Hantavirus Infection with Renal Failure and Proteinuria, Colorado, USA, 2019

Prevalence of orthohantavirus in rodents: A systematic review and meta-analysis

INTRODUCTION

Orthohantaviruses are zoonotic diseases transmitted mainly by rodents, particularly mice and rats, associated with multiple outbreaks in different continents. Despite its epidemiological relevance, there is a lack of systematic reviews and meta-analyses.

OBJECTIVE

To determine the combined global prevalence of Orthohantavirus infection in rodents.

METHODS

A systematic literature review was carried out in six databases (Web of Sciences, Scopus, PubMed, SciELO, Lilacs, Google Scholar) to evaluate the proportion of rodents infected with Orthohantavirus, defined by molecular and immunological techniques. The meta-analysis used a random effects model for the pooled prevalence and 95% confidence intervals (95%CI). Heterogeneity measures, Cochrane's Q, the I² index and the tau-squared test were estimated.

RESULTS

A total of 35,706 rodents (229 studies) were evaluated for ELISA, in which 3360 were found positive, for seroprevalence of 4.9% (95%CI 4.3-5.4%) (τ² = 0.001; Q = 4027.708; I² = 94.339%, p < 0.001). For PCR (N = 8812, 91 studies) it was 3.2% (95%CI 2.5-3.9%) (τ² = 0.001; Q = 397.483; I² = 77.358%; p < 0.001). For IFA (N = 555, 7 studies) it was 18.8% (95%CI 9.4-28.2%) (τ² = 0.011; Q = 51.239; I² = 88.29%, p < 0.001). At the genus level, the studies evaluated Oligoryzomys (8.98%), Reithrodontomys (8.98%), Peromyscus (8.20%), Rattus (8.20%), and Akodon (6.64%).

CONCLUSIONS

The global prevalence of Orthohantavirus is worrisome, with an increase in its report in certain regions, including Latin America. In this context, rodents have a role as reservoirs. The data of the present meta-analysis showed considerable seroprevalences with great variations by years, countries and Orthohantavirus species.

Speckle Noise Algorithm-Based Ultrasound Imaging in Evaluating the Therapeutic Effect of Blood Purification on Children with Kidney Failure and Analysis of Its Correlation with Serum Inflammatory Factor Levels

The study focused on the therapeutic effect of clinical treatment on urinary calculi with kidney failure and its relationship with the serum inflammatory factor levels. 90 children with melamine urinary calculi were selected as research subjects. Of them, 52 cases were in group 1 (nonrenal failure), and 38 cases were in group 2 (combined with renal failure). In addition, 35 hospitalized children with no history of melamine-contaminated milk feeding during the same period were used as healthy controls. They all underwent ultrasound imaging examination based on the speckle noise algorithm, and the prognosis was analyzed. It was found that the peak signal-to-noise ratio (PSNR), structural similarity (SSIM), and local edge preservation index (EPI) of the algorithm in this study were significantly greater than other algorithms (P < 0.05). The admission age of the children in group 1 was significantly younger than that of group 2, the bilateral stone rate was significantly higher than that in group 2, and the difference was statistically significant (P < 0.05). Of the 52 children in group 1, the stone disappeared in 25 cases after treatment, the stone was reduced in 20 cases, and the stone remained unchanged in 7 cases. The total effective rate of treatment was 88.46%. Of the 38 cases in group 2, the stone disappeared in 22 cases after treatment, the stone was reduced in 12 cases, and the stone remained unchanged in 4 cases. The total effective rate of treatment was 89.47%. No difference was noted in blood urea nitrogen (BUN), blood creatinine (Cr), TNF-α, and C-reactive protein (CRP) levels in group 1, group 2, and the healthy control group (P > 0.05). Hence, the denoising algorithm in this study has better denoising effects on ultrasound images than traditional algorithms, with higher definition and less noise and artifacts. The clinical treatment of children with urinary calculi and renal failure is highly effective, the renal function and serum inflammatory factor levels return to the normal range, and the inflammatory response is weakened.

