Volume 89, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



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.


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  1. Jonsson CB, Figueiredo JL, Vapalahti O, , 2010. A global perspective on hantavirus ecology, epidemiology, and disease. Clin Microbiol Rev 23: 412441.[Crossref] [Google Scholar]
  2. Vincent MJ, Quiroz E, Gracia F, Sanchez AJ, Ksiazek TG, Kitsutani PT, Ruedas LA, Tinnin DS, Caceres L, Garcia A, Rollin PE, Mills JN, Peters CJ, Nichol ST, , 2000. Hantavirus pulmonary syndrome in Panama: identification of novel hantaviruses and their likely reservoirs. Virology 277: 1419.[Crossref] [Google Scholar]
  3. Bayard V, Kitsutani PT, Barria EO, Ruedas LA, Tinnin DS, Munoz C, de Mosca IB, Guerrero G, Kant R, Garcia A, Caceres L, Gracia F, Quiroz E, de Castillo Z, Armien B, Libel M, Mills JN, Khan AS, Nichol ST, Rollin PE, Ksiazek TG, Peters CJ, , 2004. Outbreak of hantavirus pulmonary syndrome, Los Santos, Panama, 1999–2000. Emerg Infect Dis 10: 16351642.[Crossref] [Google Scholar]
  4. Armien AG, Armien B, Koster FT, Pascale JM, Avila M, Gonzalez P, de la Cruz M, Zaldivar Y, Mendoza Y, Gracia F, Hjelle B, Lee SJ, Yates TL, Salazar-Bravo J, , 2009. Hantavirus infection and habitat associations among rodent populations in agroecosystems of Panama: implications for human disease risk. Am J Trop Med Hyg 81: 5966. [Google Scholar]
  5. Nelson R, Canate R, Pascale JM, Dragoo JW, Armien B, Armien AG, Koster F, , 2010. Confirmation of Choclo virus as the cause of hantavirus cardiopulmonary syndrome and high serum antibody prevalence in Panama. J Med Virol 70: 22892295. [Google Scholar]
  6. Salazar-Bravo J, Armien B, Suzan G, Armien A, Ruedas LA, Avila M, Zaldivar Y, Pascale JM, Gracia F, Yates TL, , 2004. Serosurvey of wild rodents for hantaviruses in Panama, 2000–2002. J Wildl Dis 40: 103109.[Crossref] [Google Scholar]
  7. Armien B, Pascale JM, Bayard V, Munoz C, Mosca I, Guerrero G, Armien A, Quiroz E, Castillo Z, Zaldivar Y, Gracia F, Hjelle B, Koster F, , 2004. High seroprevalence of hantavirus infection on the Azuero peninsula of Panama. Am J Trop Med Hyg 70: 682687. [Google Scholar]
  8. Armien B, Pascale JM, Munoz C, Lee S-J, Choi KL, Avila M, Broce C, Armien AG, Gracia F, Hjelle B, Koster F, , 2011. Incidence rate for hantavirus infections without pulmonary syndrome, Panama. Emerg Infect Dis 17: 19361939.[Crossref] [Google Scholar]
  9. Ferrer JF, Jonsson CB, Esteban E, Galligan D, Basombrio MA, Peralta-Ramos M, Bharadwaj M, Torrez-Martinez N, Callahan J, Segovia A, Hjelle B, , 1998. High prevalence of hantavirus infection in Indian communities of the Paraguayan and Argentinean Gran Chaco. Am J Trop Med Hyg 59: 438444. [Google Scholar]
  10. Campos GM, Moro de Sousa RL, Badra SJ, Pane C, Gomes UA, Figueiredo LT, , 2003. Serological survey of hantavirus in Jardinopolis County, Brazil. J Med Virol 71: 417422.[Crossref] [Google Scholar]
  11. Mendes WS, da Silva AAM, Aragao LFC, Aragao NJL, Raposo M de L, Elkhoury MR, Suzuky A, Ferreira IB, de Sousa LT, Pannuti CS, , 2004. Hantavirus infection in Anajatuba, Maranhao, Brazil. Emerg Infect Dis 10: 14961498.[Crossref] [Google Scholar]
  12. Raboni SM, Delfraro A, de Borba L, Teixeira BR, Stella V, de Araujo MR, Carstensen S, Rubio G, Maron A, Lemos ER, D'Andrea PS, Duarte dos Santos CN, , 2012. Hantavirus infection prevalence in wild rodents and human anti-hantavirus serological profiles from different geographic areas of South Brazil. Am J Trop Med Hyg 87: 371378.[Crossref] [Google Scholar]
  13. Levis S, Rowe JE, Morzunov S, Enria DA, St. Joan S, , 1997. New hantaviruses causing hantavirus pulmonary syndrome in Central Argentina [letter]. Lancet 349: 998999.[Crossref] [Google Scholar]
  14. Castillo HC, Sanhueza HL, Tager FM, Munoz NS, Ossa AG, Vial CP, , 2002. Seroprevalence of antibodies against hantavirus in 10 communities of the IX region of Chile where hantavirus cardiopulmonary syndrome cases were reported. Rev Med Chil 130: 110. [Google Scholar]
