First clinical reports of acute hantavirus and dengue infections among pregnant women in the Caribbean

Abstract

Background

Hantavirus and dengue virus infections lead to diseases causing economic and public health concerns. Acute hantavirus infections can lead to similar clinical haemorrhagic signs as other endemic diseases including dengue and leptospirosis.

Methods

Using a retrospective case analysis of pregnant dengue and hantavirus disease patients with clinical reports and compatible clinical laboratory information during pregnancy, we report the first evidence of dengue and hantavirus infections and a case of dual dengue and hantavirus infection among pregnant women in the Caribbean. Laboratory testing by enzyme-linked immunosorbent assay (ELISA) and non-structural protein 1 (NS1) for DENV and for hantavirus infection pseudotype focus reduction neutralisation tests (pFRNT), ELISA and immunochromatographic (ICG) strips.

Results

Four pregnant cases with acute DENV infections were identified; however, only one out of the four cases (25%) had a detailed medical record to permit abstraction of clinical data. Six hantavirus infected pregnant cases were identified with gestation periods ranged from 36 to 39 weeks; none of the reported patients exhibited previous pregnancy complications prior to hospitalisation and infection. Acute liver damage was observed in three of the six cases (AST readings) who were subsequently diagnosed with hepatitis in pregnancy and variable clinical outcomes were observed with term and pre-term deliveries.

Conclusions

Whilst hantavirus infection in pregnancy is rare, consideration should be given to differential diagnosis with fever, kidney involvement, liver involvement, haemorrhagic symptoms and thrombocytopenia in endemic areas with clinically similar diseases such as dengue and leptospirosis.

Highlights

• First recorded case of hantavirus and dengue co-infection in a pregnant woman.

• First detailed report of clinical hantavirus infection in pregnant women in the Caribbean.

• First published report of clinical dengue infection in pregnant woman in the Caribbean.

• Possible complications of pregnancy following hantavirus infection.

• Pre-term birth and low birth weights.

• Clinical course of hantavirus infection in a Caribbean population.

Keywords:

• Pregnancy
• hantavirus
• dengue
• AFLP
• HELLP

Acknowledgements

The authors would like to thank the entire staff at the Leptospira Laboratory for laboratory testing and provision of the raw data, the staff of Clinical Chemistry department and Medical Records Department of the Queen Elizabeth Hospital (QEH), Barbados, Dr. Tarja Sironen and the staff at Virology Department of the University of Helsinki, Finland, for confirmatory testing of hantavirus infection in human sera. In addition, we would like to thank Professor Alafia Samuels for her supervisory assistance.

Author contributions

Conceptualisation, K.D.; methodology, K.D.; software, K.D.; validation, K.D. and M.G-S.H.; formal analysis, K.D.; investigation, K.D.; resources, K.D. and M.G-S.H; data curation, K.D.; writing – original draft preparation, K.D.; writing – review and editing, K.D. and M.G-S.H.; visualisation, K.D.; project administration, K.D. and M.G-S.H. All authors have read and agreed to the published version of the manuscript.

Consent form

No informed consent was necessary for archived human patient sera.

Disclosure statement

No potential conflict of interest was reported by the author(s).