RESUMO
Andes virus was identified in 1995 as the etiologic agent of Hantavirus Pulmonary Syndrome (HPS) in Southern Argentina. We describe herein the main clinical characteristics of 25 HPS confirmed cases acquired in this area between 1993 and September 1999. The mean age was 34 years (range 11-70), with 72% males. Clinical characteristics were similar to those previously reported for Sin Nombre virus (SNV) cases. However, in this group of patients we also observed conjuntival injection in 10/25 (42%), facial flushing in 8/25 (33%), pharyngeal congestion in 7/25 (29%) and petechiae in 3/25 (12%). On the other hand, BUN was increased in 83% of cases (mean 0.77 g/l range 0.31-2.01). Mean serum creatinine concentration was 26.8 mg/l (range: 8.1-110 mg/l) with serum creatinine being higher than 20 mg/l in 8/15 patients (53%). Urinalysis was abnormal in 12/12 cases and was characterized by presence of proteins, red blood cells and granular casts. Aminotransferases were increased in 90% of cases with levels 5-10 times over normal values in 50% of cases. Serum creatine kinase concentration was elevated in 11/14 cases. Two patients required hemodialysis. Case fatality rate was 44% (11/25) and 10 of these cases died among the first 10 days of illness. Mononuclear myocarditis was observed in two cases, a finding that has not been reported for SNV cases. During the 1996 HPS outbreak in Southern Argentina due to Andes virus, there were epidemiological and molecular evidences of person-to-person transmission, a feature not previously shown for other members of the hantavirus genus. These data would also be indicative of some distinctive clinical characteristics of HPS caused by Andes virus, with more frequent renal involvement than in SNV cases.
Assuntos
Síndrome Pulmonar por Hantavirus/complicações , Adolescente , Adulto , Idoso , Argentina/epidemiologia , Criança , Surtos de Doenças , Ensaio de Imunoadsorção Enzimática , Feminino , Orthohantavírus/genética , Síndrome Pulmonar por Hantavirus/mortalidade , Síndrome Pulmonar por Hantavirus/patologia , Humanos , Masculino , Pessoa de Meia-Idade , RNA Viral/análise , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
Andes virus was identified in 1995 as the etiologic agent of Hantavirus Pulmonary Syndrome (HPS) in Southern Argentina. We describe herein the main clinical characteristics of 25 HPS confirmed cases acquired in this area between 1993 and September 1999. The mean age was 34 years (range 11-70), with 72
males. Clinical characteristics were similar to those previously reported for Sin Nombre virus (SNV) cases. However, in this group of patients we also observed conjuntival injection in 10/25 (42
), facial flushing in 8/25 (33
), pharyngeal congestion in 7/25 (29
) and petechiae in 3/25 (12
). On the other hand, BUN was increased in 83
of cases (mean 0.77 g/l range 0.31-2.01). Mean serum creatinine concentration was 26.8 mg/l (range: 8.1-110 mg/l) with serum creatinine being higher than 20 mg/l in 8/15 patients (53
). Urinalysis was abnormal in 12/12 cases and was characterized by presence of proteins, red blood cells and granular casts. Aminotransferases were increased in 90
of cases with levels 5-10 times over normal values in 50
of cases. Serum creatine kinase concentration was elevated in 11/14 cases. Two patients required hemodialysis. Case fatality rate was 44
(11/25) and 10 of these cases died among the first 10 days of illness. Mononuclear myocarditis was observed in two cases, a finding that has not been reported for SNV cases. During the 1996 HPS outbreak in Southern Argentina due to Andes virus, there were epidemiological and molecular evidences of person-to-person transmission, a feature not previously shown for other members of the hantavirus genus. These data would also be indicative of some distinctive clinical characteristics of HPS caused by Andes virus, with more frequent renal involvement than in SNV cases.
