Hantavirus: Difference between revisions
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*Acquired by inhalation of contaminated rodent urine or feces, and possibly by bites |
*Acquired by inhalation of contaminated rodent urine or feces, and possibly by bites |
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*Essentially worldwide, though New World viruses tend to cause hantavirus pulmonary syndrome and Old World viruses tend to cause hemorrhagic fever with renal syndrome |
*Essentially worldwide, though New World viruses tend to cause hantavirus pulmonary syndrome and Old World viruses tend to cause hemorrhagic fever with renal syndrome |
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| + | **In Canada, no cases have been described east of Saskatchewan; specifically, no cases of HPS have been described in Ontario since it became reportable in 2001 |
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| + | *Incidence of HPS peaks in summer months (in North America) |
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==Clinical Manifestations== |
==Clinical Manifestations== |
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*Prodrome of fever followed 4 to 5 days later by shock and pulmonary edema |
*Prodrome of fever followed 4 to 5 days later by shock and pulmonary edema |
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**Prodrome may include myalgias, abdominal pain, and gastrointestinal symptoms |
**Prodrome may include myalgias, abdominal pain, and gastrointestinal symptoms |
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| − | **Respiratory failure can develop quickly |
+ | **Respiratory failure can develop quickly and often requires intubation |
| + | *Chest x-ray almost always shows bilateral infiltrates suggestive of [[ARDS]] |
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| − | *Elevated hematocrit (from third-spacing), leukocytosis, atypical lymphocytes, |
+ | *Elevated hematocrit (from third-spacing), leukocytosis, atypical lymphocytes, thrombocytopenia (with severity predicting mortality), prolonged PTT, and mild elevations in AST and LDH |
| − | *Creatinine may be elevated, but not as severe as HFRS |
+ | **Creatinine may be elevated, but not as severe as HFRS |
| + | *Case fatality rate is about 35% |
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==Differential Diagnosis== |
==Differential Diagnosis== |
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*PCR or immunohistochemical staining are both possible |
*PCR or immunohistochemical staining are both possible |
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*Viral culture is difficult |
*Viral culture is difficult |
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| + | *Of note, it is a [[Biosafety risk groups|biosafety risk group]] 3 pathogen, which requires special precautions in the lab |
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==Management== |
==Management== |
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Revision as of 11:12, 20 September 2023
Background
- Enveloped, single-stranded RNA virus within the order Bunyavirales, family Hantaviridae
- Acquired by inhalation of contaminated rodent urine or feces, and possibly by bites
- Essentially worldwide, though New World viruses tend to cause hantavirus pulmonary syndrome and Old World viruses tend to cause hemorrhagic fever with renal syndrome
- In Canada, no cases have been described east of Saskatchewan; specifically, no cases of HPS have been described in Ontario since it became reportable in 2001
- Incidence of HPS peaks in summer months (in North America)
Clinical Manifestations
- Incubation period of 14 days (range 5 to 42 days)
Hemorrhagic Fever With Renal Syndrome (HFRS)
- Caused by Old World hantaviruses, such as Hantaan, Dobrava, Seoul, Puumala, and other Old World hantaviruses
- Fever, thrombocytopenia, and AKI caused by acute interstitial nephritis
- Also headache, abdominal pain, low back pain, dizziness, and blurred vision
- Can have conjunctival injection and petechiae on upper trunk and soft palate
- Febrile phase lasts 4 to 7 days of acute, severe illness, followed by hypotensive, oliguric, and polyuric phases
- Leukocytosis and thrombocytopenia seen on CBC
- Mortality up to 5%
Hantavirus Pulmonary Syndrome (HPS)
- Caused by New World hantaviruses such as Sin Nombre, Bayou, and Black Creek Canal
- Prodrome of fever followed 4 to 5 days later by shock and pulmonary edema
- Prodrome may include myalgias, abdominal pain, and gastrointestinal symptoms
- Respiratory failure can develop quickly and often requires intubation
- Chest x-ray almost always shows bilateral infiltrates suggestive of ARDS
- Elevated hematocrit (from third-spacing), leukocytosis, atypical lymphocytes, thrombocytopenia (with severity predicting mortality), prolonged PTT, and mild elevations in AST and LDH
- Creatinine may be elevated, but not as severe as HFRS
- Case fatality rate is about 35%
Differential Diagnosis
- HPS: other causes of unexplained pulmonary edema
Diagnosis
- Serology usually positive by presentation (both IgM and IgG)
- PCR or immunohistochemical staining are both possible
- Viral culture is difficult
- Of note, it is a biosafety risk group 3 pathogen, which requires special precautions in the lab
Management
- Supportive
