Hantaviruses in humans cause 2 syndromes: hantavirus pulmonary syndrome (HPS), a noncardiogenic pulmonary edema; and hemorrhagic fever with renal syndrome (HFRS) (see Hemorrhagic Fevers and Related Syndromes). The prodromal illness of HPS is 3 to 7 days and is characterized by fever; chills; headache; myalgia of the shoulders, lower back, and thighs; nausea; vomiting; diarrhea; dizziness; and sometimes cough. Respiratory tract symptoms or signs usually do not occur for the first 3 to 7 days until pulmonary edema and severe hypoxemia appear abruptly after the onset of cough and dyspnea, and then the disease progresses over a few hours. In severe cases, persistent hypotension caused by myocardial dysfunction is present.
The extensive bilateral interstitial and alveolar pulmonary edema and pleural effusions are the result of a diffuse pulmonary capillary leak and appear to be caused by immune responses to hantavirus in endothelial cells of the microvasculature. Intubation and assisted ventilation usually are required for only 2 to 4 days, with resolution heralded by the onset of diuresis and rapid clinical improvement.
The severe myocardial depression is different from that of septic shock; the cardiac indices and the stroke volume index are low, the pulmonary wedge pressure is normal, and systemic vascular resistance is increased. Poor prognostic indicators include persistent hypotension, marked hemoconcentration, a cardiac index of less than 2, and abrupt onset of lactic acidosis with a serum lactate concentration of greater than 4 mmol/L (36 mg/dL).
The mortality rate for patients with HPS in recent years has been 30% to 40%. Asymptomatic and mild forms of disease are rare in adults, but limited information suggests they may be more common in children. Serious sequelae are uncommon.
Hantavirus Pulmonary Syndrome has been found in Red Book 28e
If you are a registered user, please login below.