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Potentially life-threatening emergency
Hantavirus pulmonary syndrome
See also in: Pulmonary
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Potentially life-threatening emergency

Hantavirus pulmonary syndrome

See also in: Pulmonary
Print Images (5)
Contributors: E. Gregory Marchand MD, William Bonnez MD
Other Resources UpToDate PubMed

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Synopsis

Prodromal
Hantaviruses are single strand RNA viruses and are members of the Bunyaviridae family. Hantavirus produces 2 different syndromes depending on the strain: hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS). Both are zoonotic infections with rodents as their natural host. Natural infection is acquired by inhalation of an aerosol or dust containing rodent excreta and by rodent bites. The mortality rate of HPS is 50%; HFRS has a mortality rate of only 5%.

The incubation period for HPS is 1-6 weeks but usually lasts for 2 weeks. Initial symptoms include the sudden onset of 3-5 days of fever, dry cough, fatigue, dizziness, myalgia, headaches, chills, nausea, vomiting, and abdominal complaints. Arthralgias and back pain occur less frequently. The disease progresses rapidly to fever, severe coughing, dyspnea, tachypnea, tachycardia, rales, diffuse pulmonary edema, acute respiratory distress syndrome (ARDS), and death. Rarely, some patients may develop disseminated intravascular coagulation (DIC). At the time most patients seek medical care, they usually require immediate intubation and mechanical ventilation.

HPS was first identified in the southwestern United States in 1993. Since that time, more than 500 cases have been identified throughout the country. In 2012, several confirmed cases of HPS were associated with staying at cabins in Yosemite National Park in Yosemite Valley, California. There are 4 major hantavirus strains in North America: Sin Nombre, which is carried by the deer mouse (found throughout North America); Black Creek Canal, which is carried by the cotton rat (found in the southeastern United States and Central and South America); New York, which is carried by the white-footed mouse (found in southern New England, the mid-Atlantic, southern, midwestern, and western United States, and Mexico), and Bayou, which is carried by the rice rat (found in the southeastern United States and Central America). The common house mouse and house pets do not carry hantaviruses. Person-to-person transmission has not been documented except for Andes hantavirus (ANDV) (endemic in Chile and Argentina; the only hantavirus for which person-to-person transmission has been reported). At present, no vaccine is available.

Some farm and domestic workers, building and fire inspectors, hikers, campers, laboratory workers, mammalogists, pest-control workers, and people who enter or clean rodent-infested structures are susceptible to contracting HPS.

Note: Use HEPA or N-95 filter mask and gloves when handling rodents or traps or when cleaning large deposits of rodent excreta. Air out and disinfect rodent-infected areas with a solution of 1 part bleach in 9 parts water.

Codes

ICD10CM:
B33.4 – Hantavirus (cardio)-pulmonary syndrome

SNOMEDCT:
120639003 – Hantavirus pulmonary syndrome

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Due to the nonspecific nature of the prodromal symptoms, HPS is difficult to distinguish clinically from other viral infections.

Patients with acute respiratory distress syndrome (ARDS) have a less depressed cardiac function, and their cardiac output responds better to fluid challenge.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 09/28/2017
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Potentially life-threatening emergency
Hantavirus pulmonary syndrome
See also in: Pulmonary
Print 5 Images
View all Images (5)
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Hantavirus pulmonary syndrome (Prodromal) : Abdominal pain, Diarrhea, Dizziness, Fever, Headache, Nausea, Vomiting, Tachycardia, Myalgia, RR increased, WBC elevated, PLT decreased, Rodent exposure
Imaging Studies image of Hantavirus pulmonary syndrome

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