Hantavirus pulmonary syndrome(HPS) was first identified in 1993 in the Four Corners region of New Mexico as a flu-like illness followed by respiratory distress, shock, and a mortality rate as high as 50%. Workers are infected by inhaling aerosols of rodent excreta.
CASES/YEAR
230 (US); 100,000 (Global)
OTHER NAMES
HPS; Hantavirus cardiopulmonary syndrome (HCPS); Hantavirus ARDS; Sin Nombre, Black Creek Canal, Bayou, Laguna Negra, New York, Monongahela, or Andes virus infection;
INCUBATION
Not completely defined, but thought to be about 2 weeks with a range of a few days to 6 weeks; [CCDM]
INITIAL SYMPTOMS
Flu-like syndrome (fever, myalgia, headache, nausea & vomiting, diarrhea & abdominal pain) followed by cough & dyspnea; [ID] 30% of patients have radiographic pulmonary edema at presentation & about 100% within 48 hours; [Cecil, p. 2217]
PRECAUTIONS
Standard; "Not transmitted from person to person." [CDC 2007 Guideline for Isolation Precautions] Person-to-person transmission has been documented for Andes virus in Argentina, but it is believed to be rare. [CCDM, p. 248]
COMMENTS
EPIDEMIOLOGY:
Hantavirus pulmonary syndrome (HPS) was first identified in 1993 in the Four Corners region of New Mexico as a flu-like illness followed by respiratory distress, shock, and a mortality rate as high as 50%. Workers are infected by inhaling aerosols of rodent excreta. The hantaviral diseases share the following: febrile prodrome, thrombocytopenia, leukocytosis, and capillary leakage. [CCDM, p. 245-9] Only the Andes virus is suspected of human-to-human transmission. [Harrison ID, 2nd Ed, p. 1048]
FINDINGS:
A flu-like illness (fever, myalgias and gastrointestinal symptoms) is followed by respiratory distress and hypotension rapidly progressing to pulmonary edema and shock. Renal disease and hemorrhagic manifestations are absent except in severe cases. [CCDM, p. 245-9] Renal failure may develop. Large amounts of pleural fluid are present in fatal cases of HPS. Delirium is a symptom of patients in shock. Bleeding diathesis occurs in a minority of patients infected with Sin Nombre virus. [Guerrant, p. 475-6]
DIAGNOSTIC
Almost all patients have IgM antibodies at the time of hospitalization, and most have IgG detectable; PCR preferred over culture; [CCDM] Serology; Hantavirus-specific RNA (PCR) or antigen; Viral culture: rarely isolated; [ABX Guide]
SCOPE
USA, Canada, and South America (Argentina, Bolivia, Brazil, Chile, Panama, and Paraguay); [CCDM]
SIGNS & SYMPTOMS
-
>fatigue, weakness
-
>fever
-
>myalgia
-
G abdominal pain
-
G diarrhea
-
G liver function test, abnormal
-
G nausea, vomiting
-
H leukocytosis
-
H thrombocytopenia
-
N confusion, delirium
-
N headache
-
R cough
-
R dyspnea
-
X lung infiltrates
-
X pleural effusions
-
*acute renal failure
-
*ARDS
-
*bleeding tendency
-
*pneumonitis
-
*pulmonary edema
-
*shock
SOURCE
Person-to-Person, Animal Excreta
RISK FACTORS
- Handle infected laboratory rats or mice
- Handle infected rodents (not bite)
- Raise dust of excreta from rodents
- Travel to endemic area
- Work in a medical or research lab
REFERENCES FOR CASES/YEAR
1. (US) Published in MMWR 2011 = 23;; Use correction factor of 10 for reported diseases: 23 X 10 = 230;
2. (Global) 50,000 to 150,000 cases/year; [Cecil, p. 2215]