Browsing by Author "Vial, Cecilia"

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    Hantavirus in humans: a review of clinical aspects and management
    (2023) Vial Clavo, Pablo Agustín; Ferrés, Marcela; Vial, Cecilia; Klingstrom, Jonás; Ahlm, Clas; López, René; Le Corre Pérez, Monique Nicole; Mertz J., Gregory
    Hantavirus infections are part of the broad group of viral haemorrhagic fevers. They are also recognised as a distinct model of an emergent zoonotic infection with a global distribution. Many factors influence their epidemiology and transmission, such as climate, environment, social development, ecology of rodent hosts, and human behaviour in endemic regions. Transmission to humans occurs by exposure to infected rodents in endemic areas; however, Andes hantavirus is unique in that it can be transmitted from person to person. As hantaviruses target endothelial cells, they can affect diverse organ systems; increased vascular permeability is central to pathogenesis. The main clinical syndromes associated with hantaviruses are haemorrhagic fever with renal syndrome (HFRS), which is endemic in Europe and Asia, and hantavirus cardiopulmonary syndrome (HCPS), which is endemic in the Americas. HCPS and HFRS are separate clinical entities, but they share several features and have many overlapping symptoms, signs, and pathogenic alterations. For HCPS in particular, clinical outcomes are highly associated with early clinical suspicion, access to rapid diagnostic testing or algorithms for presumptive diagnosis, and prompt transfer to a facility with critical care units. No specific effective antiviral treatment is available.
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    Platelet Count in Patients with Mild Disease at Admission is Associated with Progression to Severe Hantavirus Cardiopulmonary Syndrome
    (2019) Lopez, Rene; Vial, Cecilia; Graf, Jeronimo; Calvo, Mario; Ferres, Marcela; Mertz, Gregory; Cuiza, Analia; Agueero, Begonia; Aguilera, Dante; Araya, Diego; Pailamilla, Ignacia; Paratori, Flavia; Torres-Torres, Victor; Vial, Pablo A.; Abarca, Juan; Miguel Noriega, Luis; Valdivieso, Francisca; Delgado, Iris; Martinez, Constanza; Carlos Chamorro, Juan; Hernandez, Jury; Pino, Marcelo; Vega, Ivonne; Otarola, Irisol; Ortega, Carlos; Daube, Elizabeth; Castillo, Constanza; Mardones, Jovita; Sanhueza, Ligia; Inostroza, Jaime; Donoso, Solange; Navarrete, Maritza; Araneda, Andres; Aguilera, Teresa; Osorio, Carola; Yobanolo, Veronica; Scholz, Luis; Riquelme, Raul; Riquelme, Mauricio; Munoz, Miriam
    Background: Hantavirus cardiopulmonary syndrome (HCPS) has a mortality up to 35-40% and its treatment is mainly supportive. A variable to predict progression from mild to severe disease is unavailable. This study was performed in patients with documented infection by Andes orthohantavirus, and the aim was to find a simple variable to predict progression to moderate/severe HCPS in patients with mild disease at admission. Methods: We performed a retrospective analysis of 175 patients between 2001 and 2018. Patients were categorized into mild, moderate, and severe disease according to organ failure and advanced support need at hospital admission (e.g., mechanical ventilation, vasopressors). Progression to moderate/severe disease was defined accordingly. Clinical and laboratory variables associated with progression were explored. Results: Forty patients with mild disease were identified; 14 of them progressed to moderate/severe disease. Only platelet count was different between those who progressed versus those that did not (37 (34-58) vs. 83 (64-177) K/mm(3), p < 0.001). A ROC curve analysis showed an AUC = 0.889 (0.78-1.0) p < 0.001, with a platelet count greater than 115K /mm(3) ruling out progression to moderate/severe disease. Conclusions: In patients with mild disease at presentation, platelet count could help to define priority of evacuation to tertiary care centers.