Hantavirus Fever without Pulmonary Syndrome in Panama

Blas Armien Epidemiology and Microbiology, Gorgas Memorial Institute for Health Research, Panama City, Panama; Epidemiology, Ministry of Health, Panama City, Panama; Clinical Medicine, Social Security Health System, Panama City, Panama; Pulmonary Medicine, Santo Tomas Hospital, Panama City, Panama; Departments of Pathology, Biology, and Molecular Genetics and Microbiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Lovelace Respiratory Research Institute, Albuquerque, New Mexico

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Juan M. Pascale Epidemiology and Microbiology, Gorgas Memorial Institute for Health Research, Panama City, Panama; Epidemiology, Ministry of Health, Panama City, Panama; Clinical Medicine, Social Security Health System, Panama City, Panama; Pulmonary Medicine, Santo Tomas Hospital, Panama City, Panama; Departments of Pathology, Biology, and Molecular Genetics and Microbiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Lovelace Respiratory Research Institute, Albuquerque, New Mexico

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Carlos Muñoz Epidemiology and Microbiology, Gorgas Memorial Institute for Health Research, Panama City, Panama; Epidemiology, Ministry of Health, Panama City, Panama; Clinical Medicine, Social Security Health System, Panama City, Panama; Pulmonary Medicine, Santo Tomas Hospital, Panama City, Panama; Departments of Pathology, Biology, and Molecular Genetics and Microbiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Lovelace Respiratory Research Institute, Albuquerque, New Mexico

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Jamileth Mariñas Epidemiology and Microbiology, Gorgas Memorial Institute for Health Research, Panama City, Panama; Epidemiology, Ministry of Health, Panama City, Panama; Clinical Medicine, Social Security Health System, Panama City, Panama; Pulmonary Medicine, Santo Tomas Hospital, Panama City, Panama; Departments of Pathology, Biology, and Molecular Genetics and Microbiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Lovelace Respiratory Research Institute, Albuquerque, New Mexico

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Heydy Núñez Epidemiology and Microbiology, Gorgas Memorial Institute for Health Research, Panama City, Panama; Epidemiology, Ministry of Health, Panama City, Panama; Clinical Medicine, Social Security Health System, Panama City, Panama; Pulmonary Medicine, Santo Tomas Hospital, Panama City, Panama; Departments of Pathology, Biology, and Molecular Genetics and Microbiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Lovelace Respiratory Research Institute, Albuquerque, New Mexico

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Milagro Herrera Epidemiology and Microbiology, Gorgas Memorial Institute for Health Research, Panama City, Panama; Epidemiology, Ministry of Health, Panama City, Panama; Clinical Medicine, Social Security Health System, Panama City, Panama; Pulmonary Medicine, Santo Tomas Hospital, Panama City, Panama; Departments of Pathology, Biology, and Molecular Genetics and Microbiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Lovelace Respiratory Research Institute, Albuquerque, New Mexico

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José Trujillo Epidemiology and Microbiology, Gorgas Memorial Institute for Health Research, Panama City, Panama; Epidemiology, Ministry of Health, Panama City, Panama; Clinical Medicine, Social Security Health System, Panama City, Panama; Pulmonary Medicine, Santo Tomas Hospital, Panama City, Panama; Departments of Pathology, Biology, and Molecular Genetics and Microbiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Lovelace Respiratory Research Institute, Albuquerque, New Mexico

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Deyanira Sánchez Epidemiology and Microbiology, Gorgas Memorial Institute for Health Research, Panama City, Panama; Epidemiology, Ministry of Health, Panama City, Panama; Clinical Medicine, Social Security Health System, Panama City, Panama; Pulmonary Medicine, Santo Tomas Hospital, Panama City, Panama; Departments of Pathology, Biology, and Molecular Genetics and Microbiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Lovelace Respiratory Research Institute, Albuquerque, New Mexico

