Hantavirus: an old bug learns new tricks

Hantavirus pulmonary syndrome in Texas: 1993-2006

BACKGROUND

Hantavirus pulmonary syndrome (HPS) is a rare cardiopulmonary disease that was first described after a 1993 epidemic in the southwestern United States. This study reviewed all cases reported in Texas to date.

METHODS

We reviewed case report forms submitted to the Texas Department of State Health Services and medical records (when available) to determine demographic and clinical features of Texas HPS cases.

CONCLUSIONS

Middle-aged adults were more commonly affected. Respiratory symptoms were often accompanied by fever, gastrointestinal symptoms, and headache. Hypoxemia was observed in all cases. Common laboratory features included thrombocytopenia (92% of patients), elevated creatinine (61% of patients), increased polymorphonuclear leukocyte band forms (52% of patients), and hematocrit more than 55% (32% of patients). Most cases were associated with seeing rodents or rodent excreta at home. HPS was frequently misdiagnosed on initial presentation. Mortality was over 46%, higher for infection with the Sin Nombre virus (50%) than with the Bayou virus (0%). In Texas, the distribution of HPS is mainly along the coast and in west Texas.

Hantavirus pulmonary syndrome: Report of four Alberta cases

Four Alberta cases of hantavirus pulmonary syndrome are reported. Three cases required intensive care, with one experiencing a fulminant course resulting in death. A fourth case with milder illness was identified after epidemiological investigations. Ribavirin was used in one patient who experienced a successful outcome. A recent open label trial has not supported the efficacy of this drug. The epidemiology of Peromyscus maniculatus, the primary rodent host, and the clinical features of this syndrome are summarized.