Hantavirus pulmonary syndrome

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Hantavirus pulmonary syndrome
Other namesFour Corners disease
Radiographic progression of hantavirus pulmonary syndrome in patient.jpg
Progression of hantavirus pulmonary syndrome
Specialty Pulmonology   OOjs UI icon edit-ltr-progressive.svg
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]
PreventionRodent control
TreatmentSupportive, including mechanical ventilation
Medication None
Prognosis Poor
Deaths36–40% 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]

Contents

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]

Signs and symptoms

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]

Transmission

The hispid cotton rat, indigenous to southern Florida, is the carrier of the Black Creek Canal virus Sigmodon hispidus1.jpg
The hispid cotton rat, indigenous to southern Florida, is the carrier of the Black Creek Canal virus

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]

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. [15]

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. [16]

Treatment

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]

Epidemiology

Hantavirus pulmonary syndrome was first recognized during the 1993 outbreak in the Four Corners region of the southwestern United States. It was identified by 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 ]

See also

Related Research Articles

<i>Orthohantavirus</i> Genus of viruses

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.

<i>Sin Nombre orthohantavirus</i> Prototypical agent of hantavirus cardiopulmonary syndrome

Sin Nombre orthohantavirus (SNV), a member of the genus Orthohantavirus, is the prototypical etiologic agent of hantavirus cardiopulmonary syndrome (HCPS).

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.

<i>Andes orthohantavirus</i> Species of 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.

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.

<span class="mw-page-title-main">1993 Four Corners hantavirus outbreak</span> 1993 disease outbreak

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.

<span class="mw-page-title-main">Hantavirus hemorrhagic fever with renal syndrome</span> Group of clinically similar illnesses caused by species of hantaviruses

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.

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.

Topografov virus is an enveloped, negative-sense RNA virus of the genus Orthohantavirus in the Bunyavirales order. It is the first hantavirus to be isolated from Siberian lemmings found near the Topografov River in the Taymyr Peninsula, Siberia.

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.

Calabazo virus is an enveloped, single-stranded, negative-sense RNA hantavirus species of the order Bunyavirales. It is a novel New World microtine rodent-borne hantavirus discovered in Central America on the Azuero Peninsula of Panama in early 2000. Human infection with Calabazo virus results in respiratory illness similar to Hantavirus pulmonary syndrome but it is not severe or fatal and rarely requires hospitalization.

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.

Hantavirus vaccine is a vaccine that protects in humans against hantavirus infections causing hantavirus hemorrhagic fever with renal syndrome (HFRS) or hantavirus pulmonary syndrome (HPS). The vaccine is considered important as acute hantavirus infections are responsible for significant morbidity and mortality worldwide. It is estimated that about 1.5 million cases and 46,000 deaths occurred in China from 1950 to 2007. The number of cases is estimated at 32,000 in Finland from 2005 to 2010 and 90,000 in Russia from 1996 to 2006.

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.

