Hantavirus Pulmonary Syndrome Clinical Presentation

Updated: Jan 15, 2019
  • Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Michael Stuart Bronze, MD  more...
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Presentation

History

The incubation period of Hantavirus pulmonary syndrome (HPS) ranges from 1-4 weeks. HPS has been divided into 3 clinical phases: (1) the prodromal phase, (2) the cardiopulmonary phase, and (3) the convalescent phase.

Prodromal symptoms resemble those of many viral illnesses, including fever, headache, and myalgias. Vomiting, diarrhea, and abdominal pain are common. Because symptoms initially referable to the respiratory tract are minimal or absent, the physician may incorrectly conclude that the patient has viral gastroenteritis. Neurologic symptoms, except dizziness, are uncommon. This phase lasts 3-5 days.

The cardiopulmonary phase is initiated by dyspnea, nonproductive cough, and circulatory collapse. This stage typically lasts only 24-48 hours, although has been observed for up to 7 days. Seventy-five percent of patients with pulmonary edema require mechanical ventilation. Oliguric renal failure is uncommon. When it does occur, it is due to acute tubular necrosis (ATN), as compared to the renal tubular cell damage observed in hemorrhagic fever with renal failure syndrome (HFRS).

Resolution of the cardiopulmonary stage of HPS is heralded by the onset of significant diuresis. After this occurs, the patient improves quite rapidly (ie, convalescent phase). The chronic sequelae of HPS are minimal.

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Physical Examination

Physical examination findings of Hantavirus pulmonary syndrome are typically consistent with those of sepsis, as follows:

  • Vitals reveal fever, tachycardia, and tachypnea.
  • Hypotension is seen in about one third of cases.
  • Pulmonary examination shows diffuse rales.
  • Rash is typically absent.
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Causes

Sin Nombre virus (SNV) is the primary agent responsible for Hantavirus pulmonary syndrome (HPS) and is the deadliest member of the Hantavirus family. However, there are numerous other pathogenic hantaviruses. The New York virus has been identified as the cause of HPS in New York and Rhode Island, and the Bayou and Black Creek Canal viruses, found in the southeastern United States, produce a variant of the syndrome that includes a greater degree of renal failure. The more distantly related Hantaan, Seoul, Dobrava/Belgrade, and Puumala hantaviruses produce a distinct syndrome of hemorrhagic fever and renal failure (HFRS).

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Complications

Renal failure due to ATN may occur.

Severe capillary pulmonary leakage may result in intractable noncardiogenic pulmonary edema and cardiorespiratory collapse and/or shock.

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