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Hantavirus Pulmonary Syndrome - Causes, Symptoms and Treatment

What is Hantavirus Pulmonary Syndrome?

Mainly occurring in the southwestern United States, hantavirus pulmonary syndrome was first reported in May 1993. The syndrome, which rapidly progresses from flu­like symptoms to respiratory failure and, possibly, death, is known for its high mortality.

What are the Causes of Hantavirus Pulmonary Syndrome?

A member of the Bunyaviridae family, the genus Hantavirus is responsible for hantavirus pulmonary syndrome. However, the hantavirus strain that causes disease in Asia and Europe - mainly hemorrhagic fever and kidney disease is distinctly different from the one described in North America. In the United States, most disease is caused by the strain called sin nombre virus.

The disease is transmitted by infected rodents, the primary reservoir for this virus. Data suggest that the deer mouse is the main source, but pinion mice, brush mice, and western chipmunks in proximity to humans in rural areas are also sources. Infected rodents are asymptomatic but shed the virus in feces, urine, and saliva.

Human infection may occur from inhalation, ingestion of contaminated food or water, contact with rodent excrement, or rodent bites. Transmission from person to person or by mosquito's, fleas, or other arthropod vectors has not been reported.

Hantavirus infections have been documented in people whose activities are associated with rodent contact, such as farming, hiking, or camping in rodent-infested areas, and occupying rodent-infested dwellings.

What are the Signs and Symptoms of Hantavirus Pulmonary Syndrome?

Noncardiogenic pulmonary edema distinguishes the syndrome. Common chief complaints include myalgia, fever, headache, nausea, vomiting, and cough. Respiratory distress typically follows the onset of a cough. Fever, hypoxia and, in some patients, serious hypertension typify the hospital course.

Other signs and symptoms include a rising respiratory rate (28 breaths per minute) and an increased heart rate (120 beats per minute).

Diagnosis for Hantavirus Pulmonary Syndrome

Despite efforts to identify clinical and laboratory features that distinguish hantavirus pulmonary syndrome from other infections with similar features, diagnosis is based on clinical suspicion along 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 tests usually reveal an elevated white blood cell count with a predominance of neutrophils, myeloid precursors, and atypical lymphocytes; elevated hematocrit; decreased platelet count; prolonged 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 for Hantavirus Pulmonary Syndrome

Primarily supportive, treatment consists of maintaining adequate oxygenation, monitoring vital signs, and intervening to stabilize the patient's heart rate and blood pressure.

Drug therapy includes administering vasopressors, such as dopamine or epinephrine, for hypotension. Fluid volume replacement may also be ordered (with precautions not to overhydrate the patient). Intravenous ribavirin early in the illness has shown benefit.

Special Considerations and Prevention Tips for Hantavirus Pulmonary Syndrome

Below are some of the Tips to Control the disease and prevent it from getting more serious:

  • Keep a clean area, especially the kitchen and keep food in rodent-proof containers.
  • Keep a tight fitting lid on the garbage and discard uneaten pet food.
  • Set covered bait stations following instructions carefully. Do not use a poison like D-Con® as the mouse may die elsewhere, possibly out of reach for disposal.
  • Seal all entry holes 1/4 inch wide or wider with steel wool, cement, wire screening or other patching materials, inside and out.

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