Hantavirus pulmonary syndrome

Hantavirus pulmonary syndrome (HPS) is one of two potentially fatal syndromes of zoonotic origin caused by species of hantavirus.[2] These include Black Creek Canal virus (BCCV), New York orthohantavirus (NYV), Monongahela virus (MGLV), Sin Nombre orthohantavirus (SNV), and certain other members of hantavirus genera that are native to the United States and Canada.[3]

Hantavirus pulmonary syndrome
Other namesFour Corners disease
Progression of hantavirus pulmonary syndrome
SpecialtyPulmonology 
SymptomsFever, cough, shortness of breath, headaches, muscle pains, lethargy, nausea, diarrhea
ComplicationsRespiratory failure, cardiac failure[1]
CausesHantaviruses spread by rodents
Differential diagnosisCommunity acquired pneumonia, leptospirosis, tularemia, pneumonic plague[1]
PreventionRodent control
TreatmentSupportive, including mechanical ventilation
MedicationNone
PrognosisPoor
Deaths36–40% mortality

Specific rodents are the principal hosts of the hantaviruses including the hispid cotton rat (Sigmodon hispidus) in southern Florida, which is the principal host of Black Creek Canal virus.[4][5] The deer mouse (Peromyscus maniculatus) in Canada and the Western United States is the principal host of Sin Nombre virus.[6][7] The white-footed mouse (Peromyscus leucopus) in the eastern United States is the principal host of New York virus.[8] In South America, the long-tailed mouse (Oligoryzomys longicaudatus) and other species of the genus Oligoryzomys have been documented as the reservoir for Andes virus.[9][10][11]

Signs and symptoms

Initially, HPS has an incubation phase of 2–4 weeks, in which patients remain asymptomatic.[1] Subsequently, patients can experience 3–5 days of flu-like prodromal phase symptoms, including fever, cough, muscle pain, headache, lethargy, shortness of breath, nausea, vomiting and diarrhea.[1]

In the following 5–7 day cardiopulmonary phase, the patient's condition rapidly deteriorates into acute respiratory failure, characterized by the sudden onset of shortness of breath with rapidly evolving pulmonary edema, as well as cardiac failure, with hypotension, tachycardia and shock.[1] In this phase, patients may develop acute respiratory distress syndrome. It is often fatal despite mechanical ventilation and intervention with diuretics.

After the cardiopulmonary phase, patients can enter a diuretic phase of 2–3 days characterized by symptom improvement and diuresis. Subsequent convalescence can last months to years.[1]

As of 2017, patient mortality in the US from HPS is 36%.[12]

Transmission
The hispid cotton rat, indigenous to southern Florida, is the carrier of the Black Creek Canal virus

The virus can be transmitted to humans by a direct bite or inhalation of aerosolized virus, shed from stool, urine, or saliva from a natural reservoir rodent.[1] In general, droplet and/or fomite transfer has not been shown in the hantaviruses in either the pulmonary or hemorrhagic forms.[13][14]

Diagnosis

The preferred method for diagnosis of Hantavirus Pulmonary Syndrome is serological testing which identifies both acute (IgM) and remote infections (IgG); however, PCR may also be used to identify early infections.[15]

Prevention

Rodent control in and around the home or dwellings remains the primary prevention strategy, as well as eliminating contact with rodents in the workplace and at campsites. Closed storage sheds and cabins are often ideal sites for rodent infestations. Airing out of such spaces prior to use is recommended. People are advised to avoid direct contact with rodent droppings and wear a mask while cleaning such areas to avoid inhalation of aerosolized rodent secretions.[16]

Treatment

There is no cure or vaccine for HPS. Treatment involves supportive therapy, including mechanical ventilation with supplemental oxygen during the critical respiratory-failure stage of the illness.[1] Although ribavirin can be used to treat hantavirus infections, it is not recommended as a treatment for HPS due to unclear clinical efficacy and likelihood of medication side effects.[1] Early recognition of HPS and admission to an intensive care setting offers the best prognosis.[16]

Epidemiology

Hantavirus pulmonary syndrome was first recognized during the 1993 outbreak in the Four Corners region of the southwestern United States. It was identified by Dr. Bruce Tempest. It was originally called Four Corners disease, but the name was changed to Sin Nombre virus after complaints by Native Americans that the name "Four Corners" stigmatized the region.[17] It has since been identified throughout the United States.

