Hantavirus infection overview: Difference between revisions
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{{Hantavirus infection}} | {{Hantavirus infection}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{SMP}} {{USAMA}} | ||
==Overview== | ==Overview== | ||
Revision as of 21:18, 7 July 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2] Usama Talib, BSc, MD [3]
Overview
Hantavirus pulmonary syndrome (HPS) is a deadly disease from rodents.
Historical Perspective
Classification
Hantavirus infection can be classified on the basis of the clinical manifestations and the type of hantavirus responsible for the manifestation. The clinical manifestations may include hantavirus cardiopulmonary syndrome (HCPS), hemorrhagic fever with renal syndrome (HFRS) and nephropathia epidemica (NE).[1]
Pathophysiology
Hantavirus is usually transmitted via the inhalation of aerosolized viral antigens or rodent bites. The incubation period of hantavirus infection is of 9 to 33 days. Following inhalation, the virus replicates in pulmonary macrophages and dendritic cells. The primary target cells of hantavirus infection are endothelial cells of capillaries. Infection is followed by impairment of the barrier function of endothelial cells, fluid extravasation, and subsequent organ failure.
Causes
Hantaviruses belong to the bunyaviridae family of viruses. There are 5 genera within the bunyaviridae family: bunyavirus, phlebovirus, nairovirus, tospovirus, and hantavirus. Each is made up of negative-sensed, single-stranded RNA viruses. All these genera include arthropod-borne viruses, with the exception of hantavirus, which is a genus of rodent-borne agents.
Differentiating Hantavirus from other Diseases
Epidemiology and Demographics
Hantavirus infection has a diverse epidemiology and demographics due to the vast number of viruses classified under hantaviruses. The total number of hantavirus pulmonary syndrome (HPS) cases reported in the United States from 2004-2015 is 323. HPS cases have been reported in 30 states, including most of the western half of the country and some eastern states as well. Over half of the confirmed cases have been reported from areas outside the Four Corners area. The mean age of confirmed HPS cases is 38 years (range: 5 to 84 years).[2]
Risk Factors
Little is known about activities that lead to a greater risk of infection. However, an early case-control study suggests that increased numbers of rodents in the household is the strongest risk factor for infection.
Screening
There are no screening recommendations for hantavirus infection.
Natural History, Complications and Prognosis
If hantavirus infection left untreated, it may result in multi-organ failure and death. Possible complications include, acute encephalomyelitis, Pituitary hemorrhage, Glomerulonephritis, Pulmonary edema, acute respiratory distress syndrome, Disseminated intravascular coagulation, Thrombocytopenia, and shock. Its prognosis depends on the extent of the diseases. The hantavirus cardiopulmonary syndrome (HCPS) has 38% mortality rate but, hemorrhagic fever with renal syndrome (HFRS) has a better prognosis with 1 to 15% mortality rate.[3][4][5]
Diagnosis
History and Symptoms
The symptoms of hantavirus infection may include sudden fever, prostration, myalgia, and abdominal discomfort. Pulmonary and hemorrhagic symptoms may also arise in severe disease.
Physical Examination
Patients with hantavirus infection usually exhibit prostration. Physical examination of patients with hantavirus infection is remarkable for abdominal discomfort, fever, skin petechia, low blood pressure and abnormal cardiopulmonary examination.[1][6]
Laboratory Findings
Diagnosis of hantavirus infection is usually made by a positive serological test result. Evidence of viral antigen in tissue by immunohistochemistry, or the presence of amplifiable viral RNA sequences in blood or tissue, with a compatible history of HPS, is considered diagnostic for HPS.
X ray
On x-ray, hantavirus infection may manifest as noncardiogenic pulmonary edema is characterized by alveolar infiltrates.
CT scan
On CT scan, hantavirus pulmonary syndrome is characterized by ground-glass opacities and interlobular and intralobular septal thickening.
MRI
There are no MRI findings associated with hantavirus infection.
Ultrasound
Other Imaging findings
Other Diagnostic Studies
Treatment
Medical Therapy
There is no specific treatment, cure, or vaccine for hantavirus infection. However, we do know that if infected individuals are recognized early and receive medical care in an intensive care unit, they may do better.
Surgery
Primary Prevention
Eliminate or minimize contact with rodents in your home, workplace, or campsite. Seal up holes and gaps in your home or garage. Place traps in and around your home to decrease rodent infestation. Clean up any easy-to-get food. Recent research results show that many people who became ill with HPS developed the disease after having been in frequent contact with rodents and/or their droppings around a home or a workplace. On the other hand, many people who became ill reported that they had not seen rodents or rodent droppings at all. Therefore, if you live in an area where the carrier rodents are known to live, try to keep your home, vacation place, workplace, or campsite clean.
Secondary Prevention
References
- ↑ 1.0 1.1 Jiang H, Zheng X, Wang L, Du H, Wang P, Bai X (2017). "Hantavirus infection: a global zoonotic challenge". Virol Sin. 32 (1): 32–43. doi:10.1007/s12250-016-3899-x. PMID 28120221.
- ↑ "Hantavirus Pulmonary Syndrome (HPS) Cases, by State of Exposure | Hantavirus | DHCPP | CDC".
- ↑ Crowley MR, Katz RW, Kessler R, Simpson SQ, Levy H, Hallin GW, Cappon J, Krahling JB, Wernly J (1998). "Successful treatment of adults with severe Hantavirus pulmonary syndrome with extracorporeal membrane oxygenation". Crit. Care Med. 26 (2): 409–14. PMID 9468181.
- ↑ Mertz GJ, Hjelle B, Crowley M, Iwamoto G, Tomicic V, Vial PA (2006). "Diagnosis and treatment of new world hantavirus infections". Curr. Opin. Infect. Dis. 19 (5): 437–42. doi:10.1097/01.qco.0000244048.38758.1f. PMID 16940866.
- ↑ Levy H, Simpson SQ (1994). "Hantavirus pulmonary syndrome". Am. J. Respir. Crit. Care Med. 149 (6): 1710–3. doi:10.1164/ajrccm.149.6.8004332. PMID 8004332.
- ↑ Imazio M, Gaita F, LeWinter M (2015). "Evaluation and Treatment of Pericarditis: A Systematic Review". JAMA. 314 (14): 1498–506. doi:10.1001/jama.2015.12763. PMID 26461998.