Hantavirus Cardiopulmonary Syndrome

Excerpt

Hantaviruses are single-stranded, negative-sense RNA viruses in the Bunyavirales order. Infection occurs via inhalation of aerosolized excretions from infected rodents. These viruses are associated with both hantavirus cardiopulmonary syndrome (HCPS) caused by hantaviruses of the New World and hemorrhagic fever with renal syndrome (HFRS) caused by hantaviruses of the Old World. HCPS, also known as hantavirus pulmonary syndrome (HPS), is a febrile illness characterized by respiratory failure with diffuse interstitial edema. The illness has three distinct phases: the prodrome, cardiopulmonary phase, and the convalescent phase. After a non-specific prodromal phase, patients have significant respiratory symptoms as their lungs fill with fluid. This is often associated with hemodynamic compromise with a clinical picture resembling cardiogenic shock. Treatment remains largely supportive and includes ventilator support and even extracorporeal membrane oxygenation if necessary.

The etiologic agent causing HFRS was first described in 1978 and named after the Hantan river in South Korea. This virus caused Korean hemorrhagic fever among United Nations troops during the Korean War between 1951 and 1953. HCPS was first described in 1993 after several people from the Navajo tribe developed an acute respiratory illness in the Four Corners region in the US. Patients initially presented with symptoms of fevers, chills, cough, and myalgias, however, progressed to significant respiratory distress and hemodynamic compromise. An early case-control study identified exposure to rodents as a risk factor for disease, thus a rodent-trapping operation was initiated. A genetic detection assay was used to determine that patients were infected with a novel hantavirus which was termed the Sin Nombre virus (SNV). The clinical illness became known as hantavirus cardiopulmonary syndrome.