Hantavirus Pulmonary Syndrome Clinical Presentation

Updated: Oct 27, 2015
  • Author: Burke A Cunha, MD; 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 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 lasts only 24-48 hours. 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 the 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

Physical findings, reported in 80-90% of patients, include fever, tachypnea, tachycardia, and rales.

Upon presentation, hypotension is found in only one third of patients.

Rash is quite uncommon.

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Causes

Sin Nombre virus (SNV) is thought to cause most cases of HPS in the United States.

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