Hantavirus pulmonary syndrome in Southern Argentina.

Andes virus was identified in 1995 as the etiologic agent of Hantavirus Pul monary Syndrome (HPS) in Southern Argentina. We describe herein the main cl inical characteristics of 25 HPS confirmed cases acquired in this area betw een 1993 and September 1999. The mean age was 34 years (range 11-70), with 72% males. Clinical characteristics were similar to those previously report ed 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 0.3 1-2.01). 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 in creased 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. Tw o patients required hemodialysis. Case fatality rate was 44% (11/25) and 10 of these cases died among the first 10 days of illness. Mononuclear myocar ditis was observed in two cases, a finding that has not been reported for S NV cases. During the 1996 HPS outbreak in Southern Argentina due to Andes v irus, there were epidemiological and molecular evidences of person-to-perso n transmission, a feature not previously shown for other members of the han tavirus genus. These data would also be indicative of some distinctive clin ical characteristics of HPS caused by Andes virus, with more frequent renal involvement than in SNV cases.