OUP accepted manuscript

Hantavirus-induced diseases are emerging zoonoses with endemic appearances and frequent outbreaks in different parts of the world. In humans, hantaviral pathology is characterized by the disruption of the endothelial cell barrier followed by increased capillary permeability, thrombocytopenia due to platelet activation/depletion and an overactive immune response. Genetic vulnerability due to certain human leukocyte antigen haplotypes is associated with disease severity. Typically, two different hantavirus-caused clinical syndromes have been reported: hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). The primarily affected vascular beds differ in these two entities: renal medullary capillaries in HFRS caused by Old World hantaviruses and pulmonary capillaries in HCPS caused by New World hantaviruses. Disease severity in HFRS ranges from mild, e.g. Puumala virus-associated nephropathia epidemica, to moderate, e.g. Hantaan or Dobrava virus infections. HCPS leads to a severe acute respiratory distress syndrome with high mortality rates. Due to novel insights into organ tropism, hantavirus-associated pathophysiology and overlapping clinical features, HFRS and HCPS are believed to be interconnected syndromes frequently involving the kidneys. As there are no specific antiviral treatments or vaccines approved in Europe or the USA, only preventive measures and public awareness may minimize the risk of hantavirus infection. Treatment remains primarily supportive and, depending on disease severity, more invasive measures (e.g., renal replacement therapy, mechanical ventilation and extracorporeal membrane oxygenation) are needed.

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

OBJECTIVES

To determine the relative frequency and prognosis value of proteinuria in hantavirus cardiopulmonary syndrome (HCPS) due to Andes virus.

METHODS

This observational analytical study prospectively obtained data from patients admitted to 12 health centers in nine Chilean cities between 2001 and 2018. Only patients with confirmed Andes virus HCPS and laboratory characterization that included qualitative proteinuria determination at admission were considered.

RESULTS

The database involved 175 patients, 95 of them had a measurement of urine protein at the time of hospital admission. They were mainly male (71%) and the median age was 35 [22-47] years. Median duration of the febrile prodromal time was 5 [4-7] days. Hospital length of stay and hospital mortality rate were 10 [7-14] days and 21.1%, respectively. Seventy-three patients (77%) were identified with proteinuria at admission, which was associated with increased mortality rate (26% versus 5%, p=0.036) and the relative risk was 1.3 [1.1-1.6], p=0.002.

CONCLUSIONS

Proteinuria is a frequent finding in patients with HCPS, which is associated with a higher mortality rate.

Clinical features of fatal cases of Chapare virus hemorrhagic fever originating from rural La Paz, Bolivia, 2019: A cluster analysis

INTRODUCTION

In 2003 an emerging mammarenavirus (formerly arenaviruses) was discovered in Bolivia and named Chapare (CHAPV). It was associated with severe and fatal hemorrhagic fever, being similar in clinical features to Machupo (MACV). In mid-2019, CHAPV was the cause of a cluster of five cases, two of them laboratory confirmed, three of them fatal. Here, we report the main clinical findings, epidemiological features and the potential ecological aspects, of that cluster of cases in rural La Paz, Bolivia.

METHODS

For this observational, retrospective and cross-sectional study, information was obtained from the Hospitals and the Ministry of Health for the cases that were laboratory-diagnosed and related, during 2019. RT-PCR was used for the detection of the RNA of CHAPV in the blood samples.

RESULTS

Two cases were RT-PCR + for CHAPV. The median age of patients was 42 y-old (IQR 25-45), four out of five were male. All patients were hospitalized, admitted to the ICU and had fever, upper digestive hemorrhage, with two of them, presenting ARDS, and requiring mechanical ventilation. Three patients died (case fatality rate, CFR 60%).

CONCLUSIONS

Mammarenaviruses led to a high fatality rate. These cases occurred in areas with suitable ecoepidemiological conditions for rodent-borne diseases, including CHAPV infection. Socioenvironmental and occupational factors in rural areas of Bolivia may contribute with the risk of zoonotic spillover and transmission to humans.

Meeting report: Eleventh International Conference on Hantaviruses

The 2019 11th International Conference on Hantaviruses (ICH 2019) was organized by the International Society for Hantaviruses (ISH), and held on September 1-4, 2019, at the Irish College, in Leuven, Belgium. These ICHs have been held every three years since 1989. ICH 2019 was attended by 158 participants from 33 countries. The current report summarizes research presented on all aspects of hantavirology: ecology; pathogenesis and immune responses; virus phylogeny, replication and morphogenesis; epidemiology; vaccines, therapeutics and prevention; and clinical aspects and diagnosis.