Study objectives: To describe the clinical features and
laboratory abnormalities of 16 adults with confirmed Hantavirus
pulmonary syndrome (HPS) due to Andes virus in Temuco, Chile.
Design: A retrospective chart review abstracting clinical,
radiologic, laboratory, and epidemiologic data.
Setting: ICU of the university teaching hospital in Temuco,
Patients: Sixteen patients with HPS 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 incubation
period ranging from 5 to 25 days, a prodromal influenza-like phase
frequently was accompanied by abdominal symptoms. From 1 to 7 days
later, respiratory insufficiency and hemodynamic instability suddenly
appeared. In 81%, hemorrhage was evident; in 63%, moderate-to-severe
bleeding occurred. The most prominent laboratory abnormalities were
hemoconcentration, leukocytosis, 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, lower Pao2/fraction of inspired
oxygen values, prolonged PTT, hemorrhage, greater volume load, and
profuse bronchorrhea. The effects of treatment with corticosteroids
could not be determined. Hemorrhage and renal involvement were common
in our patients, features not often described in the North American
literature of Sin Nombre virus HPS.