We report the case of a previously healthy 36-year-old man who consulted and was admitted to the Hospital de Castro, Isle of Chiloé, Chile, on August 2006.
The patient had a clinical picture of 4 days of evolution with fever, severe myalgia, malaise, nausea, abdominal pain and disorientation.
The chest X-ray at admission was normal.
The evolution was unfavorable, with important and progressive thrombocytopenia, hemoconcentration, alteration of liver tests and elevation of total CK.
Due to the antecedent of ingestion of pork meat, it was decided to use the trichile.
On the second day, there was a progressive worsening, adding illiteracy in August 2006, respiratory shock in Puerto Montt, hemodynamic reason for the intuition and admission to the Intensive Care Unit (ICU) of the Hospital.
After reviewing the series of chest X-rays, it was observed that in a second plaque taken prior to transfer, there were tenuous bilateral pulmonary infiltrates in patches.
He suffered sepsis and HPS.
Blood cultures were taken and ceftriaxone and cloxacillin IV were started.
The patient was connected to mechanical ventilation and was managed with vasoactive drugs through a central venous line.
The patient had fever up to 40.2°C and oligoanuria.
She died 4 hours after admission to the ICU.
Laboratory: Tests at admission and their evolution are described.
There was an increase in hematocrit from 41 to 46.7%, progressive thrombocytopenia from 82,000 to 21,700 x mm3, important left deviation (25-20% bacilliform) without leukocytosis, hyponatremia 133 mmol/L, third kidney failure
Total CK increased progressively from 190 (dL to 2,544 U/L (normal: 25-308), LDH increased from 437 to 2,544 U/L (normal: 100-190), and C-reactive protein measured on day three.
Total bilirubin increased from 3.22 to 5.92 mg/dL, with direct bilirubin 4.49.
GOT/AST increased from 66 to 2,471 U/L (normal: 15-37), GPT/ALT from 92 to 1,355 U/L (normal 30-65), and 79 prothrombin decreased from 326%.
Upon admission to the ICU, hyperkalemia 6.02, severe metabolic acidosis with pH 7.24 and 7.07, bicarbonate 8.6 and base excess 17.1 mmol/L, respiratory failure with PAFI 108 were observed.
Felineogen 591 mg/dL (normal lower 200), lactic acid mmol/L (normal 0.4-2), TTPK 48 seconds.
Urine examination showed proteinuria of 100 mg/dL and microhematuria with 10-15 red blood cells per field.
The presence of Hanta virus was confirmed at the University Austral, Valdivia, by serology IgG and IgM (+) by ELISA, using virus antigen Sin Nombre from the CentersforDiselanta North Georgia, Prevention
Two blood cultures were positive for Staphylococcus aureus methicillin-sensitive.
Serology for Leptospira: negative.
Agglutination reaction for typhoid and paratyphoid:
Necropsy: Male patient, 182 cm and 95 kg, lungs of 680 g each, edematous and bronchiectasis, with decreased crepitation and hemorrhagic areas on the surface.
Cutting revealed hemorrhagic areas with purulent content and areas of anthracosis.
Pleural cavities contained 100 ce of purulent citrine liquid.
The liver weighed 2900 g and at the cut was congestive and of decreased consistency.
Bazo 150 g, congestive and violet.
The right kidney was 70 g and the left kidney was 90 g. The predominant surface area was steroid-medullary without differentiation.
Peritoneum, stomach and intestine without injury.
Histological analysis revealed a lung parenchyma with extensive areas of intraalveolar hemorrhage, edema and multiple foci of bronchopneumonia and necrosis, small abscesses with colonies of Gram-positive bacteria (+) in
There was also hepatosplenic congestion and acute tubular necrosis in the kidneys.
At the University of São Paulo, Brazil, an immunohistochemical study was conducted to investigate the presence of Hantavirus antigens with the Sao conjugated lung technique with enzyme and secondary antibodies, the result of which was negative.
