Clinical features of fatal cases of Chapare virus hemorrhagic fever originating from rural La Paz, Bolivia, 2019: A cluster analysis
Introduction
During the last years, the recognition and further understanding of infections due to the species belonging to the genus Mammarenavirus (arenavirus of mammals, formerly just Arenavirus) [1,2], has significantly improved worldwide [[3], [4], [5]]. In many countries of South America and abroad, the amplitude and the magnitude of Mammarenavirus outbreaks has been increasing and detected due to the advent of metagenomic and metatranscriptomic approaches that have resulted in the identification of an outstanding number of novel viruses [4,6], including the Mammarenaviruses of Bolivia, such as Machupo (MACV), Latino (LATV) and Chapare (CHAPV) [1,7,8].
However, the number of studies in certain countries, are still limited. In Bolivia, South America, there are less than 30 studies published about arenavirus in any field of knowledge [7,9,10]. These arenavirus in Bolivia mainly cause the Bolivian hemorrhagic fever (BHF) or Machupo hemorrhagic fever (ICD-10 A96.1 – ICD-11 1D61.1), that was firstly identified in 1959 as a sporadic hemorrhagic illness in rural areas of Beni department. BHF is a potentially severe febrile illness caused by MACV (a member of the family Arenaviridae in the New World) [1]. Clusters of BHF patients were noted the same year and by 1962, BHF was recognized as a new epidemic infectious disease. In 1963, the etiological agent was isolated from patients with acute hemorrhagic fever in San Joaquin (Mamoré province) [7].
Close to 2000 cases of BHF have been reported since 1959 [7], but in 2003, a small focus of apparently BHF cases, three presenting with hemorrhagic fever symptoms and cardiopulmonary compromise in the rural community of Samusaveti, near Cochabamba, led to the reporting of a new different virus years later [8]. RT-PCR analysis from samples of one fatal case and subsequent analysis of the complete virus S and L RNA segment sequences identified the virus as a member of the New World Clade B arenaviruses, which includes all the pathogenic South American arenaviruses. The virus was shown to be most closely related to Sabiá virus (SBAV), but with 26% and 30% nucleotide difference in the S and L segments, and 26%, 28%, 15% and 22% amino acid differences for the L, Z, N, and GP proteins, respectively, indicating that this virus represented a newly discovered arenavirus, for which authors proposed the name of Chapare virus (CHAPV), the name of both the province in Cochabamba department and the nearby river in the region of the initial cases [1,8]. The phylogenetic relationship between SBAV and CHAPV has been later independently confirmed [11].
The described patient with confirmed CHAPV infection, presented fever, headache, arthralgia, myalgia and vomiting with subsequent deterioration and multiple hemorrhagic signs and death after 14 days post onset [8]. As occurred with BHF due to MACV and another rodent-borne viral zoonosis, such as Orthohantavirus, that patient was a farmer [7,8,12,13].
Bolivian Mammarenavirus such as MACV, LATV and CHAPV present a complex ecoepidemiology, particularly related to the maintenance by rodents [4,7,8,14,15]. Mammarenavirus in South America are associated with rodent hosts such as Oryzomys and Calomys. The last one, also associated with Orthohantaviruses in Bolivia and border countries [4,13]. However, so far although for MACV and LATV, the rodent reservoirs have been established, C. callosus, this is not the case yet for CHAPV [4].
In this context, during May–June 2019, a cluster of five cases, two of them CHAPV-laboratory confirmed, three of them with fatal outcomes, occurred in rural areas of La Paz department. Herein, we report the main clinical findings, epidemiological features and the potential ecological aspects of them.
Section snippets
Methods
Bolivia is a South American country constituted by nine departments (main administrative level), 112 provinces (second administrative level) and 337 municipalities (third administrative level) (Fig. 1). The territory presents climatic, geographic, and epidemiological conditions suitable for the transmission of many zoonotic and vector-borne diseases (Fig. 1). Rodent reservoirs of Mammarenaviruses are widely distributed over most of the departments, constituting large areas where environmental
Results
During 2019, a total of five cases were diagnosed and hospitalized at rural and urban areas in the municipality of Caranavi, Caranavi province, La Paz department, and La Paz capital city, Bolivia (Fig. 1). The median age of patients was 42 y-old (IQR 25–45), four of them were male. Index patient (Case 1) was a rice and coffee farmer at the rural areas of the municipality of Guanay, Larecaja province and Alto Beni, Caranavi province (Fig. 1). This first case, a 64 y-old male, was attended at the
Discussion
Previously known as Arenavirus [18], the genus Mammarenavirus (renamed in 2012) [6], is part of one of the 12 accepted families of the order Bunyavirales, the family Arenaviridae [19]. In that order, another group of rodent-associated zoonotic viruses or roboviruses (rodent-borne viruses), is also included [3], the family Hantaviridae [13]. This family compromises the genus Orthohantavirus (formerly Hantavirus) [20] that contain the Laguna Negra Virus (LANV) orthohantavirus and Bermejo (BMJV)
Funding source
Universidad Franz Tamayo, Cochabamba, Bolivia. Study sponsors had no role in the study design, in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.