  15. Hjelle B, Jenison S, Torrez-Martinez N, Herring B, Quan S, Polito A, Pichuantes S, Yamada T, Morris C, Eigh F, Lee HW, Artsob H, Dinello R, , 1997. Rapid and specific detection of Sin Nombre virus antibodies in patients with hantavirus pulmonary syndrome by a strip immunoblot assay suitable for field diagnosis. J Clin Microbiol 35: 600608. [Google Scholar]
  16. Feldmann H, Sanchez A, Morzunov S, Spiropoulou CF, Rollin PE, Ksiazek TG, Peters CJ, Nichol ST, , 1993. Utilization of autopsy RNA for the synthesis of the nucleocapsid antigen of a newly recognized virus associated with hantavirus pulmonary syndrome. Virus Res 30: 351367.[Crossref] [Google Scholar]
  17. Cardona MN, Moros RM, Lopez EA, Perez JL, Hernandez RC, , 2008. Diagnostico de leptospirosis mediante la PCR en pacientes con sindrome febril icterohemorragico. Rev Soc Venez Microbiol 28: 2430. [Google Scholar]
  18. Zavasky DM, Hjelle B, Peterson MC, Denton RW, Reimer L, , 1999. Acute infection with Sin Nombre hantavirus without pulmonary complications. Clin Infect Dis 29: 664666.[Crossref] [Google Scholar]
  19. Kitsutani PT, Denton RW, Fritz CL, Murray RA, Todd RL, Pape WJ, Wyatt Frampton J, Young JC, Khan AS, Peters CJ, Ksiazek TG, , 1999. Acute Sin Nombre hantavirus infection without pulmonary syndrome, United States. Emerg Infect Dis 5: 701705.[Crossref] [Google Scholar]
  20. Galeno H, Mora J, Villagra E, Fernandez J, Hernandez J, Mertz GJ, Ramirez E, , 2002. First human isolate of hantavirus (Andes virus) in the Americas. Emerg Infect Dis 8: 657661.[Crossref] [Google Scholar]
  21. Bruce MG, Sanders EJ, Leake JA, Zaidel O, Bragg SL, Aye T, Shutt KA, Deseda CC, Rigau-Perez JG, Tappero JW, Perkins BA, Spiegel RA, Ashford DA, , 2005. Leptospirosis among patients presenting with dengue-like illness in Puerto Rico. Acta Trop 96: 3646.[Crossref] [Google Scholar]
  22. Ellis T, Imrie A, Katz AR, Effler PV, , 2008. Underrecognition of leptospirosis during a dengue fever outbreak in Hawaii, 2001–2002. Vector Borne Zoonotic Dis 8: 541547.[Crossref] [Google Scholar]
  23. Koster F, Foucar K, Hjelle B, Scott A, Chong Y-Y, Larson R, McCabe M, , 2011. Rapid presumptive diagnosis of hantavirus cardiopulmonary syndrome by peripheral blood smear review. Am J Clin Pathol 116: 665672.[Crossref] [Google Scholar]
  24. Gavrilovskaya IN, Shepley M, Shaw R, Ginsberg MH, Mackow ER, , 1998. Beta3 integrins mediate the cellular entry of hantaviruses that cause respiratory failure. Proc Natl Acad Sci USA 95: 70747079.[Crossref] [Google Scholar]
  25. Hooper JW, Larsen T, Custer DM, Schmaljohn CS, , 2001. A lethal disease model for hantavirus pulmonary syndrome. Virology 289: 614.[Crossref] [Google Scholar]
  26. Campen MJ, Milazzo ML, Fulhorst CF, Obot Akata CJ, Koster F, , 2006. Characterization of shock in a hamster model of hantavirus infection. Virology 356: 4549.[Crossref] [Google Scholar]
  27. Matthys VS, Gorbunova EE, Gavrilovskaya IN, Mackow ER, , 2010. Andes virus recognition of human and Syrian hamster beta3-integrins is determined by an L33P substitution in the PSI domain. J Virol 84: 352360.[Crossref] [Google Scholar]
  28. Eyraguirre EJ, Milazzo ML, Koster FT, Fulhorst CF, , 2008. Choclo virus infection in the Syrian golden hamster. Am J Trop Med Hyg 78: 669674. [Google Scholar]
  29. Suzan G, Marce E, Giermakowski JT, Armien B, Pascale J, Mills J, Ceballos G, Gomez A, Aguirre AA, Salazar-Brazo J, Armien A, Parmenter R, Yates T, , 2008. The effect of habitat fragmentation and species diversity loss on hantavirus prevalence in Panama. Ann N Y Acad Sci 1149: 8083.[Crossref] [Google Scholar]
  30. Suzan G, Marce E, Giermakowski JT, Mills JN, Ceballos G, Ostfeld RS, Armien B, Pascale JM, Yates TL, , 2009. Experimental evidence for reduced rodent diversity causing increased hantavirus prevalence. PLoS One 4: e5461.[Crossref] [Google Scholar]

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  • Received : 22 May 2012
  • Accepted : 21 May 2013
  • Published online : 04 Sep 2013

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