hantavirus cases in manitoba

  • 12 min read
  • Jan 26, 2020

Hantavirus pulmonary syndrome in Canada - Canada.ca
Hantavirus pulmonary syndrome in Canada – Canada.ca

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1Health Canada, National Microbiology Laboratory, Zoonotic Diseases and Special Pathogens, Canadian Science Center for Human and Animal Health, Winnipeg, Manitoba;

1Health Canada, National Microbiology Laboratory, Zoonotic Diseases and Special Pathogens, Canadian Science Center for Human and Animal Health, Winnipeg, Manitoba;

2Manitoba Health, Marquette, Brandon and Westman Regional Health Authority South, Brandon, Manitoba

1Health Canada, National Microbiology Laboratory, Zoonotic Diseases and Pathogens particular, Canadian Science Center for Human and Health animals, Winnipeg, Manitoba;

The first confirmed case of hantavirus pulmonary syndrome in Manitoba were diagnosed in 1999 to determine both the risk of exposure to hantaviruses in this area, the clinical picture and epidemiological factors related to the case described, and serological surveys collected in mice near the residence of patients do. small mammals collected using live traps, anesthetized via inhalation of isoflurane and bled. Serologic human and mice by using ELISA to detect the particular hantavirus immunoglobulin G and / or antibody immunoglobulin M. In addition, a full medical assessment and epidemiology, as well as risk factors and exposures of individual analysis, performed. A Manitoba woman 27 years presented with severe respiratory disorders and diseases spread radiological bilateral air space. Although the steps are very aggressive, including mechanical ventilation, antibiotics, fluid management and inotropic support, the patient’s condition quickly deteriorated, and she died eight hours after admission. Hantavirus pulmonary syndrome was confirmed by detection of immunoglobulin M and immunoglobulin G antibodies to Sin Nombre virus (SNV) in sera and demonstrations by SNV genome sequence in his lung tissue. Hantavirus exposure may occur in and around the house or in a rural area where he lives. A total of 252 small mammals, especially deer mice (Peromyscus maniculatus), collected from 17 different locations in or close to where patients live. SNV antibodies were detected in 28 of 244 (11.5%) of deer mice, which were collected within 9 km from the residence of the fatal cases, showed that these mice are a significant reservoir for SNV in this area.

Hantavirus pulmonary syndrome (HPS) are initially recognized in the southwestern United States in 1993 (). HPS is caused by hantavirus outbreaks originally called ‘Muerto Canyon’ or virus ‘Four Corners’ (), but which is now called ‘Sin Nombre’ virus (SNV) (). Since the original identification of SNV, at least 12 other species of hantavirus have been identified in the United States, including six which are known as the etiologic agent of HPS (). HPS cases have been recognized in Canada but, until now, SNV is the only species of hantavirus have been documented to cause HPS in the country.

Although SNV has been shown to infect many species of rodents, deer mouse, Peromyscus maniculatus, is the main reservoir of SNV in the southwestern United States (). Mouse deer are widely distributed in Canada () and is believed to be issued SNV in the urine, saliva and feces (). infection in humans usually occur when the virus is inhaled aerosol (,).

On January 1, 2000, 32 Canadian cases of HPS have been confirmed in the laboratory. All cases were reported in British Columbia, Alberta, Saskatchewan or Manitoba, with a case fatality rate of 37.5%, including the case described below (). Patients ranged in age from 15-62 years (average 39 years), and the majority (19 of 32 [60%]) were male (). Prior to 1999, human cases of HPS have not been recognized in Manitoba. However, in July 1999, a woman died of HPS; He recently moved from McAuley, Manitoba Brandon, Manitoba. To get more information on this case, local health authorities conduct a full medical assessment and epidemiology, as well as risk factors and exposures of individual analysis. Personnel from Zoonotic Diseases and Special Pathogens (ZDSP) Program and bleed trapped small mammals in and around the main residence of the patient and at 17 other sites within 9 km from this residence in southwest Manitoba.

This paper describes the clinical presentation and laboratory findings for the first confirmed HPS cases in Manitoba, as well as the distribution and prevalence of hantavirus infection in small mammals were collected in 17 locations in southwest Manitoba.

