Hantavirus Fever without Pulmonary Syndrome in Panama

Abstract

Abstract. In Panama, hantavirus pulmonary syndrome (HPS) is caused by Choclo virus, a species phylogenetically related to Andes and Maporal viruses. Up to 60% of the population has been positive for specific serum antibody in community-based surveys, but mortality is very uncommon. In four western Panama clinics, we tested individuals presenting with a severe febrile prodrome for acute hantavirus (HV) infection by immunoglobulin M enzyme-linked immunosorbent assay and reverse transcription polymerase chain reaction as well as clinically similar infections, such as dengue and leptospirosis. From 2006 to 2009, at least 21% of 117 patients diagnosed with HV infection had HV Fever (HF) with no evidence of pulmonary edema (no respiratory distress or radiographic lung infiltrates), and 44% of patients had very mild HPS (radiographic pulmonary edema but no respiratory insufficiency). HV infection caused by Choclo virus in Panama presents often as HF, which contrasts with HV in the Americas but is consistent with the high seroprevalence in endemic regions.

Viral load of patients with hantavirus pulmonary syndrome in Argentina

“…Asymptomatic infected individuals with IgM, IgG, and RT‐nPCR positive were detected, similar to those reported in Brazil [de Borba et al, ], Panamá [Armien et al, ] and northwestern Argentina [Levis et al, ]; suggesting an underestimation of hantavirus infection.…”

Hantavirus infection: a global zoonotic challenge

“…Furthermore, serological evidence of hantavirus infection has also been detected in Suriname (Armien et al, 2013;Figueiredo et al, 2014;Goeijenbier et al, 2015). One imported HFRS case has been reported in Ecuador (Demeester et al, 2010).…”

Serological diagnosis of hantavirus pulmonary syndrome in a febrile patient in Colombia

“…In a study done in bordering Panama, 21% of diagnosed HPS patients did not show pulmonary oedema and 44% had mild HPS with mild oedema but no respiratory insufficiency. 6 The investigators in Panama described three categories of hantavirus infection: hantavirus fever (absence of dyspnoea, normal chest X-ray, not requiring oxygen therapy), mild HPS (occasional or no dyspnoea, abnormal chest X-ray), and moderate to severe HPS (marked dyspnoea, abnormal chest X-ray, mechanical ventilation required). 6 The present serologically confirmed HPS case is compatible with hantavirus fever, as described above.…”

“…6 The investigators in Panama described three categories of hantavirus infection: hantavirus fever (absence of dyspnoea, normal chest X-ray, not requiring oxygen therapy), mild HPS (occasional or no dyspnoea, abnormal chest X-ray), and moderate to severe HPS (marked dyspnoea, abnormal chest X-ray, mechanical ventilation required). 6 The present serologically confirmed HPS case is compatible with hantavirus fever, as described above. In Colombia we have observed other cases that are compatible with hantavirus fever, but none have been confirmed serologically.…”

“…Furthermore, the clinical presentation was similar to that found in neighbouring Panama. 6 Finally, although there is strong evidence of a broad geographic distribution of HPS in the Americas and in neighbouring countries, 2-5,9 a high prevalence of hantavirus infection in local rodent populations, and associated risk factors for HPS (exposure to rural rodents), the apparent incidence of HPS in Colombia is low. One reason for this disparity is likely poor surveillance within Colombia.…”