Date: Sat 1 Dec 2018
Source: Pagina Siete [In Spanish, trans., edited]
<https://www.paginasiete.bo/sociedad/2018/12/1/sedes-reporta-1101-casos-positivos-de-leishmaniasis-201831.html>

The Departmental Health Service (SEDES) of La Paz reported yesterday [30 Nov 2018] that this year [2018], to date, 1101 positive cases of leishmaniasis have been reported. "We have 1101 cases reported and confirmed with a laboratory in the department of La Paz," said Gunder Gutierrez, head of the SEDES vector-borne diseases program. He recommended that people take preventive measures if they visit endemic areas, such as using repellents, wearing long-sleeved clothing and avoiding staying out in the open after sunset.

Gutierrez indicated that in the La Paz municipality of Ixiamas, where the Madidi National Park is located, this year [2018] 42 cases were reported, and this sector registered 2. He indicated that there would not be an epidemic in that sector, but if the vector issue is in that place.

According to the authority, to access the medication, patients have to meet a series of requirements, such as the clinical record, epidemiology and personal documents, among others. The Dermatology unit of the Hospital de Clinicas de La Paz reported on Thursday [29 Nov 2018] the outbreak of cases of leishmaniasis in the Madidi, a tourist site that is located in the northeast of the department of La Paz.

The specialists explain that the vector now adapts to the urban areas of the Yungas of La Paz. "We have cases of leishmaniasis in Arcopongo, Palos Blancos, Caranavi, La Asunta, Chulumani and others; in fact, from the Yungas of La Paz, but what is striking is that Madidi patients have begun to arrive," the chief of the Dermatology unit of the Hospital de Clinicas de La Paz, Sandra Encinas, said.

Encinas explained that the Hospital de Clinicas is the only place where the treatment for leishmaniasis is performed. "Before we had few patients, but now we register at least 15 a month," he said.
======================
[Leishmaniasis in Bolivia has been reviewed (Alvar J, Velez ID, Bern C, et al. Leishmaniasis worldwide and global estimates of its incidence. PLoS ONE 2012;7(5):e35671 <https://doi.org/10.1371/journal.pone.0035671>).

Bolivia has the highest incidence of cutaneous leishmaniasis (CL) in Latin America, with 33 cases per 100 000 population reported in 2006. In the department La Paz, the forest of the Yungas area is highly endemic for CL. Most CL cases are caused by _Leishmania braziliensis_, and 10% to 20% of all CL cases progress to mucosal leishmaniasis, more than anywhere else in the Americas, with the municipality of Palos Blancos in the Yungas region the most affected. In addition, 12% of dogs are seropositive in areas highly endemic for CL. - ProMED Mod.EP]

[HealthMap/ProMED-mail map:
Bolivia: <http://healthmap.org/promed/p/5>]
Date: Sun 14 Oct 2018
Source: El Periodico [in Spanish, trans., edited]
<http://elperiodico-digital.com/2018/10/14/confirman-9-casos-de-hantavirus-en-el-departamento-de-tarija/>

The Tarija Departmental Health Services (SEDES) reported the latest case of [a] hantavirus [infection] in Bermejo city, making a total of 9 confirmed cases so far in the 2018 term. Hantavirus [causes] an acute viral disease that is transmitted to humans via rats from their saliva, faeces and urine.

The responsible departmental head of the Chagas Program of SEDES, Eduardo Rueda, stated that to date in [2018], there are 28 suspected cases of hantavirus [infection] in Tarija, of which 9 were confirmed. "To date so far this year [2018] we have 28 suspected cases of which corresponding tests were done and of which 9 were confirmed, and those are being treated by specialists," he said.

According to the information from SEDES, the Bemejo municipality registered 5 cases, followed by Yacuiba with 2 cases, Carapari with one and Padcaya with one. In addition, "according the epidemiological report, the last case was registered in Bermejo and those responsible for the program presented the suspected or confirmed cases, carrying out the prevention and control tasks for this disease," he added.

For the past 2 decades, the Bermejo and Padcaya municipalities have not stopped reporting this disease. For this reason, Tarija is one of the departments that received 100 kg [220 lb] of rodenticides (rat poison) from the Ministry of Health, and other amounts have been distributed in La Paz, Santa Cruz, Beni and Cochabamba [departments]. "The goal is to eliminate the rodents and prevent diseases such as bubonic plague, hantaviruses, hemorrhagic fever and leptospirosis," he mentioned.

