanied by dry cough that turns progressively productive, evolving to dyspnea and respiratory failure with cardiogenic shock. Although the majority of patients receive hospital care in intensive care therapy units, case-fatality rate in Brazil ranges from 33% to 100% depending on the region. Besides it has to be added the problem of differential diagnosis with other prevalent diseases in the country, like dengue and leptospirosis. Questions about the impact of uncontrolled urbanization and other environmental changes caused by human action have been raised. Due to increasing incidence and high case-fatality, there is an urge to respond to such questions to recommend preventative measures. This article aims to review the main acquisitions in clinical and epidemiological knowledge about HPS in Brazil in the last twenty years.

Serological evidence of hantavirus infection in an urban area in Mato Grosso State, Brazil

“…Therefore, it is possible that they had contact with the natural reservoirs of the hantavirus. In fact, deforestation promotes rodent proliferation, especially those prone to anthropogenic change, such as the rodents belonging to Sigmodontinae, thus driving them to invade human dwellings (14) (15) .Humans are typically infected via contaminated aerosolized secretions (feces, urine, and saliva) of the reservoir animals. Considering that 47.4% of the seropositive participants were housewives, primarily responsible for household tasks, it is possible that the practice of activities that allow the dispersion of aerosols or dust, such as cleaning in the domestic environment, has been the main form of contamination for these women.…”

Conocimientos Y Prácticas Asociadas a Transmisión De Triquinelosis, Hanta Y Equinococosis Quística

“…La población valora más ventilar los lugares que han estado deshabitados que el cubrir la vía aérea, quedando igualmente expuestos al ingreso del virus por esta vía. Destaca que la población subestima el riesgo de contagio por ser residentes de zonas rurales, contrario a los reportes de Pinto et al (24) , en donde la población percibía que vivir en el área rural era un factor de riesgo de contagio. Si hay factores protectores como reconocer a los depredadores y mantener el entorno limpio y desmalezado, se favorece el control del reservorio.…”

“…La transmisión ocurre por inhalación de partículas víricas que han quedado expuestas a partir de orina, fecas y saliva de roedores reservorios (23) . Las zonas agrícolas, rurales y de deforestación son las de mayor riesgo de exposición (24) . La alteración del entorno y densa vegetación o ingreso a viviendas y galpones en mal estado favorecen el contagio y los grupos más expuestos son los trabajadores agrícolas (25) .…”

Methylprednisolone-Responsive Leptospiral Acute Pulmonary Syndrome

“…Significant pulmonary changes as well as low platelet counts can pose other concerns about diagnostic pitfalls with Hantavirus and dengue Santos infections, especially in developing countries. [2][3][4][5] Since the first reports in North American Indians, the possibility of mistakes involving the acute pulmonary syndrome caused by leptospirosis and HPS was commented in Brazilian Journals. 4 Brazilian authors described a 19-year-old man with the diagnosis of anicteric leptospirosis, who had a productive cough without hemoptysis, reduced lung sounds on the right lower third of the thorax, and normal kidney function.…”