See also

References
  1. Barros, N; McDermott, S; Wong, AK; Turbett, SE (16 April 2020). "Case 12-2020: A 24-Year-Old Man with Fever, Cough, and Dyspnea". New England Journal of Medicine. 382 (16): 1544–1553. doi:10.1056/NEJMcpc1916256. PMID 32294350. S2CID 215792383.
  2. Koster FT. Levy H. "Hantavirus cardiopulmonary syndrome: a new twist to an established pathogen", In: Fong IW, editor; Alibek K, editor. New and Evolving Infections of the 21st Century, New York: Springer-Verlag New York, Inc.; 2006. pp. 151–170.
  3. Nichol ST. Beaty BJ. Elliott RM. Goldbach R, et al. Family Bunyaviridae. In: Fauquet CM, editor; Mayo MA, editor; Maniloff J, editor; Desselberger U, et al., editors. Virus Taxonomy: 8th Report of the International Committee on Taxonomy of Viruses. San Diego, CA: Elsevier Academic Press;
  4. Rollin PE. Ksiazek TG. Elliott LH. Ravkov EV, et al. "Isolation of Black Creek Canal virus, a new hantavirus from Sigmodon hispidus in Florida", J Med Virol. 1995;46:35–39. [PubMed]
  5. Glass GE. Livingstone W. Mills JN. Hlady WG, et al. "Black Creek Canal virus infection in Sigmodon hispidus in southern Florida", Am J Trop Med Hyg. 1998;59:699–703. PubMed
  6. Childs JE, Ksiazek TG, Spiropoulou CF, Krebs JW, Morzunov S, Maupin GO, Gage KL, Rollin PE, Sarisky J, Enscore RE (1994). "Serologic and genetic identification of Peromyscus maniculatus as the primary rodent reservoir for a new hantavirus in the southwestern United States". J. Infect. Dis. 169 (6): 1271–80. doi:10.1093/infdis/169.6.1271. PMID 8195603.
  7. Drebot MA. Gavrilovskaya I. Mackow ER. Chen Z, et al. "Genetic and serotypic characterization of Sin Nombre-like viruses in Canadian Peromyscus maniculatus mice", Virus Res. 2001;75:75–86. [PubMed]
  8. Hjelle B. Lee SW. Song W. Torrez-Martinez N, et al. "Molecular linkage of hantavirus pulmonary syndrome to the white-footed mouse, Peromyscus leucopus: genetic characterization of the M genome of New York virus", J Virol. 1995;69:8137–8141. [PMC free article] [PubMed]
  9. Wells RM, Sosa Estani S, Yadon ZE, Enria D, Padula P, Pini N, Mills JN, Peters CJ, Segura EL (April–June 1997). "An unusual hantavirus outbreak in southern Argentina: person-to-person transmission? Hantavirus Pulmonary Syndrome Study Group for Patagonia". Emerg Infect Dis. 3 (2): 171–4. doi:10.3201/eid0302.970210. PMC 2627608. PMID 9204298.
  10. Levis S, Morzunov SP, Rowe JE, Enria D, Pini N, Calderon G, Sabattini M, St Jeor SC (March 1998). "Genetic diversity and epidemiology of hantaviruses in Argentina". J Infect Dis. 177 (3): 529–38. doi:10.1086/514221. PMID 9498428.
  11. Cantoni G, Padula P, Calderón G, Mills J, Herrero E, Sandoval P, Martinez V, Pini N, Larrieu E (October 2001). "Seasonal variation in prevalence of antibody to hantaviruses in rodents from southern Argentina". Trop Med Int Health. 6 (10): 811–6. doi:10.1046/j.1365-3156.2001.00788.x. PMID 11679129.
  12. "Hantavirus Disease, by State of Reporting | Hantavirus | DHCPP | CDC". Centers for Disease Control and Prevention. 26 February 2019. Retrieved June 5, 2021.
  13. Peters, C.J. (2006). "Emerging Infections: Lessons from the Viral Hemorrhagic Fevers". Transactions of the American Clinical and Climatological Association. 117: 189–197. PMC 1500910. PMID 18528473.
  14. Crowley, J.; Crusberg, T. "Ebola and Marburg Virus Genomic Structure, Comparative and Molecular Biology". Dept. of Biology & Biotechnology, Worcester Polytechnic Institute. Archived from the original on 2013-10-15.
  15. Akram, Sami (20 November 2020). Hantavirus Cardiopulmonary Syndrome. National Center for Biotechnology Information. PMID 29083610.
  16. "CDC - Hantavirus Pulmonary Syndrome (HPS) – Hantavirus". Centers for Disease Control and Prevention. 2013-02-06. Retrieved 2013-07-07.
  17. "Death at the Corners". Discover Magazine. 1993-12-01. Retrieved 2013-03-25.
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