Hantavirus Pulmonary Syndrome

Hantavirus pulmonary syndrome is a viral disease that was first reported in May 1993. It occurs mainly in the sothwestern United States. The syndrome, which causes flulike symptoms and rapidly progresses to respiratory failure, is known for its high mortality; the mortality rate is 40% with good management. The hantavirus strain that causes disease in Asia and Europe­mainly hemorrhagic fever and renal disease - is distinctly different from the one currently found in North -America.

Causes

In the United States, most cases of hantavirus pulmonary syndrome are caused by one strain of hantavirus primarily carried by the deer mouse. These rodents appear healthy but shed the virus in their saliva, urine, and droppings. Deer mice are found in rural, semirural, and suburban areas, but not usually in cities.

Symptoms and Signs

Such as include symptoms:

• Sudden fever.
• Muscle pain (myalgia), especially in the thighs, hips, and back, and sometimes in the shoulders.
• Fatigue.

In the early stages of HPS, about one-half of the people also develop:

• Headache.
• Chills.
• Nausea and vomiting.
• Diarrhea.
• Abdominal pain.
• Dizziness and lightheadedness.

Other, less common symptoms of HPS that may occur include:

• Joint pain.
• Chest pain.
• Sweating.

Diagnostic tests

Despite ongoing efforts to identify clinical and laboratory features that distinguish hantavirus pulmonary syndrome from other infections with similar features, diagnosis currently rests mainly on clinical suspicion in conjunction with a process of elimination developed by the Centers for Disease Control and Prevention (CDC) with the Council of State and Territorial Epidemiologists. Note: The CDC and state health departments can perform definitive testing for hantavirus exposure and antibody formation.

Laboratory studies usually reveal an elevated white blood cell count with a predominance of neutrophils, myeloid precursors, and atypical lymphocytes. Tests also show an elevated hematocrit level, a decreased platelet count, an elevated partial thromboplastin time, and a normal fibrinogen level. Usually, laboratory findings demonstrate only minimal abnormalities in renal function, with serum creatinine levels no higher than 2.5 mg/dl.

Chest X-rays eventually show bilateral diffuse infiltrates in almost all patients (findings consistent with adult respiratory distress syndrome).

Treatment

Management during the first few hours is critical, requiring intubation and aggressive respiratory management. Treatment consists of maintaining adequate oxygenation, monitoring vital signs, and intervening to stabilize the patient's heart rate and blood pressure.

Drug therapy includes administration of vasopressors, such as dopamine or epinephrine, for hypotension. Fluid volume replacement may also be necessary, although precautions must be taken not to overhydrate the patient.

Recent investigational drug therapy involves ongoing clinical trials with ribavirin.

Prevention

You can reduce your exposure to rodents that may carry hantaviruses by: Reducing rodents indoors and outdoors. Cleaning up rodent-infested areas.

Special precautions for hikers and campers also may be necessary to avoid contact with infected rodents.

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