title: Hantavirus pulmonary syndrome in a highly endemic area of Brazil.
abstract: Hantavirus pulmonary syndrome (HPS) is the most frequently reported fatal rodent-borne disease in Brazil, with the majority of cases occurring in Santa Catarina. We analysed the clinical, laboratory and epidemiological data of the 251 confirmed cases of HPS in Santa Catarina in 1999-2011. The number of cases ranged from 10 to 47 per year, with the highest incidences in 2004-2006. Gastrointestinal tract manifestations were found in >60% of the cases, potentially confounding diagnosis and leading to inappropriate therapy. Dyspnoea, acute respiratory failure, renal failure, increased serum creatinine and urea levels, increased haematocrits and the presence of pulmonary interstitial infiltrate were significantly more common in HPS patients who died. In addition, we demonstrated that the six cases from the midwest region of the state were associated with Juquitiba virus genotype. The case-fatality rate in this region, 19·2%, was lower than that recorded for other mesoregions. In the multivariate analysis increase of serum creatinine and urea was associated with death by HPS. Our findings help elucidate the epidemiology of HPS in Brazil, where mast seeding of bamboo can trigger rodent population eruptions and subsequent human HPS outbreaks. We also emphasize the need for molecular confirmation of the hantavirus genotype of human cases for a better understanding of the mortality-related factors associated with HPS cases in Brazil.
authors.affiliation: Laboratório de Hantaviroses e Rickettsioses,Instituto Oswaldo Cruz,Fiocruz,Rio de Janeiro,Rio de Janeiro,Brazil.
authors.forename: R C
authors.initials: RC
authors.lastname: Oliveira
authors.affiliation: Secretaria de Saúde do Estado de Santa Catarina,Setor de Vigilância Epidemiológica,Florianópolis,Santa Catarina,Brazil.
authors.forename: M M
authors.initials: MM
authors.lastname: Sant'ana
authors.affiliation: Laboratório de Hantaviroses e Rickettsioses,Instituto Oswaldo Cruz,Fiocruz,Rio de Janeiro,Rio de Janeiro,Brazil.
authors.forename: A
authors.initials: A
authors.lastname: Guterres
authors.affiliation: Laboratório de Hantaviroses e Rickettsioses,Instituto Oswaldo Cruz,Fiocruz,Rio de Janeiro,Rio de Janeiro,Brazil.
authors.forename: J
authors.initials: J
authors.lastname: Fernandes
authors.affiliation: Secretaria Municipal de Saúde,Setor de Vigilância Epidemiológica,Concórdia,Santa Catarina,Brazil.
authors.forename: N L F K
authors.initials: NL
authors.lastname: Hillesheim
authors.affiliation: Secretaria Municipal de Saúde,Setor de Vigilância Epidemiológica,Joaçaba,Santa Catarina,Brazil.
authors.forename: C
authors.initials: C
authors.lastname: Lucini
authors.affiliation: Laboratório de Hantaviroses e Rickettsioses,Instituto Oswaldo Cruz,Fiocruz,Rio de Janeiro,Rio de Janeiro,Brazil.
authors.forename: R
authors.initials: R
authors.lastname: Gomes
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas,Fiocruz,Rio de Janeiro,RJ,Brazil.
authors.forename: C
authors.initials: C
authors.lastname: Lamas
authors.affiliation: Laboratório de Informação Científica e Tecnológica em Saúde,Instituto de Comunicação e Informação Científica e Tecnológica em Saúde,Fiocruz,Rio de Janeiro,RJ,Brazil.
authors.forename: R
authors.initials: R
authors.lastname: Bochner
authors.affiliation: Secretaria de Saúde do Estado de Santa Catarina,Setor de Vigilância Epidemiológica,Florianópolis,Santa Catarina,Brazil.
authors.forename: S
authors.initials: S
authors.lastname: Zeccer
authors.affiliation: Laboratório de Hantaviroses e Rickettsioses,Instituto Oswaldo Cruz,Fiocruz,Rio de Janeiro,Rio de Janeiro,Brazil.
authors.forename: E R S
authors.initials: ER
authors.lastname: DE Lemos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004197:Disease Reservoirs / Q000662:veterinary*; D005260:Female; D006476:Orthohantavirus / Q000235:genetics / Q000502:physiology*; D018804:Hantavirus Pulmonary Syndrome / Q000453:epidemiology* / Q000662:veterinary / Q000821:virology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D012189:Retrospective Studies; D012376:Rodent Diseases / Q000453:epidemiology / Q000821:virology; D012377:Rodentia; D017422:Sequence Analysis, DNA; D014764:Viral Proteins / Q000235:genetics / Q000378:metabolism; D055815:Young Adult
chemical_list: D014764:Viral Proteins
keywords: Brazil; case series; hantavirus pulmonary syndrome