Hantavirus Pulmonary Syndrome

Excerpt

Hantavirus pulmonary syndrome (HPS) is a rare but severe pulmonary disease characterized by pulmonary edema, hypoxia, and hypotension. HPS is caused by viruses of the Orthohantavirus genus and the Hantaviridae family. Hantaviruses cause 2 main clinical presentations:

1. Hemorrhagic fever renal syndrome is characterized by acute kidney injury, thrombocytopenia, fever, and hypotension. Found mainly in Asia, Eastern Russia, and parts of Europe, the primary causative virus species are Hantaan, Dobrava, Seoul, and Puumala. Please see our companion StatPearls article, "Hemorrhagic Fever Renal Syndrome," for further information.

2. Fever, myalgias, and severe respiratory compromise characterize HPS. Found mainly in North and South America, the primary causative virus species are Sin Nombre in North America and Andes in South America. Clinically, patients often require mechanical ventilation, and despite appropriate care, mortality is up to 40% (compared to 1%-15% for HFRS).

Both syndromes involve the primary mechanism of virus inhalation, can affect the lungs and kidneys, and involve increased microvascular permeability, consumptive platelet coagulopathy, and hyperactivity of the host immune system. Over 24 known Hantaviridae are capable of causing human disease, and the virus type varies primarily by geographic location and animal vector. All types are carried by rodents (and shrews and bats, but rarely) and spread to humans through inhalation of aerosolized urine, feces, or animal bites. (The animals are asymptomatic carriers.) There is no known cure, and treatment is supportive. The highest risk of infection is seen in those who have close contact with animal hosts, and prevention is focused on decreasing human-rodent contact.

Due to a plethora of newly sequenced viral genomic data, the taxonomy classifications were updated in 2016 to include Bunyavirales as an order, and the previous genus Hantavirus became the family classification Hantaviridae. Orthohantavirus became the genus, and in this review, will be referred to as "Hantavirus."