Hantavirus cardiopulmonary syndrome
History and exam
Key diagnostic factors
common
exposure to rodent excreta/bite
A history of peridomestic exposure to rodents or cleaning rodent-infested enclosures is an epidemiologic clue to diagnosing hantavirus infection.[21]
dyspnea
Early in infection, may not be associated with hypoxemia and is nonspecific. The patient may rapidly progress to severe respiratory distress.
hypotension
A feature of moderate to severe disease. May progress to cardiogenic shock.
Other diagnostic factors
common
fever
A nonspecific feature of the viremic prodrome.[5]
myalgia
A nonspecific feature of the viremic prodrome.[5]
gastrointestinal symptoms
headache
Nonspecific symptoms during the viremic prodrome.[5]
normal or low oxygen saturation
Oxygen saturation is normal in the early phase of the disease, but patients become hypoxic as the disease progresses.
lung rales
A sign of pulmonary edema. Typical of moderate to severe disease and heralds the onset of the cardiopulmonary phase.
cough, chest tightness
A cough or chest tightness may develop during the cardiopulmonary phase as a sign of pulmonary edema.[6]
Risk factors
strong
exposure to rodent excreta/bite
The deer mouse, host for Sin Nombre virus (SNV), is widely distributed in the US, excluding the southeast Atlantic coastal states. Numerous rodents have been identified as hosts for different hantavirus subtypes in Central and South America.[21] Infected rodents do not show signs of disease.
Risk is related to rodent exposure, particularly peridomestic activities such as cleaning in and around homes with evidence of infestation, and cleaning or inhabiting seasonally closed structures that have had rodent habitation.[16]
weak
close contact with hantavirus-infected humans
Human-to-human transmission of the Andes virus (ANDV) has been reported in Argentina and Chile and has been documented to occur mainly in family clusters.[24][25] Sexual partners were found to have a 10-fold increase in risk of infection compared with the rest of household contacts.[26] Close contact with a sick person during the prodromal phase of the disease (12 to 27 days from initial exposure of the source case) appeared to increase the chances of human-to-human transmission.[4] However, meta analysis of the available evidence does not support routine human-to-human transmission of ANDV.[29]
Only two cases of nosocomial transmission have been reported so far, both in Chile.[25]
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