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Hantavirus

Two major groups of hantaviruses are recognized based on their clinical presentation. The first group includes Sin Nombre Virus (SNV), which causes hantavirus pulmonary syndrome. A second group of hantaviruses includes Seoul, Hantaan, Dobrava, and Puumala viruses. This group of hantaviruses causes hemorrhagic fever with renal syndrome, which is not commonly seen in the United States.

Hantavirus pulmonary syndrome (HPS) is an acute, zoonotic viral disease that is spread by contact with infected rodents, primarily deer mice (Peromyscus maniculatus). Most persons with HPS are infected by breathing in small viral particles from rodent urine or droppings that have been stirred up into the air. Sin Nombre virus causes the majority of infections in the United States. The majority of HPS cases occur in spring and summer; however, the seasonality of HPS can vary by elevation, location, and biome. The fatality rate is 30 to 40%.

The incubation period for HPS is typically 2 to 4 weeks after exposure, with a range of a few days up to 6 weeks. Hantavirus pulmonary syndrome (HPS) typically begins as headache, fever, chills, myalgia, cough and gastrointestinal symptoms in a previously healthy person. Characteristic laboratory abnormalities include thrombocytopenia, leukocytosis, hemoconcentration, hypoalbuminemia, and elevated serum lactate dehydrogenase. Bilateral diffuse interstitial pulmonary edema usually develops within 72 hours of hospitalization. Radiographically, the edema can resemble acute respiratory distress syndrome. There is no specific treatment available, but early recognition and administration of supportive care greatly increase the chance of survival.

Laboratory testing of patients with symptoms consistent with HPS is required to confirm the diagnosis. Sera are initially screened for IgG and IgM antibodies recognizing the nucleocapsid protein common to all hantaviruses. All IgM positive samples are then tested for SNV-specific IgM and SNV-specific IgG. A positive result in the screening ELISA but a negative result in confirmatory assays may indicate reactivity to a hantavirus causing hemorrhagic fever with renal syndrome.

Because it is a reportable disease in the United States, clinicians suspecting HPS should notify their state health department. For additional information about HPS symptoms and diagnosis, please go to the CDC’s Hantavirus webpage at: http://www.cdc.gov/hantavirus/technical/hps/index.html.

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