The person responsible for the National Program for Diseases Transmitted by Rodents and Influenza of the Ministry of Health, Yandira Alcon, stated that a [risk] forecast was made on 21 Feb [2018] with the provision of rodenticides at a cost of 135,000 bolivianos [USD 19,500] to control rodent population densities. "From February [2018] until now, the chemical was given to 5 departmental health services that they [in turn] later gave to the endemic municipalities," he pointed out.

The [health] professionals recommended to families that they take preventive measures such as eliminating vegetation around their houses, disinfecting the environment, not living with farm animals and notifying health personnel of the presence of rodents.

Hantavirus [infections cause] an acute, serious viral disease transmitted through the saliva, feces and urine of the [infected] rodents.  [Byline: Saul Cardozo]
=======================
[Cases of hantavirus infection have occurred in Tarija department in recent years, including the current one [2018]. The previously reported cases in 2015 of hantavirus pulmonary syndrome (HPS) that occurred in Tarija department were confirmed. The above advice to the public in the endemic municipalities is prudent. Control and significant reduction of rodent populations, especially in rural areas, is difficult, and unless the recommended measures are applied continuously, likely to be of short-term effect. As noted in previous comments, earlier cases of HPS have been reported from tropical lowland areas of Bolivia. The specific hantaviruses involved in these or previous cases in 2013 and 2014 in Bolivia are not given.

In the lowland Amazon Basin of Bolivia, the possible hantavirus and its rodent hosts that might be involved in these HPS cases, include the following:
- Laguna Negra virus (_Calomys laucha_, _Calomys callosus_ and
_Oligoryzomys microtis_)
- Rio Mamore (_C. callosus_ and _C. laucha_)
- Rio Mearim (_Holochilus sciureus_)
- Bermejo (_Oligoryzomys chacoensis_)
- Neembucu (_O. chacoensis_)
- Oran (_Oligoryzomys longicaudatus_ ).

Clearly, there are a variety of hantaviruses in Bolivia that can cause HPS involving several rodent hosts and found in many different ecological settings.

Dr. Jan Clement earlier pointed out the need to be able to differentiate Seoul hantavirus, with its wide distribution around the world, from hantaviruses found in the Americas. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Bolivia: <http://healthmap.org/promed/p/5>]
Date: Thu 11 Oct 2018, 1:07 AM
Source: Pagina 7 [in Spanish, trans., ProMED Mod.TY, edited]
<https://www.paginasiete.bo/sociedad/2018/10/11/confirman-casos-positivos-de-hantavirus-en-la-asunta-196557.html>

Local physicians in the La Asunta municipality confirmed yesterday [Wed 10 Oct 2018] 9 positive hantavirus infections and declared a health emergency in the communities of this population, located in the Yungas in the La Paz department. "A total of 9 hantavirus [infection] positive cases have been confirmed as well as one death," Carlos Tintaya, the La Asunta municipal hospital physician, said to Page 7. He indicated that 17 members of the Fuerza de Tarea Conjunta (FTC) [military joint taskforce] were evacuated this past weekend, "9 were positive according to laboratory tests. With one death, there are 10 cases," he emphasized.

Of the 9 hantavirus [infected] soldiers, according to Tintaya, one is in intensive care and the other 8 are recovering in a hospital in Santa Cruz. According to the physician, a team of professionals were sent to 2 camps in the Puerto Aroma and Inchura sector to examine the soldiers. "We took samples from 3 of them because they had pain in the abdomen, muscles and joints, and send them yesterday [Tue 9 Oct 2018] to Santa Cruz," he said. The physician added that the 3 samples were sent as a preventive measure.

He stated that during the inspection of the camps of those affected, they did not find remnants of rodent feces or urine; "We have not found anything that caught our attention," he stated. He added that a brigade from SEDES [Servicio Departamental de Salud; Health Services Department] will arrive to both localities in order to take further samples. The La Paz SEDES stated via an information release that today [Thu 11 Oct 2018] they will release a report about the hantavirus cases in La Asunta. Hantavirus [infection can result in] a disease that humans contract when they breathe in places contaminated by urine, excrement and saliva of [infected] rodents.
================================
[Hantavirus infections have occurred previously in various parts of Bolivia, including in tropical areas of La Paz department. Occurrence of hantavirus infections in soldiers in military camps in Bolivia is not surprising. As noted in the previous comments, earlier cases of hantavirus pulmonary syndrome have been reported from tropical, lowland areas of Bolivia.

