Volume 26, Number 1—January 2020
Research Letter
Hantavirus Pulmonary Syndrome in Traveler Returning from Nepal to Spain
Elena Sulleiro1, Maria Luisa Aznar1, Núria Serre-Delcor, Fernando Salvador, Adrian Sanchez-Montalvá, Mateu Espasa, Daniel Molina, Fernando de Ory, M. Paz Sanchez-Seco, Israel Molina, Candido Diaz-Lagares, Miguel J. Martinez, Tomàs Pumarola, and Inés Oliveira
Table
Clinical and laboratory findings over time of a patient with hantavirus pulmonary syndrome after travel, Spain*
| Findings | Acute phase, day 2 | ICU admission, day 6 | ICU discharge, day 12 | Follow-up, day 22 | Follow-up, day 82 |
|---|---|---|---|---|---|
| Clinical |
Fever, myalgia, headache, vomiting, and diarrhea |
Acute noncardiac pulmonary edema and hypotension; pleural effusions and respiratory failure |
Eupneic, resolution of the pulmonary edema |
Mild dyspnea general condition with fatigue |
Completely recovered |
| Hematalogic |
Leukocytes 4.38 × 109 cells/L; platelets 125 × 109/L |
Leukocytes 6.17 × 109 cells/L; platelets 92 × 109/L |
Leukocytes 7.00 × 109 cells/L; platelets 306 × 109/L |
Leukocytes 4.91 × 109 cells/L; platelets 205 × 109/L |
Leukocytes 5.82 × 109 cells/L; platelets 208 × 109/L |
| Biochemical |
AST 81 IU/L; ALT 127 IU/L; ALP 142 IU/L; GGT 128 IU/L; creatinine 1.02 g/dL; urea 37 mg/dL; Na+ 140 mmol/L; K+ 4.24 mmol/L; cholesterol 113 mg/dL; triglycerides 78 mg/dL; CRP 10.33 |
AST 448 IU/L; ALT 424 IU/L; ALP 151 IU/L; GGT 150 IU/L; cardiac biomarkers (troponin and natriuretic peptide) normal; creatinine 0.86 mg/dL; urea 53 mg/dL; Na+ 135.6 mmol/L; K+ 4.39 mmol/L; LDH 830 UI/L; CRP 14.58 |
AST 117 IU/L; ALT 205 IU/L; Creatinine 0.56 mg/dL; Urea 28 mg/dL; Na+ 141.8 mmol/L; K+ 4.38 mmol/L; cholesterol 121 mg/dL; triglycerides 218 mg/dL; CRP 2.81 |
AST 46 IU/L; ALT 106 IU/L; ALP 176 IU/L; GGT 143 IU/L; creatinine 0.71 mg/dL; Urea 30 mg/dL; Na+ 139.5 mmol/L; K+ 4.58 mmol/L |
AST 24 IU/L; ALT 19 IU/L; GGT 12 IU/L; creatinine 0.95 mg/dL; urea 33 mg/dL; Na+ 140.2 mmol/L; K+ 4.78 mmol/L |
| Arterial blood gas analysis |
NA |
pH 7.36; PaCO2 32 mm Hg; PaO2 40 mm Hg; SaO2 85.5%; HCO3- 26.3 mm Hg |
NA |
NA |
NA |
| Pleural effusion characteristics |
NA |
Glucose 114 mg/dL; proteins 2.1 g/dL; LDH 423 IU/L; cytology inflammatory process with lymphocyte predominance |
NA |
NA |
NA |
| Hantavirus diagnosis | IgG (ELISA) negative; IgG (IBT) negative; IgM (ELISA) negative; IgM (IBT) negative; PCR (serum + urine) negative | NA | IgG (ELISA) weak positive; IgG (IBT) positive, PUUV indeterminate, Dobrava Seoul, Hantaan, Sin Nombre and Andes negative; IgM (ELISA) indeterminate; IgM (IBT) negative; PCR (serum) negative; DENV IgG, IgM negative, PCR (serum) negative | IgG (ELISA) positive; IgG (IBT) positive; PUUV indeterminate; Dobrava, Sin Nombre and Andes and negative Seoul and Hantaan; IgM (ELISA) positive; IgM (IBT) negative; PCR (serum) negative | IgG (ELISA) indeterminate; IgG (IBT) indeterminate; PUUV, Dobrava, and Seoul negative Hantaan, Sin Nombre and Andes; IgM (ELISA) negative; IgM (IBT) negative; PCR (serum) negative |
*Days are days after initial symptom onset. An expanded table including additional results is available (https://wwwnc.cdc.gov/EID/article/26/1/18-1685-T1.htm). ALP, alkaline phosphatase; ALT, alanine transaminase; AST, aspartate transaminase; CRP, C-reactive protein; DENV, dengue virus; GGT, gamma-glutamyl transpeptidase; IBT, immunoblot; ICU, intensive care unit; LDH, lactate dehydrogenase; NA, not applicable; PUUV, Puumala virus.
1These authors contributed equally to this article.
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