Hantavirus
Background
- Infection by the Sin Nombre virus can range from a nonspecific viral syndrome to the Hanta Pulmonary Syndrome (HPS), which is a severe respiratory manifestation with a high mortality rate
- Virus is transmitted by rodent urine, droppings, and saliva
- Resevoir includes deer mouse, white footed mouse, and cotton rat
- Most cases of exposure US have occurred in southwest states
Clinical Features
- Incubation of 1-8 weeks after exposure to source
- Early symptoms are nonspecific and includes fever, fatigue, myalgia, and headache
- May also exhibit abdominal pain, nausea, vomiting, and diarrhea
- HPS develops several days later including shortness of breath and cough which rapidly progresses to noncardiogenic pulmonary edema and respiratory failure over 24-48 hours
- Hemodynamical instability may ensue in the late phase
- Symptoms that make HPS less likely includes conjunctival injection, petechiae, or rashes
Differential Diagnosis
Lower Respiratory Zoonotic Infections
- Psittacosis
- