Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

Hantavirus Pulmonary Syndrome 655

■Hantavirus pulmonary syndrome first identified 1993 in humans in

the U.S.

■Primarily Sin Nombre virus (aka “Four Corners virus”) in U.S.

■Reservoir is deer mouse, Peromyscus maniculatus (widespread in

U.S.)

■Humans accidental host

■Aerosol transmission from rodent excreta

■Incubation approximately 2 wks (with range: few days-6 wks)

■Almost all cases occur in adults.

■Risk factors; handling or trapping rodents, cleaning or entering

closed rodent-infested structures, cleaning feed storage or animal

shelter areas

➣Or living in home with increased density of mice

■Risk groups: Mammal workers, utility company staff, agricultural

and forestry employees

Signs & Symptoms

■Prodrome lasts 3–7 days: myalgias/chills/fever (pharyngitis and rhi-

norrhea are rare), sometimes GI complaints

■Later non-productive cough that progresses to dyspnea

■Level of dyspnea is variable.

■Profound capillary leak syndrome often occurs, which results in pul-

monary edema and pleural effusions

■Respiratory failure, myocardial depression and shock seen in severe

cases

■Milder cases (without severe pulmonary edema) have been de-

scribed.

tests

Nonspecific

■CXR: may be normal early on, later interstitial pulmonary infiltrates,

pleural effusions

■Low albumin

■Hemoconcentration, hypoproteinemia common

■LDH may be increased

■Thrombocytopenia (around 40,000 is common)

■Leukocytosis with left shift

■Severe cases: immunoblastic lymphocytes

Specific

■Best method of diagnosis is serologic