After the first laboratory confirmation of cases of HPS in Manitoba, local public health authorities conduct a full medical assessment and epidemiology, as well as risk factors and exposures of individual analysis.

during the field investigations for HPS cases, attempts to entrap focused on rural property located southwest of McAuley, Manitoba where patients live and at 17 other sites within 9 km from this location. The entire area where sampling is performed is approximately 16×10 km, the average distance from the patient’s residence to another trap site is 3.2 km, and the average distance between these sites is 4.3 km (0.8 range -9 km).

Small mammals collected in Sherman live traps (HB Sherman traps Inc., USA) set every night from July 17 to 22, 1999. All of the traps baited with a mixture of peanut butter and rolled oats; they are set in the late afternoon and checked the following morning. The majority of traps are set in a building such as a patient’s home, storage sheds, barns, granaries, or abandoned or rarely used vehicles. In most other locations, traps are set in or on the edge of woodland or grassland habitats. Animals anesthetized by inhalation of isoflurane as Aerrane (Anaquest, USA). They bleed through the retro-orbital sinus using Natelson (Fisher Scientific, USA) blood collecting tube or by cardiac puncture. Sera from blood samples were obtained by centrifugation at 15,000 rpm for 5 to 10 minutes in Microtainer (Becton Dickinson, USA) serum separator.

Human and mouse serum samples were tested for antibodies to SNV using ELISA. Sera from mice only tested for antibody immunoglobulin (Ig) G whereas human serum tested for IgM and IgG antibodies. ELISA for IgG antibodies in rodents that live test in which the plates are coated with recombinant SNV N-protein (ie, a positive antigen – many #SPR 293, Center for Disease Control and Prevention [CDC], USA) and a mixture of recombinant proteins nonviral (ie , antigen negative – many #SPR 292, CDC). Test sera diluted 1: 100 with master plate diluent for the initial screening, and a peroxidase conjugate comprising the same volume of goat anti-mouse (lot # UB050, CDC) and goat anti-Peromyscus (lot # SB30, CDC). positive control consisted of sera from known infected deer mice (lot # 703 110, CDC), whereas the negative control sera from mice deer colony at the University of Manitoba (Winnipeg, Manitoba) who previously had tested negative to the SNV. ELISA for IgG antibodies in human serum are identical to those used to test rat sera for IgG antibodies, except that the conjugate goat anti-human IgG (catalog # 074-1006, Kirkegaard & Perry Laboratories, USA), the positive control consisted of positive sera humans (lot # 703 109, CDC), and negative control consisted of human sera previously tested negative for SNV (HAN-389/95, ZDSP).

for the ELISA test for IgM antibodies in human sera, the plate is coated with goat anti-human IgM (catalog #AHI 0601, Biosource International, USA). Test sera diluted 1: 100 for initial screening and added to the positive control wells (ie, inactive cell culture propagated SNV – many #SPR 305, CDC) and negative wells (ie, slurry Vero E6 cells – many #SPR 306, CDC ). SNV hyperimmune anti-mouse antibody (lot # 703 110, CDC) was added at 1: 1000 followed by peroxidase-conjugated goat anti-mouse IgG (catalog # 074-1806, Kirkegaard & Perry Laboratories). Serum control human sera previously tested positive (HAN 262/98, CDC) or negative (many #MA 757/88, ZDSP). All sera were reacting at the screening dilution of 1: 100 dilution is titrated with a four-fold dilution of serum to the end point up to 1: 6400, and samples with antibody titer 1 :. 400 or more is considered positive

A 27-year female patient treated at the Brandon Regional Health Center on July 5, 1999. Six days before admission, he developed a fever, headache, vomiting, weakness and lethargy. On July 4, 1999, he entered the emergency room, where he was treated for gastroenteritis considered and exhausted. The next day, she was admitted to the same hospital after presenting with dry cough and worsening of respiratory symptoms. Hepale, cold to the touch, hypoxia and hypotension, with a blood pressure of 74/48 mm Hg, pulse 130 beats / minute, respiratory rate of 30 to 40 breaths / min and a temperature of 35.8 ° C. He has crackles bibasilar and initial oxygen saturation 74 % on room air. Laboratory findings were: hemoglobin 190 g / L, hematocrit 0.572, leukocyte count 12.2×109 / L with 86.3% mature polymorph, platelets 38×109 / L, serum sodium level of 133 mmol / L, urea level of 4.8 mmol / L and levels creatinine of 0.09 mol / L Chest x-ray showed prominent bilateral air space disease. Provisional diagnosis of cardiogenic non adult respiratory distress syndrome was made and she was treated empirically with cefuroxime, clindamycin and erythromycin. He was immediately transferred to the intensive care unit, where he had a rapidly progressive respiratory failure requiring intubation and mechanical ventilation. He became hemodynamically unstable, requiring inotropic support, and he was arrested twice before giving up to 8 hours after admission.