RESUMO
Presenta una encuesta realizada en noviembre de 1993 con el objeto conocer y evaluar los conocimientos que tiene la población de la ciudad de Neuquén, Argentina, sobre las formas de transmisión del SIDA. Se trató de una encuesta cerrada, cuyo cuestionario fue respondido personal y anónimante. Se investigó el conocimiento sobre posibilidades de contagio a través del contacto con personas infectadas o a partir de distintos fluídos corporales. Se obtuvieron datos sobre sexo, eda y nivel de instrucción. Se encuestaron 646 personas, el 52 por ciento de las cuales eran del sexo femenino y el otro 48 por ciento, masculino, en un rango de edades de 13 a 68 años y de 12 a 77 años, respectivamente. Los resultados mostraron una relación directa entre las respuestas correctas y el nivel de escolaridad. No parece haber una relación directa entre el nivel de información de la población con los cambios de hábitos, modas o conductas. Esto demostraría que la informacion o el conocimiento no son suficientes sino que deben tomarse como punto de partida para las campañas de prevención
Assuntos
Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/transmissão , Atitude Frente a Saúde , Conhecimentos, Atitudes e Prática em Saúde , ArgentinaRESUMO
Presenta una encuesta realizada en noviembre de 1993 con el objeto conocer y evaluar los conocimientos que tiene la población de la ciudad de Neuquén, Argentina, sobre las formas de transmisión del SIDA. Se trató de una encuesta cerrada, cuyo cuestionario fue respondido personal y anónimante. Se investigó el conocimiento sobre posibilidades de contagio a través del contacto con personas infectadas o a partir de distintos fluídos corporales. Se obtuvieron datos sobre sexo, eda y nivel de instrucción. Se encuestaron 646 personas, el 52 por ciento de las cuales eran del sexo femenino y el otro 48 por ciento, masculino, en un rango de edades de 13 a 68 años y de 12 a 77 años, respectivamente. Los resultados mostraron una relación directa entre las respuestas correctas y el nivel de escolaridad. No parece haber una relación directa entre el nivel de información de la población con los cambios de hábitos, modas o conductas. Esto demostraría que la informacion o el conocimiento no son suficientes sino que deben tomarse como punto de partida para las campañas de prevención
Assuntos
Atitude Frente a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/transmissão , ArgentinaRESUMO
We studied retrospectively the clinical records of 291 hospital patients with liver cirrhosis, 95% of which was alcohol related. Within this group, 114 patients presented 155 episodes of infection in 144 separate hospital admissions. In a previous communication, we pointed out that although infection was the fourth cause of admission, it was the main cause of death in this group. The main incidence of infection was among the female group. The most common infections episodes were respiratory and bacterial spontaneous peritonitis (BSP). On admission, 57% of the patients were diagnosed as belonging to the C Child group; 38% presented sepsis and 22% were hospitalary infections. The most frequent infections were respiratory and BSP. We obtained bacteriologic documentation in 55% of the episodes with prevalence of Gram negative bacilli (E. coli), with high relative frequency of neumoccocus. The most frequent complications were related to hepatic insufficiency. Global death rate was 27.1%, while nosocomial death rates were 42.1% and 40.9% for patients with Child C. We observed the highest incidence of mortality in patients with SBP and non localized bacteriemia. Survival rates were 42% for 2 years and 18% for 5 years. In summary, we stress the relevancy of checking the presence of infection systematically in every cirrhotic patient with encephalopathy and/or renal insufficiency without justifiable cause.
Assuntos
Infecções Bacterianas/epidemiologia , Infecção Hospitalar/epidemiologia , Cirrose Hepática Alcoólica/complicações , Adulto , Distribuição por Idade , Idoso , Infecções Bacterianas/mortalidade , Infecção Hospitalar/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/epidemiologia , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Distribuição por SexoRESUMO
We studied retrospectively the clinical records of 291 hospital patients with liver cirrhosis, 95
of which was alcohol related. Within this group, 114 patients presented 155 episodes of infection in 144 separate hospital admissions. In a previous communication, we pointed out that although infection was the fourth cause of admission, it was the main cause of death in this group. The main incidence of infection was among the female group. The most common infections episodes were respiratory and bacterial spontaneous peritonitis (BSP). On admission, 57
of the patients were diagnosed as belonging to the C Child group; 38
presented sepsis and 22
were hospitalary infections. The most frequent infections were respiratory and BSP. We obtained bacteriologic documentation in 55
of the episodes with prevalence of Gram negative bacilli (E. coli), with high relative frequency of neumoccocus. The most frequent complications were related to hepatic insufficiency. Global death rate was 27.1
, while nosocomial death rates were 42.1
and 40.9
for patients with Child C. We observed the highest incidence of mortality in patients with SBP and non localized bacteriemia. Survival rates were 42
for 2 years and 18
for 5 years. In summary, we stress the relevancy of checking the presence of infection systematically in every cirrhotic patient with encephalopathy and/or renal insufficiency without justifiable cause.