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A. Characteristics

  1. Febrile viral infection
  2. Progression to severe noncardiogenic pulmonary edema
  3. Disease in USA caused by two "new" hantaviruses
    1. Sin Nombre Virus (SNV, transmitted by Deer Mouse) [1]
    2. Black Creek Canal Virus (BCCV, transmitted by cotton rats) [2]
  4. Old world hantaviruses include Puumala, Seoul, and Hantaan
  5. Transmitted to humans from rodent excrement only, not insect-borne [3]
  6. Related to hemorrhagic fever viruses

B. Symptoms and Signs

  1. Fever
  2. Myalgias, chills, abdominal pain, nausea
  3. Shortness of breath
  4. Progressive to severe hypoxemia
  5. Organ Dysfunction
    1. Sepsis Syndrome (including disseminated intravascular coagulopathy, DIC)
    2. Acute Renal Failure
    3. Rhabdomyolysis
    4. Respiratory Failure

C. Laboratory

  1. DIC: reduced platelets, increased PT and PTT, fibrin split products
  2. Severe A-a gradient
  3. Acute Renal Failure - BUN and creatinine elevations
  4. Hemolysis and/or Rhabdomyolysis
  5. Leukocytosis or Leukocytopenia with immature forms
  6. Antisera are available

D. Treatment

  1. Mainly supportive
  2. May require ventilatory support
  3. No specific therapy currently known

References

  1. Duchin J, Koster F, Peters CJ, et al. 1994. NEJM. 330:949 abstract
  2. Khan AS, Gaviria M, Rollin PE, et al. 1996. Am J Med. 100(1):46 abstract
  3. Franz DR, Jahriling PB, Friedlander AM, et al. 1997. JAMA. 278(5):399 abstract