Hantavirus pulmonary syndrome in Southern Argentina

Fil: Resa, Amanda J. Hospital de Area El Bolsón; Argentina.Fil: Barclay, Carlos M. Sanatorio San Carlos; Argentina.Fil: Calanni, Liliana. Hospital Provincial de Neuquén; Argentina.Fil: Samengo, Luis. Hospital Zonal Bariloche; Argentina.Fil: Lazaro, María Ester. Hospital Zonal Bariloche; Argentina.Fil: Martinez, Lucia. Hospital Zonal Bariloche; Argentina.Fil: Padula, Paula. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Pini, Noemi. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Virales Humanas; Argentina,Fil: Lasala, María Beatriz. Universidad de Buenos Aires. Hospital de Clínicas José de San Martín; Argentina.Fil: Elsner, Boris. Universidad de Buenos Aires. Hospital de Clínicas José de San Martín; Argentina.Fil: Enria, Delia. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Virales Humanas; Argentina,Fil: Resa, Amanda J. Hospital de Area El Bolsón; Argentina.Fil: Barclay, Carlos M. Sanatorio San Carlos; Argentina.Fil: Calanni, Liliana. Hospital Provincial de Neuquén; Argentina.Fil: Samengo, Luis. Hospital Zonal Bariloche; Argentina.Fil: Lazaro, María Ester. Hospital Zonal Bariloche; Argentina.Fil: Martinez, Lucia. Hospital Zonal Bariloche; Argentina.Fil: Padula, Paula. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Pini, Noemi. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Virales Humanas Dr. Julio Maiztegui; Argentina.Fil: Lasala, María Beatriz. Universidad de Buenos Aires. Hospital de Clínicas José de San Martín; Argentina.Fil: Elsner, Boris. Universidad de Buenos Aires. Hospital de Clínicas José de San Martín; Argentina.Fil: Enria, Delia. Instituto Nacional de Enfermedades Virales Humanas Dr. Julio Maiztegui; Argentina.El virus Andes fue identificado en 1995 como el agente etiológico del Síndrome Pulmonar por Hantavirus (SPH) en la región surandina argentina. En este trabajo describimos la presentación clínica de 25 casos de SPH confirmados adquiridos en la zona entre 1993 y septiembre de 1999. La edad media fue de 34 años (rango 11-70) y el 72% eran varones. Las características clínicas fueron similares a las referidas para el virus Sin Nombre (VSN), con algunas diferencias: se presentó inyección conjuntival en 10 casos (42%), rubicundez facial en 8 (33%), fauces congestivas en 7 (29%) y petequias en 3 casos (12%). El laboratorio mostró urea plasmática elevada en 83% de los casos (media 0.77 g/l; rango 0.31-2.01) y en el 56% la creatininemia superó 20 mg/l (media 26.8 mg/l; rango: 9.6-110); en 12/12 pacientes el sedimento urinario fue patológico con proteinuria, hematuria y cilindros granulosos. Las transaminasas, elevadas en el 90% de los casos, superaron 5-10 veces su valor normal en el 50% de los pacientes. La creatinfosfoquinasa estuvo elevada en 11/14 casos. Dos pacientes requirieron hemodiálisis. Se observó miocarditis mononuclear en dos casos, un hallazgo no descripto para VSN. La letalidad fue del 44% y diez pacientes fallecieron dentro de los primeros 10 días de enfermedad. Durante el brote de SPH por virus Andes en 1996 hubo evidencias epidemiológicas y moleculares de transmisión interpersonal no demostrada hasta entonces para otros miembros del género hantavirus. Estos datos muestran algunas diferencias clínicas del SPH por virus Andes con mayor frecuencia de compromiso renal que el descripto para el VSN

Clusters of Hantavirus Infection, Southern Argentina

Person-to-person transmission should be suspected when Andes virus case-patients are linked

Clusters of Hantavirus Infection, Southern Argentina

Fil: Lazaro, María Ester. Hospital Zonal Bariloche; Rio Negro, Argentina.Fil: Cantoni, Gustavo. Unidad Regional de Epidemiología y Salud Ambienta; Rio Negro, Argentina.Fil: Calanni, Liliana. Hospital Castro Rendón; Neuquén, Argentina.Fil: Resa, Amanda J. Hospital de área El Bolsón; Rio Negro, Argentina.Fil: Herrero, Eduardo. Unidad Regional de Epidemiología y Salud Ambienta; Rio Negro, Argentina.Fil: Iacono, Marisa A. Hospital Castro Rendón; Neuquen, Argentina.Fil: Enria, Delia. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Virales Humanas; Argentina.Fil: Cappa, Stella M. González. Universidad de Buenos Aires; Argentina.Person-to-person transmission of a hantavirus was first confirmed during a 1996 outbreak of hantavirus pul- monary syndrome in southern Argentina, where Andes virus is endemic. To identify other episodes of secondary transmission, we reviewed reports of 51 cases of han- tavirus infection from this region (November 1993–June 2005). Nine clusters involving 20 cases (39.2%) were found. Two patients, who had symptoms 3 weeks after they shared risks for rodent exposure, were considered a clus- ter. The other 8 clusters each began with an index case, which was almost always fatal, followed 19–40 days later by the illness of at least 1 person who had close and pro- longed contact with the index case-patient. Person-to-per- son transmission was considered the probable source of these 8 clusters. The probability of initiating secondary cases was 41% for patients who died versus 4% for those who survived (p = 0.005). Interpersonal transmission of Andes virus infection should be considered even when rodent exposure cannot be definitively excluded

