II. 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

III. 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

IV. 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

V. 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

VI. 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

VII. Diagnosis

  1. Sin Nombre Virus serologic titers

VIII. Radiology: Chest XRay

  1. Diffuse interstitial edema
  2. Pleural Effusions
  3. Differs from ARDS by involving more central lung

X. 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)

XI. Prognosis

  1. Case fatality rate: 40%
  2. Survivors may have persistent small airway obstruction
  3. Survivors often recover within 1 week of illness

XII. Prevention

  1. Eliminate rodent populations in and around buildings
  2. Avoid rodent exposure

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Ontology: Hantavirus (C0019092)

Definition (NCI) A genus of single-stranded, segmented, negative-sense RNA viruses in the family bunyaviridae. These viruses are transmitted by aerosolized rodent excreta or rodent bites.
Definition (NCI_CDISC) Any viral organism that can be assigned to the genus Hantavirus.
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.
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.
Concepts Virus (T005)
MSH D006476
SnomedCT 49445003, 243623003
LNC LP16669-1
English Hantaan and related viruses, Hantaanvirus group, NOS, hantaviruses, hantanvirus, hantavirus, Hantavirus serogroup Hantaan (organism), Hantaviruses, HANTAVIRUS, Genus: Hantaan and related viruses, Serogroup Hantaan, Hantavirus serogroup Hantaan, Hantanvirus group, Genus Hantavirus (organism), Genus Hantavirus, Hantanvirus group, NOS, Hantavirus (organism), Hantavirus
Swedish Hantavirus
Spanish hantanvirus, grupo hantanvirus, hantanvirus (organismo), género Hantavirus (organismo), género Hantavirus, hantavirus, Hantavirus
Czech Hantavirus, virus epidemické hemoragické horečky
Finnish Hantavirus
Russian GEMORRAGICHESKOI LIKHORADKI EPIDEMICHESKOI VIRUS, GEMORRAGICHESKOI KOREISKOI LIKHORADKI VIRUS, GEMORRAGICHESKOI LIKHORADKI S POCHECHNYM SINDROMOM VIRUS, HFRS VIRUS, KHANTAVIRUS, GEMORRAGICHESKOGO NEFROZO-NEFRITA VIRUS, HFRS ВИРУС, ГЕМОРРАГИЧЕСКОГО НЕФРОЗО-НЕФРИТА ВИРУС, ГЕМОРРАГИЧЕСКОЙ КОРЕЙСКОЙ ЛИХОРАДКИ ВИРУС, ГЕМОРРАГИЧЕСКОЙ ЛИХОРАДКИ С ПОЧЕЧНЫМ СИНДРОМОМ ВИРУС, ГЕМОРРАГИЧЕСКОЙ ЛИХОРАДКИ ЭПИДЕМИЧЕСКОЙ ВИРУС, ХАНТАВИРУС
Japanese ハンタウイルス属, ハンタウイルス
Croatian HANTAVIRUS
Polish Hantavirus
French Hantavirus
Norwegian Not Translated[Hantavirus]
German Hantavirus
Italian Hantavirus
Dutch Hantaanvirus, Hantavirus, Virus, Hanta-
Portuguese Hantavirus

Ontology: Hantavirus Pulmonary Syndrome (C0243025)

Definition (MSHFRE) Maladie respiratoire humaine aiguë due au virus Muerto Canyon dont le réservoir est un rongeur, la souris Peromyscus maniculatus. D'abord identifié au sud-ouest des Etats-Unis, ce syndrome est caractérisé par de la fièvre, des myalgies, des céphalées, une toux, puis rapidement une défaillance respiratoire.
Definition (NCI) An infection caused by Hantaviruses. It manifests with flu-like symptoms but it rapidly progresses to life-threatening respiratory problems.
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.
Concepts Disease or Syndrome (T047)
MSH D018804
SnomedCT 120639003
LNC LA10469-7
English Hantavirus Pulmonary Syndrome, Hantavirus Pulmonary Syndromes, HANTAVIRUS PULM SYNDROME, Hantavirus disease pulmonary syndrome (diagnosis), Hantavirus disease pulmonary syndrome, Hanta virus pulmonary syndrome, HARDS, Hantavirus Associated Respiratory Distress Syndrome, Hantavirus-Associated Respiratory Distress Syndrome, Hantavirus Pulmonary Syndrome [Disease/Finding], Hantavirus pulmonary infection, Hantavirus pulmonary syndrome, Hantavirus pulmonary syndrome (disorder)
Italian Infezione polmonare da Hanta virus, Sindrome polmonare da Hanta virus, Sindrome polmonare da Hantavirus
Dutch Hantaan-virus longsyndroom, hantavirus pulmonaal syndroom, hantaviruslonginfectie, Hantavirussyndroom, pulmonaal, Pulmonaal hantavirussyndroom, Syndroom, pulmonaal hantavirus-
French Syndrome pulmonaire du virus Hantaan, Syndrome pulmonaire de l'hantavirus, Infection pulmonaire à Hantavirus, Syndrome pulmonaire à hantavirus, Syndrome pulmonaire à hantavirus (SPH)
German pulmonales Syndrom durch Hantavirus, pulmonale Infektion durch Hantavirus, Hantavirus-Lungensyndrom
Portuguese Síndrome pulmonar de Hantavírus, Síndrome pulmonar de Hantavirus, Infecção pulmonar por hantavirus, Síndrome Pulmonar por Hantavirus
Spanish Síndrome pulmonar por virus hanta, Síndrome de Hantavirus pulmonar, síndrome de hantavirus pulmonar (trastorno), síndrome de hantavirus pulmonar, Infección pulmonar por virus hanta, Síndrome Pulmonar por Hantavirus
Japanese ハンタウイルス性肺感染, ハンタウイルス性肺症候群, ハンタウイルスセイハイショウコウグン, ハンタウイルスセイハイカンセン, ハンタウイルス肺症候群
Swedish Hantavirus pulmonellt syndrom
Czech hantavirový plicní syndrom, Plicní infekce způsobená hantaviry, Hantavirový plicní syndrom
Finnish Hantaviruskeuhko-oireyhtymä
Russian KHANTAVIRUSNYI PUL'MONARNYI SINDROM, KHANTAVIRUSNYI LEGOCHNYI SINDROM, LEGOCHNYI SINDROM KHANTAVIRUSNYI, ЛЕГОЧНЫЙ СИНДРОМ ХАНТАВИРУСНЫЙ, ХАНТАВИРУСНЫЙ ЛЕГОЧНЫЙ СИНДРОМ, ХАНТАВИРУСНЫЙ ПУЛЬМОНАРНЫЙ СИНДРОМ
Polish Zespół hantawirusowy płuc
Croatian HANTAVIRUS, PLUĆNI SINDROM, HANTAVIRUSNI PLUĆNI SINDROM
Hungarian pulmonalis hantavirus fertőzés, Pulmonalis hantavirus syndroma, Hanta pulmonalis vírus syndroma
Norwegian HPS, Hantavirus pulmonalt syndrom, Hantavirus lungesyndrom

Ontology: Bayou virus (C1007189)

Concepts Virus (T005)
SnomedCT 116665009
English Bayou hantavirus, Bayou virus, Bayou virus (organism)
Spanish virus Bayou (organismo), virus Bayou