Hantavirus pulmonary syndrome (HPS)

First pediatric cases reported in Uruguay

Abstract

Introduction: hantavirus cause zoonoses that are transmitted by different rodents. Hantavirus pulmonary syndrome (HPS) presents inespecific symptoms followed by sudden respiratory distress. Mild or asymptomatic forms seem to be more frequent in children than in adults.
Objetives: to describe the clinical and para-clinical characteristics of pediatric cases of HPS in Uruguay, in the last ten years.
Method: descriptive, retrospective. Medical records of children with a confirmed diagnosis of HPS, or with a suspicion of HPS. Results: six patients. Average age: 5 years, four months. Coming from: four of them from Rocha, two from Canelones. They were all in contact with rodents. Five of them showed the classical clinical presentation. Chest radiography revealed diffuse bilateral infiltration in all patients, three of which had pleural compromise. Five children were admitted in the ICU, two required mechanical ventilation. One patient died.
Discussion: there are risk groups for developing HPS. In this series, lethality was 16.7%. Leukocytosis (with a deviation to the left), hemoconcentration, thrombocytopenia along with lactate dehydrogenase (LDH) and increased transaminases support the diagnosis. Renal compromise was present in half of the cases, regardless of the severity of the clinical case. Leptospirosis infection, influenza, mycoplasm and dengue need to be considered in the differential diagnosis.
Conclusions: we present the first series of cases of pediatric HPS in Uruguay. One child died and two patients required mechanical ventilation. However, hantavirus infection evidences a milder presentation in children. This condition should be considered for all healthy patients exposed to environment risk factors, since it produces severe respiratory difficulty although not necessarily serious.