Hantavirus cardiopulmonary syndrome

A notifiable condition in the US.

Epidemiologic history of rodent infestation in or around the dwelling and/or cleaning out of rodent-contaminated enclosed areas are risk factors for hantavirus infection.

Presents as a nonspecific viral illness with fever, headache, myalgias, and often prominent gastrointestinal symptoms. During the pulmonary phase there is increasing dyspnea and hypoxemia, which can progress rapidly to cardiogenic shock and death.

Although there is no specific treatment or cure, cases must be managed in an intensive care unit. Broad-spectrum antibiotic therapy, analgesia, and antipyretics are given while awaiting confirmation of diagnosis.

In the cardiopulmonary phase of the disease, a falling cardiac index with evidence of cardiovascular collapse is an indication for extracorporeal membrane oxygenation support. Mortality is up to 50%, due to pulmonary edema and cardiogenic shock.

Hantavirus infection is associated with two types of severe acute febrile illness: hantavirus cardiopulmonary syndrome (HCPS), and hemorrhagic fever with renal syndrome (HFRS). HCPS, also known as hantavirus pulmonary syndrome (HPS), is an acute febrile illness marked by a nonspecific viral prodrome followed by rapidly progressive pulmonary insufficiency and shock occurring in an otherwise healthy person. Infection is acquired through aerosol contact with rodent excreta.

New World hantaviruses (e.g., Sin Nombre, Bayou, New York, Black Creek Canal, and Monongahela viruses) are associated with HCPS, while Old World hantaviruses (e.g., Hantaan, Dobrava, Seoul, and Puumala viruses) cause HFRS.[1]Vapalahti O, Mustonen J, Lundkvist A, et al. Hantavirus infections in Europe. Lancet Infect Dis. 2003 Oct;3(10):653-61. http://www.ncbi.nlm.nih.gov/pubmed/14522264?tool=bestpractice.com

This topic focuses on the diagnosis and management of HCPS. HCPS with renal involvement has been reported, but is not considered to be HFRS.