postmortem examination is consistent with adult respiratory distress syndrome secondary noncardiogenic viral etiology, may hantavirus. bacterial culture of endotracheal secretions, blood and urine culture is negative. HPS diagnosis was later confirmed by the detection of IgM (titer 1: 1600) and IgG (titer 1: 400) antibodies to SNV in patient sera. reverse transcription polymerase chain reaction using hantavirus-specific primer () also detect the presence of viral genome in patient lung biopsy tissue. Serologic tests carried out on samples collected from family members and household contacts in the negative mid to late July, with the exception of men 13 years of age who have a significant IgG antibody titers (1: 400) for SNV, but were IgM-negative and without symptoms.

At the site near McAuley, Manitoba, a total of 252 animals from three species of mammals were arrested. Deer mouse, Peromyscus maniculatus, is the dominant species, accounting for over 96% of the total catch. A total of 244 deer mice collected from 17 of the 18 sites where traps are set, including 33 animals were collected on the property where the patient lives. Deer mice with antibodies to SNV identified in seven of the 17 areas. Although there is no 33 deer mice collected in the former residence of the patients had evidence of infection, deer mice with antibody titer found on the site within 1 km of the site. Site seropositive catching deer mice were randomly distributed in the whole area of ​​study, with no clear grouping of sites infected animal hides. At sites where animals with antibody titer is identified, the proportion of animals with antibodies SNV ranged from 12.5% ​​to 33.3%. Sera from six red-backed mouse, Clethrionomys gapperi, and two brown rat, Rattus norvegicus, has no recognizable hantavirus antibody titers. Overall, 28 of 244 deer mice (11.5%) of the sites near McAuley had antibody titers against SNV.

Since 1994, personnel from ZDSP program has conducted serological surveillance for hantavirus antibodies in deer mouse populations in Canada (). seropositive deer mice have been collected in the Yukon Territory, British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick and Newfoundland (unpublished data, ZDSP). However, confirmed cases of HPS have now only been reported in the four westernmost provinces in Canada. This is the first report of seroprevalence of hantaviruses in deer mice collected in Manitoba. The hantavirus than deer mice collected in southwestern Manitoba have been shown, with genetic analysis (), belonging to a western genogroup SNV-like virus (unpublished data, ZDSP). So, although hantaviruses are widely distributed in the deer mouse population in Canada, only SNV-like hantaviruses found in western Canada related to the cases of HPS to date.

Hantaviruses known to infect mice, where they produce chronic asymptomatic infection with viral shedding in urine, feces and saliva. Rodent to humans occurs mainly through inhalation excretions of infected rodents, primarily urine shed new (). There is a possibility that the infectious airborne particles can be produced for human activities that disturb contaminated soil, litter or nesting material. small skin break and a bite of rodent probably effective but these rare human infections. Fleas, ticks, mosquitoes and other biting arthropods are not known to have a role in the transmission of hantaviruses. Although cats and dogs are not known as reservoirs of hantaviruses, domestic animals may bring infected rodents into contact with humans (). The risk of human disease is proportional to the frequency that people come into contact with rodents or their droppings infection, the relative abundance of deer mice populations, and the prevalence of hantavirus infection in rodents that (,).