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Yaxelis Mendoza Epidemiology and Microbiology, Gorgas Memorial Institute for Health Research, Panama City, Panama; Epidemiology, Ministry of Health, Panama City, Panama; Clinical Medicine, Social Security Health System, Panama City, Panama; Pulmonary Medicine, Santo Tomas Hospital, Panama City, Panama; Departments of Pathology, Biology, and Molecular Genetics and Microbiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Lovelace Respiratory Research Institute, Albuquerque, New Mexico

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Brian Hjelle Epidemiology and Microbiology, Gorgas Memorial Institute for Health Research, Panama City, Panama; Epidemiology, Ministry of Health, Panama City, Panama; Clinical Medicine, Social Security Health System, Panama City, Panama; Pulmonary Medicine, Santo Tomas Hospital, Panama City, Panama; Departments of Pathology, Biology, and Molecular Genetics and Microbiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Lovelace Respiratory Research Institute, Albuquerque, New Mexico

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Frederick Koster Epidemiology and Microbiology, Gorgas Memorial Institute for Health Research, Panama City, Panama; Epidemiology, Ministry of Health, Panama City, Panama; Clinical Medicine, Social Security Health System, Panama City, Panama; Pulmonary Medicine, Santo Tomas Hospital, Panama City, Panama; Departments of Pathology, Biology, and Molecular Genetics and Microbiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Lovelace Respiratory Research Institute, Albuquerque, New Mexico

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In Panama, hantavirus pulmonary syndrome (HPS) is caused by Choclo virus, a species phylogenetically related to Andes and Maporal viruses. Up to 60% of the population has been positive for specific serum antibody in community-based surveys, but mortality is very uncommon. In four western Panama clinics, we tested individuals presenting with a severe febrile prodrome for acute hantavirus (HV) infection by immunoglobulin M enzyme-linked immunosorbent assay and reverse transcription polymerase chain reaction as well as clinically similar infections, such as dengue and leptospirosis. From 2006 to 2009, at least 21% of 117 patients diagnosed with HV infection had HV Fever (HF) with no evidence of pulmonary edema (no respiratory distress or radiographic lung infiltrates), and 44% of patients had very mild HPS (radiographic pulmonary edema but no respiratory insufficiency). HV infection caused by Choclo virus in Panama presents often as HF, which contrasts with HV in the Americas but is consistent with the high seroprevalence in endemic regions.

Author Notes

* Address correspondence to Frederick Koster, Lovelace Respiratory Research Institute, 2425 Ridgecrest Drive SE, Albuquerque, NM 87108. E-mail: fkoster@lrri.org

Financial support: This study was supported by an Opportunity Pool Award and supplement from the International Centers for Infectious Diseases Research program of the National Institutes of Health (U19-AI 45452); funds from Instituto Conmemorativo Gorgas de Estudios de la Salud, Hantavirus Research Project 04-90-0075-8; the Ministry of Health, Panama; and Secretaria Nacional de Ciencia y Tecnología, Innovation and Technology Program ftd06-089.

Authors' addresses: Blas Armien, Epidemiology, Gorgas Memorial Institute for Health Research, Panama City, Panama, E-mail: barmien@gorgas.gob.pa. Juan M. Pascale and Yaxelis Mendoza, Microbiology, Gorgas Memorial Institute for Health Research, Panama City, Panama, E-mails: jmpascal@yahoo.com and ymendoza@gorgas.gob.pa. Carlos Muñoz, Jamileth Mariñas, and Deyanira Sánchez, Epidemiology, Ministry of Health, Panama City, Panama, E-mails: cbmunozg@cableonda.net, drajamilethm@gmail.com, and deyaluly@hotmail.com. Heydy Núñez and Milagro Herrera, Clinical Medicine, Social Security Health System, Panama City, Panama, E-mails: hmnm07@hotmail.com and dramherrera@yahoo.es. José Trujillo, Pulmonary Medicine, Santo Tomas Hospital, Panama City, Panama, E-mail: jmtmrt14@cableonda.net. Brian Hjelle, Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM, E-mail: bhjelle@salud.unm.edu. Frederick Koster, Lovelace Respiratory Research Institute, Albuquerque, NM, E-mail: fkoster@lrri.org.

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