Hantavirus Pulmonary Syndrome IN THE RURAL AREA OF JUQUITIBA, SÃO PAULO METROPOLITAN AREA, BRAZIL

doi:10.1590/S0036-46651997000400012

LETTER TO THE EDITOR

Hantavirus Pulmonary Syndrome IN THE RURAL AREA OF JUQUITIBA, SÃO PAULO METROPOLITAN AREA, BRAZIL ^* * This paper was firstly presented at the "XXX Congresso da Sociedade Brasileira de Medicina Tropical", held in Salvador, Bahia, in 1994

Sir,

Although cases of Hantavirus infections in rodents and humans have been identified in the State of São Paulo2,3,4,5, there has not been any documented diagnosis of human disease associated with these agents.

In December 1993, acute hantavirus infection was identified in three brothers inhabiting the rural area of Juquitiba, in the São Paulo metropolitan area (Figure 1). Their living conditions were poor, with the house also used for storage of domestic animal food. Wild rodents also inhabited their domicile. The illness was characterized by fever, headache, myalgia, prostration, cough, dizziness, nausea and/or vomiting. Two of the patients died in a period of 3-5 days with an acute respiratory insufficiency and in one of them shock. The serologic conversion, in samples collected from the surviving patient, by the enzyme immunoassay (ELISA IgM and IgG) against the antigens of Hantaan (HTN) and Sin Nombre (SN) viruses, and by immunofluorescence assay (IFA) against the HTN antigen, demonstrate acute infection by Hantavirus. There was no laboratory evidence of leptospirosis in two patients or bacterial and fungal infection in the surviving one. The serologic survey in 49 persons living in the neighbourhood of the patients detected (by ELISA) 4 persons with anti-HTN antibodies (IgM or IgG) and IgG antibodies against the antigen and recombinant nucleoprotein of the Sin Nombre (SN) virus in three persons, two of whom had antibodies against HTN.

The patients had similar clinical manifestations to those described in cases of Sin Nombre (SN) infection, by a novel Hantavirus identified in the United States in May 19931, 6. The serologic evidences suggest that an antigenically similar virus to SN virus is responsible for the cases in Juquitiba.

The Hantavirus pulmonary syndrome disease transmitted by rodents has not been previously diagnosed in Brazil.

M.I. VASCONCELOS
V.P. LIMA Insitute of Infections Diseases
Emílio Ribas, São Paulo, Brazil L.B. IVERSSON
M.D.B. ROSA Public Health School -
University of São Paulo, Brazil A.P.A. TRAVASSOS DA ROSA
E.S. TRAVASSOS DA ROSA Evandro Chagas Institue,
Belém do Pará, Brazil L.E. PEREIRA
E. NASSAR Adolfo Lutz Institute,
São Paulo, Brazil G. KATZ,
L.H. MATIDA
M. A. ZAPAROLI Health Department of the
State of São Paulo, Brazil J.J.B. FERREIRA Health Department of
Juquitiba, São Paulo, Brazil C.J. PETERS Centers for Disease Control and Prevention, Atlanta, USA Fig. 1 - Localization of Juquitiba in metropolitan area of São Paulo, state of São Pualo, Brazil

Correspondence to: Lygia Busch Iversson, MD, PhD, Faculdade de Saúde Pública, Av. Dr. Arnaldo 715, 01246-904 São Paulo, SP, Brasil. FAX: (55)(11) 881 2108

REFERENCES

1. CDC - Update. Hantavirus pulmonary syndrome - United States, 1993.

MMWR,

42: 816-820, 1993.

2. IVERSSON, L.B. - Infecção humana por Hantavirus no Brasil: Região Sudeste. São Paulo, 1991. (Thesis, Public Health School, University of São Paulo, Brazil)

3. IVERSSON, L. B.; TRAVASSOS DA ROSA, A.P.A.; ROSA, M.D.B. et al. - Infecção humana por Hantavirus nas regiões Sul e Sudeste do Brasil. Rev. Ass. méd. bras., 40: 85-92, 1994.

4. LE DUC, J.W.; SMITH, G.A.; PINHEIRO, F.P . et al. - Isolation of a Hantaan related virus from Brazilian rats and serologic evidence of its widespread distribution in South America. Amer. J. trop. Med. Hyg., 34: 810-815, 1985.

5. LE DUC, J.W. - Hantaan and related virus. In: INTERNATIONAL SYMPOSIUM ON TROPICAL ARBOVIRUSES AND HAEMORRHAGIC FEVERS, 2., Belém, Pará, 1991.

6. NICHOL, S..T.; SPIROPOULOU, C.F.; MORZUNOV, S. et al - Genetic identification of a novel hantavirus associated with an outbreak of acute respiratory illness in the southwestern United States. Science, 262: 914-917, 1993.

Recebido para publicação em 12/09/1997

Aceito para publicação em 03/10/1997

1. CDC - Update. Hantavirus pulmonary syndrome - United States, 1993. MMWR, 42: 816-820, 1993.
3. IVERSSON, L. B.; TRAVASSOS DA ROSA, A.P.A.; ROSA, M.D.B. et al. - Infecçăo humana por Hantavirus nas regiőes Sul e Sudeste do Brasil. Rev. Ass. méd. bras., 40: 85-92, 1994.
4. LE DUC, J.W.; SMITH, G.A.; PINHEIRO, F.P . et al. - Isolation of a Hantaan related virus from Brazilian rats and serologic evidence of its widespread distribution in South America. Amer. J. trop. Med. Hyg., 34: 810-815, 1985.
5. LE DUC, J.W. - Hantaan and related virus. In: INTERNATIONAL SYMPOSIUM ON TROPICAL ARBOVIRUSES AND HAEMORRHAGIC FEVERS, 2., Belém, Pará, 1991.
6. NICHOL, S..T.; SPIROPOULOU, C.F.; MORZUNOV, S. et al - Genetic identification of a novel hantavirus associated with an outbreak of acute respiratory illness in the southwestern United States. Science, 262: 914-917, 1993.

*

This paper was firstly presented at the "XXX Congresso da Sociedade Brasileira de Medicina Tropical", held in Salvador, Bahia, in 1994

Publication Dates

Publication in this collection
08 Oct 1998
Date of issue
July 1997

History

Accepted
03 Oct 1997
Received
12 Sept 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. CDC - Update. Hantavirus pulmonary syndrome - United States, 1993. MMWR, 42: 816-820, 1993.

[3] 3. IVERSSON, L. B.; TRAVASSOS DA ROSA, A.P.A.; ROSA, M.D.B. et al. - Infecçăo humana por Hantavirus nas regiőes Sul e Sudeste do Brasil. Rev. Ass. méd. bras., 40: 85-92, 1994.

[4] 4. LE DUC, J.W.; SMITH, G.A.; PINHEIRO, F.P . et al. - Isolation of a Hantaan related virus from Brazilian rats and serologic evidence of its widespread distribution in South America. Amer. J. trop. Med. Hyg., 34: 810-815, 1985.

[5] 5. LE DUC, J.W. - Hantaan and related virus. In: INTERNATIONAL SYMPOSIUM ON TROPICAL ARBOVIRUSES AND HAEMORRHAGIC FEVERS, 2., Belém, Pará, 1991.

[6] 6. NICHOL, S..T.; SPIROPOULOU, C.F.; MORZUNOV, S. et al - Genetic identification of a novel hantavirus associated with an outbreak of acute respiratory illness in the southwestern United States. Science, 262: 914-917, 1993.