The specific hantaviruses involved in these or previous cases for the last several years in Bolivia are not reported. In the lowland Amazon Basin of Bolivia, the possible hantavirus, its rodent hosts that might be involved in these hantavirus pulmonary syndrome (HPS) cases, with their images, include:

- Rio Mamoré virus (small eared pygmy rice rat _Oligoryzomys microtis_ <https://www.uwsp.edu/biology/VertebrateCollection/Pages/Vertebrates/Mammals%20of%20Paraguay/Oligoryzomys%20microtis/Oligoryzomys%20microtis.aspx>);
- Laguna Negra virus (small vesper mouse _Calomys laucha_ <http://www.faunaparaguay.com/calomyslaucha.html>  and large vesper mouse _C. callosus_; <http://www.faunaparaguay.com/Calomys%20callosus%20www.pybio.org%201.jpg>);
- Bermejo virus (Chaco rice rat _Oligoryzomys chacoensis_ <http://www.faunaparaguay.com/oligorizomyschacoensis.html>);
- Oran virus (long-tailed pygmy rice rat _O. longicaudatus_ <http://calphotos.berkeley.edu/imgs/512x768/0000_0000/0711/1203.jpeg>).

Dr. Jan Clement earlier pointed out the need to be able to differentiate Seoul hantavirus, with its wide distribution around the world, from hantaviruses found in the Americas. - Mod.TY HealthMap/ProMED map available at: La Paz, La Paz, Bolivia: <http://healthmap.org/promed/p/10123>]
Date: Mon 28 May 2018
From: Jan Clement <jan.clement.dr@telenet.be> [edited]

Concomitant dual infection by leptospira and hantavirus is probably a less rare combination of infections than generally anticipated, but since multiple organ failure (MOF) in leptospirosis is globally better (and longer) known than hantavirus-induced MOF, serological proof of the latter is much less frequently considered, particularly so if, in a 1st diagnostic approach, leptospirosis is found serologically confirmed.

Both zoonoses, although of totally different origin, induce remarkably similar symptoms and laboratory anomalies, including renal and hepatic involvement with initial but transient proteinuria and microhaematuria, "transaminitis," hyponatremia, hypokalemia despite renal function impediment, etc., (Clement J, Hinrichsen S, Crescente J, Bigaignon G, Yersin C, Muthusethupathi M, et al. Am J Trop Med Hyg 1999; 61 (Suppl.):316-317).

Hantavirus-induced hemorrhagic fever with renal syndrome (HFRS) has to be considered in the differential diagnosis of leptospirosis-suspected cases in the New and the Old World (Clement J, Maes P, Van Ranst M. Acute Kidney Injury in emerging, non-tropical Infections. Acta Clin Belg 2007;62:387-95).

Concomitant dual infection by leptospira and hantavirus was recently demonstrated in a country hyperendemic for leptospirosis, such as Sri Lanka (Sunil-Chandra NP, Clement J, Maes P, de Silva HJ, Van Esbroeck M, Van Ranst M. Concomitant leptospirosis-hantavirus co-infection in acute patients hospitalized in Sri Lanka: implications for a potentially worldwide underestimated problem. Epidemiol Inf 2015;143(10):2081-2093 doi: <http://dx.doi.org/10.1017/S0950268814003707>. Epub 13 Jan 2015), as well as in a non-endemic country, such as Belgium (Clement J, Van Esbroeck M, Lagrou K, Verschueren J, Sunil-Chandra NP, Van Ranst M. Letter to the Editor: Leptospirosis versus hantavirus infections in the Netherlands and in Belgium, 2000 to 2014. Euro Surveill. 2014;19(38):pii=20912. Available online: <http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20912>).

It is no coincidence that the Bolivian journal El Periodico pictures 2 rats [they appear to be the brown rat, _Rattus norvegicus_ - ProMED Mod.TY] for the publication of the fatal dual infection in this 6-year-old boy, since the wild rat is the main global reservoir and vector of the 2 now found zoonoses. If so, then the victim suffered in fact (also, besides leptospirosis) from rat-induced Seoul virus (SEOV) HFRS, instead of some form of HCPS. In that case, CENETROP in Santa Cruz has to be warned that exact determination of the causative SEOV is not reliable with serological techniques alone, since the most widely used screening antigens for hantavirus infections in South America are based on Andes virus (ANDV) and/or Araraquara virus (ARAV). These sigmodontid hantaviruses cross-react poorly with the murid SEOV, which consequently can be missed.