Clusters of Hantavirus Infection, Southern Argentina

Fil: Lazaro, María Ester. Hospital Zonal Bariloche; Rio Negro, Argentina.Fil: Cantoni, Gustavo. Unidad Regional de Epidemiología y Salud Ambienta; Rio Negro, Argentina.Fil: Calanni, Liliana. Hospital Castro Rendón; Neuquén, Argentina.Fil: Resa, Amanda J. Hospital de área El Bolsón; Rio Negro, Argentina.Fil: Herrero, Eduardo. Unidad Regional de Epidemiología y Salud Ambienta; Rio Negro, Argentina.Fil: Iacono, Marisa A. Hospital Castro Rendón; Neuquen, Argentina.Fil: Enria, Delia. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Virales Humanas; Argentina.Fil: Cappa, Stella M. González. Universidad de Buenos Aires; Argentina.Person-to-person transmission of a hantavirus was first confirmed during a 1996 outbreak of hantavirus pul- monary syndrome in southern Argentina, where Andes virus is endemic. To identify other episodes of secondary transmission, we reviewed reports of 51 cases of han- tavirus infection from this region (November 1993–June 2005). Nine clusters involving 20 cases (39.2%) were found. Two patients, who had symptoms 3 weeks after they shared risks for rodent exposure, were considered a clus- ter. The other 8 clusters each began with an index case, which was almost always fatal, followed 19–40 days later by the illness of at least 1 person who had close and pro- longed contact with the index case-patient. Person-to-per- son transmission was considered the probable source of these 8 clusters. The probability of initiating secondary cases was 41% for patients who died versus 4% for those who survived (p = 0.005). Interpersonal transmission of Andes virus infection should be considered even when rodent exposure cannot be definitively excluded

Hantavirus pulmonary syndrome in Southern Argentina

Fil: Resa, Amanda J. Hospital de Area El Bolsón; Argentina.Fil: Barclay, Carlos M. Sanatorio San Carlos; Argentina.Fil: Calanni, Liliana. Hospital Provincial de Neuquén; Argentina.Fil: Samengo, Luis. Hospital Zonal Bariloche; Argentina.Fil: Lazaro, María Ester. Hospital Zonal Bariloche; Argentina.Fil: Martinez, Lucia. Hospital Zonal Bariloche; Argentina.Fil: Padula, Paula. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Pini, Noemi. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Virales Humanas; Argentina,Fil: Lasala, María Beatriz. Universidad de Buenos Aires. Hospital de Clínicas José de San Martín; Argentina.Fil: Elsner, Boris. Universidad de Buenos Aires. Hospital de Clínicas José de San Martín; Argentina.Fil: Enria, Delia. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Virales Humanas; Argentina,Fil: Resa, Amanda J. Hospital de Area El Bolsón; Argentina.Fil: Barclay, Carlos M. Sanatorio San Carlos; Argentina.Fil: Calanni, Liliana. Hospital Provincial de Neuquén; Argentina.Fil: Samengo, Luis. Hospital Zonal Bariloche; Argentina.Fil: Lazaro, María Ester. Hospital Zonal Bariloche; Argentina.Fil: Martinez, Lucia. Hospital Zonal Bariloche; Argentina.Fil: Padula, Paula. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Pini, Noemi. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Virales Humanas Dr. Julio Maiztegui; Argentina.Fil: Lasala, María Beatriz. Universidad de Buenos Aires. Hospital de Clínicas José de San Martín; Argentina.Fil: Elsner, Boris. Universidad de Buenos Aires. Hospital de Clínicas José de San Martín; Argentina.Fil: Enria, Delia. Instituto Nacional de Enfermedades Virales Humanas Dr. Julio Maiztegui; Argentina.El virus Andes fue identificado en 1995 como el agente etiológico del Síndrome Pulmonar por Hantavirus (SPH) en la región surandina argentina. En este trabajo describimos la presentación clínica de 25 casos de SPH confirmados adquiridos en la zona entre 1993 y septiembre de 1999. La edad media fue de 34 años (rango 11-70) y el 72% eran varones. Las características clínicas fueron similares a las referidas para el virus Sin Nombre (VSN), con algunas diferencias: se presentó inyección conjuntival en 10 casos (42%), rubicundez facial en 8 (33%), fauces congestivas en 7 (29%) y petequias en 3 casos (12%). El laboratorio mostró urea plasmática elevada en 83% de los casos (media 0.77 g/l; rango 0.31-2.01) y en el 56% la creatininemia superó 20 mg/l (media 26.8 mg/l; rango: 9.6-110); en 12/12 pacientes el sedimento urinario fue patológico con proteinuria, hematuria y cilindros granulosos. Las transaminasas, elevadas en el 90% de los casos, superaron 5-10 veces su valor normal en el 50% de los pacientes. La creatinfosfoquinasa estuvo elevada en 11/14 casos. Dos pacientes requirieron hemodiálisis. Se observó miocarditis mononuclear en dos casos, un hallazgo no descripto para VSN. La letalidad fue del 44% y diez pacientes fallecieron dentro de los primeros 10 días de enfermedad. Durante el brote de SPH por virus Andes en 1996 hubo evidencias epidemiológicas y moleculares de transmisión interpersonal no demostrada hasta entonces para otros miembros del género hantavirus. Estos datos muestran algunas diferencias clínicas del SPH por virus Andes con mayor frecuencia de compromiso renal que el descripto para el VSN

