Hantavirus pulmonary syndrome (HPS) is one of two potentially fatal
syndrome
A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. The word derives from the Greek language, Greek σύνδρομον, meaning "concurrence". When a sy ...
s of
zoonotic origin caused by species of
hantavirus. These include
Black Creek Canal virus (BCCV),
New York orthohantavirus
New York orthohantavirus or New York virus is an ''Orthohantavirus''. It is considered a strain of ''Sin Nombre orthohantavirus''. It was first isolated from a white-footed mouse (''Peromyscus leucopus'') caught on an island off New York. The ...
(NYV),
Monongahela virus
Monongahela virus (MGLV) is a single-stranded, negative-sense ''Orthohantavirus'' virus of zoonotic origin that causes hantavirus pulmonary syndrome.
Discovery of virus
Monongahela virus was first detected in '' Peromyscus maniculatus nubiterr ...
(MGLV), ''
Sin Nombre orthohantavirus
''Sin Nombre orthohantavirus'' (SNV) (from Spanish, meaning "without a name") is the prototypical etiologic agent of hantavirus cardiopulmonary syndrome (HCPS).
Discovered in 1993 near the Cañon de la Muerte on the Navajo Reservation, it was o ...
'' (SNV), and certain other members of hantavirus genera that are native to the United States and Canada.
Specific
rodent
Rodents (from Latin , 'to gnaw') are mammals of the order Rodentia (), which are characterized by a single pair of continuously growing incisors in each of the upper and lower jaws. About 40% of all mammal species are rodents. They are n ...
s are the principal hosts of the hantaviruses including the
hispid cotton rat
The hispid cotton rat (''Sigmodon hispidus'') is a rodent species long thought to occur in parts of South America, Central America, and southern North America. However, recent taxonomic revisions, based on mitochondrial DNA sequence data, ha ...
(''Sigmodon hispidus'') in
southern Florida
South Florida is the southernmost region of the U.S. state of Florida. It is one of Florida's three most commonly referred to directional regions; the other two are Central Florida and North Florida. South Florida is the southernmost part of ...
, which is the principal host of Black Creek Canal virus. The
deer mouse (''Peromyscus maniculatus'') in
Canada
Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by to ...
and the
Western United States
The Western United States (also called the American West, the Far West, and the West) is the region comprising the westernmost states of the United States. As American settlement in the U.S. expanded westward, the meaning of the term ''the We ...
is the principal host of
Sin Nombre virus.
The
white-footed mouse (''Peromyscus leucopus'') in the eastern United States is the principal host of New York virus. In
South America
South America is a continent entirely in the Western Hemisphere and mostly in the Southern Hemisphere, with a relatively small portion in the Northern Hemisphere at the northern tip of the continent. It can also be described as the sou ...
, the long-tailed mouse (''
Oligoryzomys longicaudatus
''Oligoryzomys longicaudatus'', also known as the long-tailed colilargo or long-tailed pygmy rice rat, is a species of rodent in the genus ''Oligoryzomys'' of the family Cricetidae. It is found in the southern Andes of Chile and Argentina, with ...
'') and other species of the genus ''
Oligoryzomys
''Oligoryzomys'' is a genus of rodents in the tribe Oryzomyini of family Cricetidae. Many species are known as pygmy rice rats or colilargos.Musser and Carleton, 2005 The genus is found from Mexico to Tierra del Fuego and includes approximately 1 ...
'' have been documented as the reservoir for
Andes virus.
Signs and symptoms
Initially, HPS has an incubation phase of 2–4 weeks, in which patients remain asymptomatic.
Subsequently, patients can experience 3–5 days of flu-like
prodromal phase symptoms, including
fever
Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...
, cough,
muscle pain, headache, lethargy,
shortness of breath
Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing di ...
, nausea, vomiting and diarrhea.
In the following 5–7 day cardiopulmonary phase, the patient's condition rapidly deteriorates into acute
respiratory failure
Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide, or both cannot be kept at normal levels. A drop in the oxygen carried in the blood is known as hypoxemia; a rise ...
, characterized by the sudden onset of shortness of breath with rapidly evolving
pulmonary edema
Pulmonary edema, also known as pulmonary congestion, is excessive liquid accumulation in the tissue and air spaces (usually alveoli) of the lungs. It leads to impaired gas exchange and may cause hypoxemia and respiratory failure. It is due ...
, as well as
cardiac failure
Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, ...
, with hypotension, tachycardia and shock.
