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Hantavirus Infection

by Craig R. Pringle, BSc, PhD

Hantavirus infection is a viral disease that is spread from rodents to people. The virus can cause severe infections of the lungs (with cough and shortness of breath) or kidneys (with rash, abdominal pain, and sometimes kidney failure).

  • Hantavirus is spread through contact with infected rodents or their droppings.

  • The infection starts with sudden fever, headache, muscle aches, and sometimes abdominal symptoms, which may be followed by a cough and shortness of breath or by a rash and kidney problems.

  • Blood tests to identify the virus can confirm the diagnosis.

  • Oxygen and drugs to stabilize blood pressure are used if the lungs are affected, and dialysis may be needed if the kidneys are affected.

Hantaviruses infect various species of rodents throughout the world. The virus is present in the urine and feces of the rodents. The infection is spread when people have contact with rodents or their droppings or urine or possibly when they inhale virus particles in places with large amounts of rodent droppings. Some evidence suggests that rarely, the virus spreads from person to person. Hantavirus infections are becoming more common.

There are several strains of hantavirus. Depending on the strain, the virus affects different organs:

  • The lungs, causing hantavirus pulmonary syndrome (HPS)

  • The kidneys, causing hemorrhagic fever with renal syndrome (HFRS)

However, many symptoms of the two infections overlap.

The pulmonary syndrome was first recognized in the southwestern United States in 1993. As of 2013, about 637 cases have occurred in the United States, most in the western states. Cases have also occurred in several Central and South American countries.

The renal syndrome occurs primarily in parts of Europe and Korea. Seoul hantavirus causes the renal syndrome. The virus is spread by brown Norway rats and has been spread throughout the world by rats on ships.

Symptoms

Symptoms begin with sudden fever, headache, and muscle aches, typically about 2 weeks after exposure to the rodent droppings or urine. People may also have abdominal pain, diarrhea, or vomiting.

These symptoms continue for several days (usually for about 4 but sometimes up to 15 days).

People with the pulmonary syndrome then develop a cough and shortness of breath, which may become severe within hours. Fluid collects around the lung, and blood pressure becomes low. This syndrome causes death in about 50 to 75% of people. Those who survive the first few days improve rapidly and recover completely in about 2 to 3 weeks.

In some people with hemorrhagic fever with renal syndrome, the infection is mild and does not cause symptoms. In others, vague symptoms (such as fever, muscle aches, headache, and nausea) last for 3 or 4 days. Then in most people, the face becomes red, resembling a sunburn, and is covered with hives. A rash may develop on the trunk. People with mild symptoms recover completely. In others, symptoms become severe. Very low blood pressure (shock) develops in a few people. Kidney failure develops, and urine production may stop (called anuria). People may have blood in their urine and/or stool and bruises on their skin. Death occurs in 6 to 15%. Of those who survive, most recover in 3 to 6 weeks, but recovery may take up to 6 months.

Diagnosis

  • Blood tests to identify the virus

Diagnosis is suspected when people who may have been exposed to the virus have characteristic symptoms.

Blood tests to identify the virus can confirm the diagnosis.

Doctors do other blood tests to evaluate the function of the kidneys and other organs. If the pulmonary syndrome is suspected, a chest x-ray may be done. Echocardiography (ultrasonography of the heart) is usually done to exclude other causes of fluid around the lungs.

Treatment

  • Supportive care

  • For the pulmonary syndrome, oxygen and drugs to stabilize blood pressure

  • For the renal syndrome, dialysis and ribavirin

Treatment is mostly supportive.

For the pulmonary syndrome, oxygen and drugs to stabilize blood pressure appear to be most crucial to recovery. Sometimes a ventilator is needed to help with breathing.

For the renal syndrome, dialysis may be needed and can be lifesaving, and the antiviral drug ribavirin, given intravenously, may help reduce the severity of symptoms and the risk of death.

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  • VIRAZOLE