Ethical approval
Approval was not required.
CRediT authorship contribution statement
Juan Pablo Escalera-Antezana: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing - review & editing. Omar J. Rodriguez-Villena: Formal analysis, Investigation, Methodology, Visualization, Writing - review & editing. Ariel Weimar Arancibia-Alba: Formal analysis, Investigation, Methodology, Visualization, Writing - review & editing. Lucia Elena Alvarado-Arnez: Data curation, Formal
Declaration of competing interest
All authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential.
Acknowledgments
To the Epidemiology Department of the Ministry of Health of Bolivia and the Caja Nacional de Salud for providing additional data of the patients and their laboratory results.
References (60)
- et al.
Mitigation of the global impact of Lassa fever: have we investigated enough about this Arenavirus? - a bibliometric analysis of Lassa Fever research
Trav Med Infect Dis
(2018) - et al.
Arenavirus genomics: novel insights into viral diversity, origin, and evolution
Curr Opin Virol
(2019) - et al.
Genetic diversity among Bolivian arenaviruses
Virus Res
(2009) - et al.
Orthohantavirus pulmonary syndrome in Santa Cruz and Tarija, Bolivia, 2018
Int J Infect Dis
(2020) - et al.
Detection of Latino virus (Arenaviridae: mammarenavirus) naturally infecting Calomys callidus
Acta Trop
(2018) - et al.
Hantavirus infections
Clin Microbiol Infect
(2019) - et al.
Laguna Negra virus associated with HPS in western Paraguay and Bolivia
Virology
(1997) - et al.
Brazil burning! What is the potential impact of the Amazon wildfires on vector-borne and zoonotic emerging diseases? - a statement from an international experts meeting
Trav Med Infect Dis
(2019) - et al.
Astrocyte response to Junin virus infection
Neurosci Lett
(2008) - et al.
Medical treatment of an Ebola-infected doctor--ethics over costs?
Lancet
(2015)
Hantavirus pulmonary syndrome-related virus from Bolivia
Lancet
A review of Lassa fever vaccine candidates
Curr Opin Virol
Ribavirin for the treatment of Lassa fever: a systematic review and meta-analysis
Int J Infect Dis
Arenaviruses other than Lassa virus
Antivir Res
Taxonomy of the family Arenaviridae and the order Bunyavirales: update 2018
Arch Virol
Review of mammarenavirus biology and replication
Front Microbiol
Rodent reservoirs of zoonotic viral hemorrhagic fevers in Venezuela
Acta Científica Estud
New World arenavirus biology
Annu Rev Virol
Organisms of concern but not foodborne or confirmed foodborne: Bolivian hemorrhagic fever virus (Machupo virus). Reference module in food science
Chapare virus, a newly discovered arenavirus isolated from a fatal hemorrhagic fever case in Bolivia
PLoS Pathog
Rodent control programmes in areas affected by Bolivian haemorrhagic fever
Bull World Health Organ
Bolivian hemorrhagic fever--El Beni Department, Bolivia, 1994
MMWR Morb Mortal Wkly Rep
Novel strain of Andes virus associated with fatal human infection, central Bolivia
Emerg Infect Dis
Infection of wild and laboratory animals with Machupo and Latino viruses
Bull World Health Organ
Leishmania amazonensis infections in Oryzomys acritus and Oryzomys nitidus from Bolivia
Am J Trop Med Hyg
Isolation of Machupo virus from wild rodent Calomys callosus
Am J Trop Med Hyg
Fiebres hemorrágicas por Arenavirus en Latinoamérica
Rev Salud Uninorte
Hantavirus human infections: a meta-analysis
Proc 8th Int Congr Infect Dis
Hantavirus infection with renal failure and proteinuria, Colorado, USA, 2019
Emerg Infect Dis
Hantavirus pulmonary syndrome in northwestern Argentina: circulation of Laguna Negra virus associated with Calomys callosus
Am J Trop Med Hyg
Cited by (31)
Understanding Sabiá virus infections (Brazilian mammarenavirus)
2022, Travel Medicine and Infectious DiseasePublic health implications of a new world arenavirus outbreak that occurred in Bolivia, 2019
2021, Travel Medicine and Infectious DiseasePotent inhibition of arenavirus infection by a novel fusion inhibitor
2021, Antiviral Research