A small cluster randomised clinical trial to improve health outcomes among Argentine patients disengaged from HIV care

BACKGROUND: Patients disengaged from HIV care, e.g., missed medication pick-ups, not attending physician visits, account for ≥70% of new HIV infections. Re-engaging and sustaining engagement is essential to controlling the HIV pandemic. This study tested a physician-delivered evidence-based intervention, Motivational Interviewing (MI), to improve health outcomes, adherence to antiretroviral therapy (ART), HIV virologic suppression, CD(4)+ count, retention in HIV care, and self-efficacy among patients disengaged from care in Argentina. METHODS: Regional clinics (n = 6) were randomised to condition, MI Intervention or Enhanced Standard of Care (ESOC), and recruited N = 360 patients disengaged from HIV care. ART adherence, HIV RNA viral load, CD(4)+ count retention, and self-efficacy were assessed at baseline, 6, 12, 18, and 24-months. Indirect effects from condition to main outcomes were examined using patient–provider relationship as a mediator. The study was a cluster-randomised clinical trial entitled Conexiones y Opciones Positivas en la Argentina 2 (COPA(2)) and was registered at clinicaltrials.gov, NCT02846350. FINDINGS: Participants were an average age of 39·15 (SD = 10·96), 51% were women; intervention participants were older (p = ·019), and more ESOC participants were women (60% vs. 42%, p = 0·001). Using mixed models, the intervention had no effect on ART adherence over time by condition on HIV RNA viral load, CD(4)+ count retention, or self-efficacy. However, analysing mediated paths, there was an indirect effect of condition on ART adherence (B = 0·188, p = 0·009), HIV viral load (B = −0·095, P = 0·027), and self-efficacy (B = 0·063, P = 0·001), suggesting the intervention was associated with improved patient–provider relationships, which was in turn associated with increased ART adherence, lower HIV viral load, and higher self-efficacy. INTERPRETATION: These findings suggest that physician-delivered MI may enhance the patient-provider relationship, self-efficacy, and ART adherence, and reduced HIV viral load in patients disengaged from HIV care. However, these findings are preliminary due to the small number of clusters randomised, and replication is warranted. FUNDING: National Institutes of Health

Cumulative Burden of Mental Health Factors and Engagement in HIV Care in Argentina

Cumulative burden of multiple mental health conditions may worsen physical health outcomes in vulnerable populations. Accordingly, identifying cumulative burdens of mental health conditions that may affect HIV treatment and care can guide public health strategies to reduce their impact on HIV-related health outcomes. This study examined the relationship between the cumulative burden of mental health conditions and factors associated with engagement in HIV care in Argentina. Data for this study was obtained at baseline from Conexiones y Opciones Positivas en la Argentina 2 (COPA2). Participants (N = 360) were cisgender patients living with HIV who were lost to care, recruited from seven clinics serving people living with HIV in four Argentine urban centers. Cumulative burden of mental health conditions (i.e., depressive symptoms, problematic substance use, unhealthy alcohol use, and psychotic symptoms) was assessed. Every one-point increase in the number of mental health conditions present was associated with a decrement in patient-provider communication (b = - 0.22, p < .001), self-efficacy (b = - 0.13, p = .012), and motivation for adherence (b = - 0.11, p = .039). This study found cumulative burden of depression, problematic substance use, unhealthy alcohol use, and psychotic symptoms to be negatively associated with factors related to engagement in HIV care. Results highlight the importance of identification and treatment of challenges to mental health, in order to ameliorate their influence on engagement in HIV care