Hantavirus pulmonary syndrome due to Andes virus in Temuco, Chile - Clinical experience with 16 adults

Study objectives: To describe the clinical features and laboratory abnormal ities of 16 adults with confirmed Hantavirus pulmonary syndrome (HPS) due t o Andes virus in Temuco, Chile. Design. A retrospective chart review abstracting clinical, radiologic, labo ratory, and epidemiologic data. Setting: ICU of the university teaching hospital in Temuco, Chile. Patients: Sixteen patients with BTS treated between 1997 and 1999. Results: Patients were aged from 19 to 45 years, 82% were men, and 88% were farm or timber workers with occupational acquisition of HPS. After an incu bation period ranging from 5 to 25 days, a prodromal influenza-like phase f requently was accompanied by abdominal symptoms. From 1 to 7 days later, re spiratory insufficiency and hemodynamic instability suddenly appeared. In 8 1%, hemorrhage was evident; in 63%, moderate-to-severe bleeding occurred, T he most prominent laboratory abnormalities were hemoconcentration, leukocyt osis, thrombocytopenia, altered partial thromboplastin time (PTT), creatine kinase, transaminases, and hyponatremia. Creatinine elevation was common, with clinical importance in two patients. All patients had severe hypoxemia and pulmonary edema. Fifteen patients received supportive treatment, and 5 patients were treated with corticosteroids. The mortality rate was 43.8%. Conclusions: Bad prognostic factors appeared to be severe hypotension, lowe r Pao(2)/fraction of inspired oxygen values, prolonged PTT, hemorrhage, gre ater volume load, and profuse bronchorrhea. The effects of treatment with c orticosteroids could not be determined. Hemorrhage and renal involvement we re common in our patients, features not often described in the North Americ an literature of Sin Nombre virus HPS.