In this phase, patients may develop
acute respiratory distress syndrome
Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin colo ...
. It is often fatal despite
mechanical ventilation
Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move a ...
and intervention with
diuretic
A diuretic () is any substance that promotes diuresis, the increased production of urine. This includes forced diuresis. A diuretic tablet is sometimes colloquially called a water tablet. There are several categories of diuretics. All diuretics i ...
s.
After the cardiopulmonary phase, patients can enter a diuretic phase of 2–3 days characterized by symptom improvement and
diuresis
Diuresis () is increased urination (polyuria) or, in the related word senses more often intended, the physiological process that produces such an increase or the administration of medications to encourage that process. It involves extra urine pr ...
. Subsequent
convalescence
Convalescence is the gradual recovery of health and strength after illness or injury. It refers to the later stage of an infectious disease or illness when the patient recovers and returns to previous health, but may continue to be a source of ...
can last months to years.
As of 2017, patient mortality in the US from HPS is 36%.
Transmission
The virus can be transmitted to humans by a direct bite or inhalation of
aerosolized virus, shed from stool, urine, or saliva from a
natural reservoir rodent.
In general, droplet and/or
fomite
A fomite () or fomes () is any inanimate object that, when contaminated with or exposed to infectious agents (such as pathogenic bacteria, viruses or fungi), can transfer disease to a new host.
Transfer of pathogens by fomites
A fomite is any ...
transfer has not been shown in the hantaviruses in either the pulmonary or hemorrhagic forms.
Diagnosis
The preferred method for diagnosis of Hantavirus Pulmonary Syndrome is serological testing which identifies both acute (IgM) and remote infections (IgG); however, PCR may also be used to identify early infections.
Prevention
Rodent control in and around the home or dwellings remains the primary prevention strategy, as well as eliminating contact with rodents in the workplace and at campsites. Closed storage sheds and cabins are often ideal sites for rodent infestations. Airing out of such spaces prior to use is recommended. People are advised to avoid direct contact with rodent droppings and wear a mask while cleaning such areas to avoid inhalation of aerosolized rodent secretions.
Treatment
There is no cure or vaccine for HPS. Treatment involves supportive therapy, including
mechanical ventilation
Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move a ...
with supplemental oxygen during the critical respiratory-failure stage of the illness.
Although
ribavirin
Ribavirin, also known as tribavirin, is an antiviral medication used to treat RSV infection, hepatitis C and some viral hemorrhagic fevers. For hepatitis C, it is used in combination with other medications such as simeprevir, sofosbuvir, pe ...
can be used to treat hantavirus infections, it is not recommended as a treatment for HPS due to unclear clinical efficacy and likelihood of medication side effects.
Early recognition of HPS and admission to an intensive care setting offers the best
prognosis
Prognosis ( Greek: πρόγνωσις "fore-knowing, foreseeing") is a medical term for predicting the likely or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) or remain sta ...
.
Epidemiology
Hantavirus pulmonary syndrome was first recognized during the
1993 outbreak in the
Four Corners
The Four Corners is a region of the Southwestern United States consisting of the southwestern corner of Colorado, southeastern corner of Utah, northeastern corner of Arizona, and northwestern corner of New Mexico. The Four Corners area ...
region of the
southwestern United States
The Southwestern United States, also known as the American Southwest or simply the Southwest, is a geographic and cultural region of the United States that generally includes Arizona, New Mexico, and adjacent portions of California, Colorado, N ...
. It was identified by Dr. Bruce Tempest. It was originally called Four Corners disease, but the name was changed to
Sin Nombre virus after complaints by
Native Americans that the name "Four Corners"
stigmatized the region.
It has since been identified throughout the United States.
See also
*
Sweating sickness
*
Calabazo virus
*
Rockport virus
Rockport virus (RKPV) is a single-stranded, enveloped, negative-sense RNA orthohantavirus.
Natural reservoir
Rockport virus was first isolated in archival tissues of four Eastern moles found in and around Rockport, Texas.
Virology
Phylogene ...
References
External links
"Hantaviruses, with emphasis on Four Corners Hantavirus"by Brian Hjelle, M.D., 2001, Department of Pathology, School of Medicine, University of New Mexico
US Center for Disease Control
Virus Pathogen Database and Analysis Resource (ViPR): Bunyaviridae PAHO
{{Authority control
Viral respiratory tract infections
Hantavirus infections
Rodent-carried diseases
Biological weapons
Syndromes caused by microbes
Zoonoses