It is noteworthy that the boy apparently did not have extreme dyspnoea, the cardinal hallmark of severe HCPS, but all the clinical features of HFRS. If confirmed indeed as a SEOV infection, this would be the 2nd fatal SEOV case in the Americas after the 2012 Texan case (Roig IL, Musher DM, Tweardy DJ: Severe Pulmonary Involvement in a Case Attributed to Domestically Acquired Seoul Hantavirus in the United States. Clin Infect Dis. 2012; 54(1): 91-4. doi: 10.1093/cid/cir748;  <http://cid.oxfordjournals.org/content/54/1/91.long>).

Moreover, it would be, to our knowledge, the 1st fatal case in the Americas, and even worldwide, attributed to a concomitant dual infection by leptospira and a hantavirus.
------------------------------------------------------
Jan Clement, Piet Maes and Marc Van Ranst,
Hantavirus National Reference Centre
Laboratory of Clinical and Epidemiological Virology & Rega Institute
for Medical Research,
University of Leuven, U.Z. Gasthuisberg, B-3000 Leuven, Belgium.
jan.clement@uzleuven.be
==============================
[ProMED-mail thanks Dr. Clement and his colleagues for this insightful comment on the dual leptospitosis-hantavirus infection. They make an important point: It is easy to be focused on a single pathogen, forgetting that 2 or more pathogens that can produce similar symptoms may be present concurrently. They also underscore the need to be able to differentiate Seoul hantavirus, with its wide distribution around the world, from hantaviruses found in the Americas. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Tarija department, Bolivia: <http://healthmap.org/promed/p/12643>]
Date: Fri 25 May 2018
Source: El Periodico [in Spanish trans ProMED Mod.TY, edited]
<http://elperiodico-digital.com/2018/05/25/carapari-confirman-el-fallecimiento-de-un-nino-por-leptospirosis-y-hantavirus/>

The National Center for Tropical Diseases (CENETROP), confirmed that the death of a 6 year old child from the Santa Rosa community [Carapari municipality] was caused by leptospirosis and [a] hantavirus.

Erasmo Tapial epidemiologist in the Virgen de Guadalupe Hospital, stated that the report received from CENETROP confirmed the cause of death. "We informed the authorities of a death case of a 6 year old child in our municipality, reported positive for both leptospirosis and for [a] hantavirus by CENTROP" Tapia said.

He that the child presented with symptoms 10 days earlier. His family decided to take him to the Virgen de Guadalupe Health Center 4 days after having had fever during 5 days, gastrointestinal pain, headache and vomiting, nausea and diarrhoea. Unhappily, the boy arrived at the hospital without vital signs.

Given this, the Epidemiological Surveillance Unit carried out the related inquiries to determine the cause of death. After analysis of the clinical presentation, medical personnel took samples for laboratory testing for influenza, leptospirosis and hantaviruses and sent them to CENETROP in Santa Cruz.

Once the results were available, they proceeded according to established protocol and carried out control measures with family members of the deceased boy in the educational unit in the community.
====================
[In 2015, there were several cases of hantavirus infection in Tarija department, south of Santa Cruz department. The previously reported 2015 cases of hantavirus pulmonary syndrome (HPS) that occurred in Tarija department were confirmed. As noted in the previous comments, earlier cases of hantavirus pulmonary syndrome have been reported from tropical, lowland areas of Bolivia. The specific hantaviruses involved in these or previous cases in 2013, 2014 in Bolivia are not given.

In the lowland Amazon Basin of Bolivia, the possible hantavirus and its rodent hosts that might be involved in these hantavirus pulmonary syndrome (HPS) cases, include:
- Laguna Negra virus (_Calomys laucha_, _C. callosus_ and
_Oligoryzomys microtis_)
- Rio Mamore (_Calomys calllosus_ and _Calomys laucha_)
- Rio Mearim (_Holochilus sciureus_)
- Bermejo (_Oligoryzomys chacoensis_)
- Neembucu (_O. chacoensis_)
- Oran (_O. longicaudatus_ ).

It is clear that there are a variety of hantaviruses in Bolivia that can cause HPS involving several rodent hosts and found in many different ecological settings. - ProMED Mod.TY]
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