Manitoba cases occurred in the southwestern Manitoba where the deer mouse is the dominant species and where the prevalence of infection among a sample of mice was 11.5%. Although not directly involved in the farming operation, infected women live in rural areas where deer mice are usually plentiful, and therefore, there is a relatively high probability of contact with deer mice and / or their droppings. Furthermore, rat droppings found in the trunk of the car he usually drove. In addition, the family cat often bring home a deer mice, which patients are handled. Thus, exposure to hantavirus may occur in and around the house or in a rural area where he lives. In fact, 70% of HPS cases in Canada are likely affected by SNV for agricultural and domestic activities in rural areas (). A single case has also been associated with exposure during military exercises, cleaning wood plant and wildlife surveys (,). The prevalence of antibodies to SNV in deer mice ranged from 12% to 33% in a location where at least one positive mice were collected. This percentage seropositive deer mice was comparable to that observed in the area of ​​Alberta where HPS is more frequently observed (unpublished data, ZDSP).

The clinical presentation of this case fit the usual pattern (). cardiopulmonary dysfunction, ranging from mild hypoxemia with hemodynamically stable for rapidly progressive respiratory failure with cardiogenic shock, is characteristic of patients with HPS fully developed. Patients usually present with an initial period of fever (often with chills) and myalgia, and many have gastrointestinal complaints such as nausea or vomiting, abdominal pain or diarrhea. Some patients, such as this case, has been sent home from the emergency room with symptoms are not specific, only to return a few hours or a few days later, very ill. Dyspnea was usually develops before hospitalization, along with respiratory decompensation and the appearance of pulmonary edema. The average duration of disease before hospitalization is three to four days, and, in patients who are deteriorating, the usual duration of the disease is one of the additional three days to die. However, the patient can die within hours of admission. Some patients complained of cough but, if anything, growing end of the prodrome. At the initial evaluation, the triad of thrombocytopenia, increased mature granulocytes (often with a high white blood cell count) and large immunoblastoid lymphocytes are characteristic. Hemokonsentrasi probably exceptional, and the extension of partial thromboplastin time and prothrombin time are often seen. increased serum lactate levels have been observed in the majority of patients ().

The most effective way to reduce the risk of developing HPS is to limit the exposure to rodents and their droppings. Measures to prevent HPS can be divided into four areas: eliminating rats asylum, controlling the deer population of rats, correctly clean up areas contaminated by deer mouse droppings and avoid this rodent in outdoor settings (,). The importance of identifying personal risk and follow risk reduction measures must be emphasized through health education programs. Due to the early recognition of cases can improve a patient’s chance of survival, doctors and other medical personnel play an important role in the identification of the original case. Therefore, educational programs should be targeted to all medical personnel and should focus on the clinical picture of the disease, diagnosis, patient management and treatment, and prevention recommendations. Other health professionals, such as public health officials, epidemiology and public health educators, need to be knowledgeable about maintaining active surveillance systems and to develop effective community-based educational program. Obviously, the information related to the prevention of this disease should be available to the general public in Manitoba; However, a concerted effort should be made to inform those at greatest risk of exposure (ie, the people who live and work in a rural environment either on a full-time [manufacturers] and part-time [the owner of the cottage] basis). Education and simple precautions is the best approach toward minimizing exposure and hantavirus infection.

Since the writing of this manuscript, a second case was confirmed HPS in southwest Manitoba. The patient was a 68 years old woman who lives in a rural town in 100 km from McAuley. The onset of symptoms occurred in mid-May 2000, and he was hospitalized after a five-day history of cough, nausea and vomiting. Because of rapidly progressive respiratory decline, he was transferred to the intensive care center in the area where it is required intubation and mechanical ventilation. He died four hours after admission, and HPS was confirmed when the IgM and IgG antibodies to SNV (both 1: 400) was detected in her sera. SNV exposure may occur in and around his home during gardening activities related. A field investigation was conducted from June 19 to 20, 2000; trap set at 16 sites spread over an area of ​​100 km2 around the rural town where he lives. Results of investigation similar to that reported in the current paper. Deer mice with antibodies collected in six of 13 (46.1%) of sample locations, and 10 of 67 (14.9%) were seropositive deer mice. The prevalence of antibodies in each region ranged from 18.2% to 40%.

The authors thank Kimberley Holloway, Antonia DiBernardo, Zhaoxia Chen and Maya Andonov from ZDSP program to perform laboratory diagnosis and provide logistical support for the field study. The authors also thank the residents in the area McAuley, who kindly provided access to their property so that the animals can be collected. A special debt owed to Charlie and Greg Coleman, who helped to arrange the collection of the pitch at McAuley’s website and provide valuable assistance during sampling small mammals.

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