References

  1. 1 2 3 4 5 6 7 8 9 Barros, N; McDermott, S; Wong, AK; Turbett, SE (16 April 2020). "Case 12-2020: A 24-Year-Old Man with Fever, Cough, and Dyspnea". New England Journal of Medicine. 382 (16): 1544–1553. doi:10.1056/NEJMcpc1916256. PMID   32294350. S2CID   215792383.
  2. ↑ Koster FT. Levy H. "Hantavirus cardiopulmonary syndrome: a new twist to an established pathogen", In: Fong IW, editor; Alibek K, editor. New and Evolving Infections of the 21st Century, New York: Springer-Verlag New York, Inc.; 2006. pp. 151–170.
  3. ↑ Nichol ST. Beaty BJ. Elliott RM. Goldbach R, et al. Family Bunyaviridae. In: Fauquet CM, editor; Mayo MA, editor; Maniloff J, editor; Desselberger U, et al., editors. Virus Taxonomy: 8th Report of the International Committee on Taxonomy of Viruses. San Diego, CA: Elsevier Academic Press;
  4. ↑ Rollin PE. Ksiazek TG. Elliott LH. Ravkov EV, et al. "Isolation of Black Creek Canal virus, a new hantavirus from Sigmodon hispidus in Florida", J Med Virol. 1995;46:35–39. [PubMed]
  5. ↑ Glass GE. Livingstone W. Mills JN. Hlady WG, et al. "Black Creek Canal virus infection in Sigmodon hispidus in southern Florida", Am J Trop Med Hyg. 1998;59:699–703. PubMed
  6. ↑ Childs JE, Ksiazek TG, Spiropoulou CF, Krebs JW, Morzunov S, Maupin GO, Gage KL, Rollin PE, Sarisky J, Enscore RE (1994). "Serologic and genetic identification of Peromyscus maniculatus as the primary rodent reservoir for a new hantavirus in the southwestern United States". J. Infect. Dis. 169 (6): 1271–80. doi:10.1093/infdis/169.6.1271. PMID   8195603.
  7. ↑ Drebot MA. Gavrilovskaya I. Mackow ER. Chen Z, et al. "Genetic and serotypic characterization of Sin Nombre-like viruses in Canadian Peromyscus maniculatus mice", Virus Res. 2001;75:75–86. [PubMed]
  8. ↑ Hjelle B. Lee SW. Song W. Torrez-Martinez N, et al. "Molecular linkage of hantavirus pulmonary syndrome to the white-footed mouse, Peromyscus leucopus: genetic characterization of the M genome of New York virus", J Virol. 1995;69:8137–8141. [PMC free article] [PubMed]
  9. ↑ Wells RM, Sosa Estani S, Yadon ZE, Enria D, Padula P, Pini N, Mills JN, Peters CJ, Segura EL (April–June 1997). "An unusual hantavirus outbreak in southern Argentina: person-to-person transmission? Hantavirus Pulmonary Syndrome Study Group for Patagonia". Emerg Infect Dis. 3 (2): 171–4. doi:10.3201/eid0302.970210. PMC   2627608 . PMID   9204298.
  10. ↑ Levis S, Morzunov SP, Rowe JE, Enria D, Pini N, Calderon G, Sabattini M, St Jeor SC (March 1998). "Genetic diversity and epidemiology of hantaviruses in Argentina". J Infect Dis. 177 (3): 529–38. doi: 10.1086/514221 . PMID   9498428.
  11. ↑ Cantoni G, Padula P, Calderón G, Mills J, Herrero E, Sandoval P, Martinez V, Pini N, Larrieu E (October 2001). "Seasonal variation in prevalence of antibody to hantaviruses in rodents from southern Argentina". Trop Med Int Health. 6 (10): 811–6. doi: 10.1046/j.1365-3156.2001.00788.x . PMID   11679129.
  12. ↑ "Hantavirus Disease, by State of Reporting | Hantavirus | DHCPP | CDC". Centers for Disease Control and Prevention . 26 February 2019. Retrieved June 5, 2021.
  13. ↑ Peters, C.J. (2006). "Emerging Infections: Lessons from the Viral Hemorrhagic Fevers". Transactions of the American Clinical and Climatological Association. 117: 189–197. PMC   1500910 . PMID   18528473.
  14. ↑ Crowley, J.; Crusberg, T. "Ebola and Marburg Virus Genomic Structure, Comparative and Molecular Biology". Dept. of Biology & Biotechnology, Worcester Polytechnic Institute. Archived from the original on 2013-10-15.
  15. ↑ Akram, Sami (20 November 2020). Hantavirus Cardiopulmonary Syndrome. National Center for Biotechnology Information. PMID   29083610.
  16. 1 2 "CDC - Hantavirus Pulmonary Syndrome (HPS) – Hantavirus". Centers for Disease Control and Prevention. 2013-02-06. Retrieved 2013-07-07.
  17. ↑ "Death at the Corners". Discover Magazine. 1993-12-01. Retrieved 2013-03-25.
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