hantavirus pulmonary syndrome in india

  • 6 min read
  • Jan 28, 2020

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From: Department of Intensive Medicine Care, Hospital of the Holy Family, Mumbai, Maharashtra, India

From: Department of Intensive Medicine Care, Hospital of the Holy Family, Mumbai, Maharashtra, India

of: Department of Intensive Medicine Care, Hospital of the Holy Family, Mumbai, Maharashtra, India

of: Department of Intensive Medicine Care, Hospital of the Holy Family, Mumbai, Maharashtra, India

hantavirus infection, a rare disease diagnosed in India and carries a very high mortality. There were no reports of infection in connection with pregnancy or childbirth period in our country. We present the case of 30 year-old woman diagnosed with hantavirus pulmonary syndrome in the postpartum period. We intend to create awareness of this infection and considered in the differential diagnosis of patients with acute respiratory distress syndrome and multiple organ dysfunction associated with pregnancy and the postpartum period.

Hantaviruses described as emerging pathogens as newer serotypes were found in many regions for hantaviruses nonendemic [] Hantaviruses is zoonotic rodent-borne virus most widely distributed and can cause two important clinical syndrome :. hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS) in Asia and the Americas, respectively. []

Humans are accidental hosts and infected by aerosol produced from contaminated urine, feces, and saliva of infected rodents. Rodents are the natural hosts of the virus and develop a persistent infection. human to human infection is rare, and the evolution of the virus depends on the rodent host. HPS is characterized by severe pulmonary edema noncardiogenic that cause breathing problems often resemble acute respiratory distress syndrome (ARDS). HPS case fatality rate is approximately 45% []

Very few cases of HPS have been reported in association with pregnancy in the world, in India .; we present the case of HPS in the postpartum period.

30 year old woman developed severe abdominal pain, fever, and headache 8 days, after a full-term normal vaginal delivery. antepartum and peripartum his course were uneventful. He was admitted to a private nursing home for the above symptoms. They noted the gaping wound of episiotomy and Resuturing do. He was also evaluated for fever and was found to have a platelet count of 50,000 / cumm. The next day, he had a fever worsened, begin to develop shortness of breath, and was found to be hypotension. He conservatively managed and transferred to our hospital in view of the worsening of the symptoms mentioned above.

At the entrance to our hospital, he was found to be very tachypneic, have severe hypotension requiring inotropic support. He was intubated and mechanically ventilated. On evaluation, she had 40,000 platelets / cumm, deranged liver function tests, and creatinine 4.1 mg / dl. He also has a coagulopathy with an international normalized ratio of 4.3. His chest X-ray showed bilateral chest infiltrates [], arterial blood gas showed PaO 2 / FiO 2 <100 indicate severe ARDS []. Ultrasound abdomen and pelvis and a normal two-dimensional echocardiography. With a provisional diagnosis of acute febrile illness with severe sepsis and septic shock, further evaluation to determine the etiology do. polymerase chain reaction for leptospirosis and dengue IgM negative; malaria smear showed no parasites. However, IgM antibodies tested positive for hantavirus.

The X-ray series featuring progressively deteriorating lung shadow

laboratory values ​​Serial

During its course in the intensive care unit, he had a falling platelet and coagulation in need of blood components transfusion, severe ARI requires a lung protective ventilation, renal dysfunction requiring renal replacement therapy, septic shock require broad-spectrum antibiotics and inotropic support. He worsening chest X-ray [], began developing alveolar hemorrhage, and worsening of lung function. Along with the support of hemodynamic, renal replacement therapy, broad-spectrum antibiotics, ribavirin also started as part of the therapy. , He worsening lung function and ends with multiorgan dysfunction 10 days after the onset of symptoms

There are two types of hantavirus infection are described :. HFRS and HPS

HFRS is a groupclinically similar illnesses caused by hantaviruses from the family Bunyaviridae species. It is found in Europe, Asia, and Africa. HFRS incubation period is 7-36 days. Only 10% -15% of cases have a severe program with lethal levels of between 6% and 15%. HFRS characterized by systemic involvement capillaries and venules. It induces various manifestations of bleeding and circulatory disorders. Renal involvement is characterized by acute renal failure due to interstitial hemorrhage and interstitial infiltrates. [,]

HPS found in North, Central and South America. It is often fatal lung disease. It has a mortality rate of 36% -50%. HPS is characterized by the onset of flu-like symptoms such as high fever, myalgia, and headache. The patients develop acute pulmonary edema noncardiac and hypotension in 2-15 days. bilateral infiltrates develop rapidly, sometimes associated with pleural effusion. neutrophilic leukocytosis, hemoconcentration, thrombocytopenia, and circulating immunoblasts observed. HPS severe course associated with elevated levels of lactate. The mortality rate of approximately 50% HPS. Patients who survive the acute phase of the disease typically recover within 5-7 days without any sequelae. Acute renal failure is secondary to shock and respiratory failure. []

Gilson et al. HPS has reported an association with pregnancy in the western world and has been associated with increased mortality in maternal and fetal hypoxia damage. [] Other reports of cases in pregnant women in Europe are reported by Mace et al., Mimicking acute fatty liver of pregnancy with renal failure. []

Thottapalayam virus that has been shown to be genetically similar to the hantavirus isolated from India have been reported by Carey et al. in 1971. [] Later, hantavirus infection, reported by Chandy et al. in Tamil Nadu, showed serological evidence of the existence of this disease. [] There are no clinical data in relation to pregnancy so far from India.

supportive therapy is the mainstay of treating patients with hantavirus infection. Treatment includes careful management of fluid and electrolyte parameters, respiratory and hemodynamic patient, and appropriate treatment of secondary infections. Renal replacement therapy may be needed to correct severe fluid overload. Intravenous ribavirin, an antiviral drug, has been shown to reduce disease and death associated with HFRS if used very early in the disease. [] Ribavirin has not been proven effective in HPS and needs further evaluation. []

hantavirus infection, once thought to be rare in India, need to be considered in the differential diagnosis of ARDS and mainly related to the pregnancy and postpartum period.

of early diagnosis and supportive care is the mainstay of therapy. Ribavirin may be useful in HFRS and HPS are still experimental.

Nile.

There is no conflict of interest.

,

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