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 and can be summarized in the following table.

Type of hantavirus infection	Complications
Hemorrhagic fever with renal syndrome (HFRS)	Acute encephalomyelitis Bleeding Multiorgan dysfunction Pituitary hemorrhage Glomerulonephritis Pulmonary edema Acute respiratory distress syndrome Disseminated intravascular coagulation
Hantavirus cardiopulmonary syndrome (HCPS	Renal insufficiency, Thrombocytopenia Bleeding Myalgia Vomiting Diarrhea Shock