Neumonías atípicas graves y diagnóstico diferencial con el síndrome cardiopulmonar por hantavirus. Experiencia clínica en tres casos confirmados

Abstract

Atypical bacteria, mainly Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella species can eventually cause serious community-acquired pneumonias (CAP). In Chile, the differential diagnosis also include the hantavirus cardiopulmonary syndrome (HCPS). We describe the clinical features of three patients which developed high fever, dispnea, acute respiratory failure and diffuse interstitial infiltrates on the chest radiographs, requiring intensive care assistance. On three cases, the differential diagnosis included severe CAP and HCPS. The epidemiological backround and clinical profile are useful to distinguish severe CAP and HCPS. The blood count is the most valuable laboratory test for early diagnosis of HCPS, considering that ~87% of patients have hemoconcentration, leukocytosis and thrombocytopenia. These fndings are extremely infrequent in patients with community-acquired pneumonia. The definitive diagnosis of atypical CAP could be confirmed by serology test. Thus, two of our cases had high admission IgM titles to Mycoplasma pneumoniae and one case to Chlamydia pneumoniae