Hantavirus pulmonary syndrome

Mainly occurring in the southwestern United States, but not confined to that area, Hantavirus pulmonary syndrome is a viral disease 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. The hantavirus strain that causes disease in Asia and Europe — mainly hemorrhagic fever and renal disease — is distinctly different from the one currently described in North America.

Causes

A member of the Bunyaviridae family, the genus Hantavirus (first isolated in 1977) is responsible for Hantavirus pulmonary syndrome. Disease transmission is associated with exposure to aerosols (such as dust) contaminated by urine or feces from infected rodents, the primary reservoir for this virus. Data suggest that the deer mouse is the main source, but pinon mice, brush mice, and western chipmunks in close proximity to humans in rural areas are also sources. 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.

Infected rodents manifest no apparent illness but shed the virus in feces, urine, and saliva. Human infection may occur from inhalation, ingestion (of contaminated food or water, for example), contact with rodent excrement, or rodent bites. Transmission from person to person or by mosquitoes, fleas, or other arthropods hasn’t been reported.

Signs and symptoms

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

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

Diagnosis

Despite ongoing efforts to identify clinical and laboratory features that distinguish Hantavirus pulmonary syndrome from other infections with similar features, diagnosis currently 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. (See Screening for Hantavirus pulmonary syndrome.) Serologic testing for hantavirus can be performed.

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; 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 acute respiratory distress syndrome).

Treatment

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 vasopressors, such as dopamine or epinephrine, for hypotension. Fluid volume replacement may also be ordered (with precautions not to overhydrate the patient). Ribavirin in aerosol form has been used for children, but its efficacy for adults has not been proven.

Special considerations

❑Assess the patient's respiratory status and arterial blood gas values often.

❑Monitor serum electrolyte levels and correct imbalances as appropriate.

❑Maintain a patent airway by suctioning. Ensure adequate humidification, and check ventilator settings frequently.

❑In patients with hypoxemia, assess neurologic status frequently along with heart rate and blood pressure.

❑Administer drug therapy, and monitor the patient's response.

❑Provide I.V. fluid therapy based on results of hemodynamic monitoring.

❑Provide emotional support for the patient and his family.

❑Report cases of Hantavirus pulmonary syndrome to the appropriate state health department.

❑Provide the patient with prevention guidelines. (Until more is known about Hantavirus pulmonary syndrome, preventive measures currently focus on rodent control.)

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Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.

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