Hantavirus pulmonary syndrome | |
---|---|
Other names | Four Corners disease |
Progression of hantavirus pulmonary syndrome | |
Specialty | Pulmonology |
Symptoms | Fever, cough, shortness of breath, headaches, muscle pains, lethargy, nausea, diarrhea |
Complications | Respiratory failure, cardiac failure [1] |
Causes | Hantaviruses spread by rodents |
Differential diagnosis | Community acquired pneumonia, leptospirosis, tularemia, pneumonic plague [1] |
Prevention | Rodent control |
Treatment | Supportive, including mechanical ventilation |
Medication | None |
Prognosis | Poor |
Deaths | 36–40% mortality |
Hantavirus pulmonary syndrome (HPS) is one of two potentially fatal syndromes of zoonotic origin caused by species of hantavirus. [2] These include Black Creek Canal virus (BCCV), New York orthohantavirus (NYV), Monongahela virus (MGLV), Sin Nombre orthohantavirus (SNV), and certain other members of hantavirus genera that are native to the United States and Canada. [3]
Specific rodents are the principal hosts of the hantaviruses including the hispid cotton rat (Sigmodon hispidus) in southern Florida, which is the principal host of Black Creek Canal virus. [4] [5] The deer mouse (Peromyscus maniculatus) in Canada and the Western United States is the principal host of Sin Nombre virus. [6] [7] The white-footed mouse (Peromyscus leucopus) in the eastern United States is the principal host of New York virus. [8] In South America, the long-tailed mouse ( Oligoryzomys longicaudatus ) and other species of the genus Oligoryzomys have been documented as the reservoir for Andes virus. [9] [10] [11]
Initially, HPS has an incubation phase of 2–4 weeks, in which patients remain asymptomatic. [1] Subsequently, patients can experience 3–5 days of flu-like prodromal phase symptoms, including fever, cough, muscle pain, headache, lethargy, shortness of breath, nausea, vomiting and diarrhea. [1]
In the following 5–7 day cardiopulmonary phase, the patient's condition rapidly deteriorates into acute respiratory failure, characterized by the sudden onset of shortness of breath with rapidly evolving pulmonary edema, as well as cardiac failure, with hypotension, tachycardia and shock. [1] In this phase, patients may develop acute respiratory distress syndrome. It is often fatal despite mechanical ventilation and intervention with diuretics.[ citation needed ]
After the cardiopulmonary phase, patients can enter a diuretic phase of 2–3 days characterized by symptom improvement and diuresis. Subsequent convalescence can last months to years. [1]
As of 2017, patient mortality in the US from HPS is 36%. [12]
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. [1] In general, droplet and/or fomite transfer has not been shown in the hantaviruses in either the pulmonary or hemorrhagic forms. [13] [14]
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. [15]
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. [16]
There is no cure or vaccine for HPS. Treatment involves supportive therapy, including mechanical ventilation with supplemental oxygen during the critical respiratory-failure stage of the illness. [1] Although ribavirin 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. [1] Early recognition of HPS and admission to an intensive care setting offers the best prognosis. [16]
Hantavirus pulmonary syndrome was first recognized during the 1993 outbreak in the Four Corners region of the southwestern United States. 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. [17] It has since been identified throughout the United States.[ citation needed ]
Orthohantavirus is a genus of single-stranded, enveloped, negative-sense RNA viruses in the family Hantaviridae within the order Bunyavirales. Members of this genus may be called orthohantaviruses or simply hantaviruses.
Sin Nombre orthohantavirus (SNV), a member of the genus Orthohantavirus, is the prototypical etiologic agent of hantavirus cardiopulmonary syndrome (HCPS).
Bunyavirales is an order of segmented negative-strand RNA viruses with mainly tripartite genomes. Member viruses infect arthropods, plants, protozoans, and vertebrates. It is the only order in the class Ellioviricetes. The name Bunyavirales derives from Bunyamwera, where the original type species Bunyamwera orthobunyavirus was first discovered. Ellioviricetes is named in honor of late virologist Richard M. Elliott for his early work on bunyaviruses.
Seoul orthohantavirus (SEOV) is a member of the genus Orthohantavirus of rodent-borne viruses, and is one of the four hantaviruses that are known to cause Hantavirus hemorrhagic fever with renal syndrome (HFRS). It is an Old World hantavirus; a negative sense, single-stranded, tri-segmented RNA virus.
Andes orthohantavirus (ANDV), a species of Orthohantavirus, is a major causative agent of hantavirus cardiopulmonary syndrome (HCPS) and hantavirus pulmonary syndrome (HPS) in South America. It is named for the Andes mountains of Chile and Argentina, where it was first discovered. Originating in the reservoir of rodents, Andes orthohantavirus is easily transmitted to humans who come into contact with infected rodents or their fecal droppings. However, infected rodents do not appear ill, so there is no readily apparent indicator to determine whether the rodent is infected or not. Additionally, Andes orthohantavirus, specifically, is the only hantavirus that can be spread by human to human contact via bodily fluids or long-term contact from one infected individual to a healthy person.
