Infectious Disease Book

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HantavirusAka: Hantavirus Pulmonary Syndrome, Hanta Virus, Sin Nombre Virus, Black Creek Canal Virus, Bayou Virus, New York Virus

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  1. Epidemiology
    1. United States cases: 280 cases since 1993 (30/year)
    2. Farm settings and other rural areas
      1. Associated with entering rarely opened buildings
      2. Associated with increased rodent populations
    3. Most common in spring and summer
    4. Ages affected
      1. Mean age affected is middle aged adults
      2. Less commonly affects children
    5. Locations in United States
      1. Now HPS has been identified in 31 states and Canada
      2. Initial cases were identified in southwest U.S.
        1. New Mexico
        2. Arizona
        3. California
  2. Etiology
    1. Vectors
      1. Deer mouse (main vector): Sin Nombre Virus
      2. Cotton rat (Southeast U.S.): Black Creek Canal Virus
      3. Rice rat (Southeast U.S.): Bayou Virus
      4. White-footed mouse (Northeast U.S.): New York Virus
    2. Transmission
      1. Inhalation of aerosolized rodent feces or Saliva
      2. No identified cases of person to person transmission
      3. No identified nosocomial infections
  3. Symptoms and Signs: Prodromal Phase
    1. Atypical cases may cause only prodromal phase
    2. Symptoms
      1. Mild febrile illness lasting 3-5 days
      2. Myalgias
      3. Gastrointestinal upset
      4. Headache
      5. Chills
      6. Malaise
    3. Signs
      1. Fever
      2. Tachypnea
      3. Tachycardia
    4. Findings rarely seen in HPS (Negative Predictive Value)
      1. Rash, Conjunctivitis (occur with South American HPS)
      2. Rhinorrhea
      3. Pharyngitis
  4. Symptoms and Signs: Cardiopulmonary Phase
    1. Symptoms
      1. Progressive Tachypnea
      2. Cough productive of copious secretions
    2. Signs: Acute pulmonary edema
      1. Hypoxia
      2. Respiratory failure within first 24 hours
      3. Cardiogenic Shock in severe cases
        1. Low cardiac output
        2. Hypotension
        3. High peripheral vascular resistance
        4. Oliguria
  5. Labs
    1. Hypoalbuminemia (later finding)
    2. Lactic Acidosis (later finding)
    3. Liver Function Tests elevated
    4. Renal Function Tests
      1. Acute Renal Failure may occur
    5. Complete Blood Count
      1. Repeat in 8-12 hours if initial CBC normal
      2. Combination of all 4 criteria rare in other viral ID
        1. Thrombocytopenia
        2. Leukocytosis with left-shift
        3. Circulating immunoblasts
        4. Hemoconcentration
  6. Diagnosis
    1. Sin Nombre Virus serologic titers
  7. Radiology: Chest XRay
    1. Diffuse interstitial edema
    2. Pleural Effusions
    3. Differs from ARDS by involving more central lung
  8. Differential Diagnosis
    1. Pneumonia
    2. ARDS
    3. Acute bacterial endocarditis
    4. Plague
    5. Tularemia
    6. Histoplasmosis
    7. Coccidioidomycosis
    8. Myocardial Infarction
    9. Goodpasture's Syndrome
  9. Management
    1. Intensive cardiopulmonary support
      1. Mechanical Ventilation
      2. Pressors
      3. Invasive hemodynamic monitoring
    2. Initial broad spectrum antibiotics (for other causes)
      1. Employ while awaiting SNV serologic titers
      2. Covers other causes on differential diagnosis
    3. Experimental measures being investigated
      1. Extracorporeal membrane oxygenation
      2. Ribavirin (Virazole)
  10. Prognosis
    1. Case fatality rate: 40%
    2. Survivors may have persistent small airway obstruction
    3. Survivors often recover within 1 week of illness
  11. Prevention
    1. Eliminate rodent populations in and around buildings
    2. Avoid rodent exposure
  12. References
    1. (1996) MMWR Morb Mortal Wkly Rep 1996 45:291
    2. Graziano (2002) Am Fam Physician 66:1015
    3. Vitek (1996) Clin Infect Dis 22:824

Hantavirus (C0019092)

Definition (CSP)genus of the family Bunyaviridae causing diseases such as hemorrhagic fever, nephropathia epidemica, and Hantavirus Pulmonary Syndrome; first identified during the Korean war; infection is found primarily in rodents and humans; includes the species Hantaan virus.
Definition (MSH)A genus of the family BUNYAVIRIDAE causing HANTAVIRUS INFECTIONS, first identified during the Korean war. Infection is found primarily in rodents and humans. Transmission does not appear to involve arthropods. HANTAAN VIRUS is the type species.
ConceptsVirus (T005)
EnglishGenus Hantavirus, Genus: Hantaan and related viruses, Hantanvirus group, Hantavirus, Hantavirus serogroup Hantaan, Hantaviruses, Serogroup Hantaan
Spanishgénero Hantavirus, genero Hantavirus, grupo hantanvirus, hantanvirus, hantavirus
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Hantavirus Pulmonary Syndrome (C0243025)

Definition (MSH)Acute respiratory illness in humans caused by the Muerto Canyon virus whose primary rodent reservoir is the deer mouse Peromyscus maniculatus. First identified in the southwestern United States, this syndrome is characterized most commonly by fever, myalgias, headache, cough, and rapid respiratory failure.
ConceptsDisease or Syndrome (T047)
EnglishHANTAVIRUS PULM SYNDROME, Hantavirus Pulmonary Syndrome, Hantavirus Pulmonary Syndromes
Spanishsíndrome de hantavirus pulmonar, sindrome de hantavirus pulmonar
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Bayou virus (C1007189)

ConceptsVirus (T005)
EnglishBayou hantavirus, Bayou virus
Spanishvirus Bayou
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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