Hantavirus infection natural history, complications and prognosis

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Patient Information Hantavirus cardiopulmonary syndrome (HCPS) (patient information) Hemorrhagic fever with renal syndrome (HFRS) (patient information)
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Natural History

• Within 24 hours of initial evaluation, most patients develop some degree of hypotension and progressive evidence of pulmonary edema and hypoxia, usually requiring mechanical ventilation.
• The patients with fatal infections appear to have severe myocardial depression which can progress to sinus bradycardia with subsequent electromechanical dissociation, ventricular tachycardia or fibrillation.
• Hemodynamic compromise occurs a median of 5 days after symptom onset--usually dramatically within the first day of hospitalization.
• In contrast to HFRS, overt hemorrhage occurs rarely in HPS, although hemorrhage is occasionally seen in association with disseminated intravascular coagulation.
• In contrast to septic shock, HPS patients have a low cardiac output with a raised systemic vascular resistance. Poor prognostic indicators include a plasma lactate of greater than 4.0 mmol/L or a cardiac index of less than 2.2 L/min/m2 Whilst pulmonary edema and pleural effusions are common, multiorgan dysfunction syndrome is rarely seen. *However, HPS patients sometimes have mildly impaired renal function. Survivors frequently become polyuric during convalescence and improve almost as rapidly as they decompensated.

Complications

Complications that can develop as a result of Hantavirus infection depends on the type of infection which include

• Acute encephalomyelitis
• Bleeding
• Multiorgan dysfunction
• Pituitary hemorrhage
• Glomerulonephritis
• Pulmonary edema
• Acute respiratory distress syndrome
• Disseminated intravascular coagulation

• renal insufficiency,
• Thrombocytopenia
• Bleeding
• Myalgia
• Vomiting
• Diarrhea
• Shock

lethal outcome