Playa de Oro virus (OROV) is a probable species of orthohantavirus found in the rodents Oryzomys couesi and Sigmodon mascotensis in the Mexican state of Colima. The former is thought to be the main host. The sequences of parts of the virus's RNA-based genome have been determined; they differ by 7–10% in amino acid composition and 22–24% in nucleotide composition from closely related viruses.
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 caught on an island off New York. The virus is associated with typical hantavirus pulmonary syndrome.
Black Creek Canal orthohantavirus (BCCV) is a single-stranded, negative sense RNA virus species of New World Orthohantavirus. It was first isolated in cotton rats found in the Black Creek Canal area of Dade County, Florida in 1995. The discovery followed from an isolated case of Hantavirus pulmonary syndrome diagnosed in a Dade County resident.
The 1993 Four Corners hantavirus outbreak was an outbreak of hantavirus that caused the first known human cases of hantavirus disease in the United States. It occurred within the Four Corners region – the geographic intersection of the U.S. states of Utah, Colorado, New Mexico, and Arizona – of the Southwestern United States in mid-1993. This region is largely occupied by Native American tribal lands, including the Hopi, Ute, Zuni, and Navajo reservations, from which many of the cases were reported.
Sangassou orthohantavirus(SANGV) is single-stranded, negative-sense RNA virus species of the genus Orthohantavirus in the Bunyavirales order. It was first isolated in an African wood mouse (Hylomyscus simus) in the forest in Guinea, West Africa in 2010. It is named for the village near where the mouse was trapped. It is the first indigenous Murinae-associated African hantavirus to be discovered.
Hantavirus hemorrhagic fever with renal syndrome (HFRS) is a group of clinically similar illnesses caused by species of hantaviruses. It is also known as Korean hemorrhagic fever and epidemic hemorrhagic fever. It is found in Europe, Asia, and Africa. The species that cause HFRS include Hantaan orthohantavirus, Dobrava-Belgrade orthohantavirus, Saaremaa virus, Seoul orthohantavirus, Puumala orthohantavirus and other orthohantaviruses. Of these species, Hantaan River virus and Dobrava-Belgrade virus cause the most severe form of the syndrome and have the highest morbidity rates. When caused by the Puumala virus, it is also called nephropathia epidemica. This infection is known as sorkfeber in Swedish, myyräkuume in Finnish, and musepest in Norwegian.
Dobrava-Belgrade orthohantavirus (DOBV), also known as Dobrava virus, is an enveloped, single-stranded, negative-sense RNA virus species of Old World Orthohantavirus. It is one of several species of Hantavirus that is the causative agent of severe Hantavirus hemorrhagic fever with renal syndrome. It was first isolated in 1985 from a yellow-necked mouse found in the village of Dobrava, southeastern Slovenia. It was subsequently isolated in striped field mice in Russia and other parts of Eastern Europe. It has also been found in Germany but the reservoir host there is unknown.
Soochong virus (SOOV) is a zoonotic negative sense single-stranded RNA virus. It may be a member of the genus Orthohantavirus, but it has not be definitively classified as a species and may only be a strain. It is one of four rodent-borne Hantaviruses found in the Republic of Korea. It is the etiologic agent for Hantavirus hemorrhagic fever with renal syndrome (HFRS). The other species responsible for HFRS in Korea are Seoul virus, Haantan virus, and Muju virus.
Monongahela virus (MGLV) is a single-stranded, negative-sense Orthohantavirus virus of zoonotic origin that causes hantavirus pulmonary syndrome.
Limestone Canyon virus (LSC) is a single-stranded, negative-sense RNA zoonotic Orthohantavirus that is genetically similar to Sin Nombre orthohantavirus which causes Hantavirus pulmonary syndrome (HPS) in humans. HPS causing hantaviruses are found only in the United States and South America.
Choclo orthohantavirus (CHOV) is a single-stranded, negative-sense RNA zoonotic New World hantavirus. It was first isolated in 1999 in western Panama. The finding marked the first time Hantavirus pulmonary syndrome (HPS) was found in Central America.
El Moro Canyon orthohantavirus is a single-stranded, negative sense RNA virus of the genus Orthohantavirus. It is a causative agent of Hantavirus pulmonary syndrome.
Nova virus is a single-stranded, negative-sense, enveloped RNA virus with a trisegmented genome. It belongs to one of the most divergent lineages of the hantavirus group, which consists of zoonotic viruses belonging to the family Bunyaviridae. As of now, no human cases of infection have been reported.
Rockport virus (RKPV) is a single-stranded, enveloped, negative-sense RNA orthohantavirus.
Blue River virus (BRV) is a single-stranded, negative sense RNA virus of New World hantavirus isolated from a white-footed mouse near the Blue River in Jackson County, Missouri in 1995. Its genome is similar to Sin Nombre orthohantavirus (SNV) but varies in the S1 and S2 segments. Like Sin Nombre orthohantavirus, Blue River virus causes Hantavirus pulmonary syndrome (HPS) in humans.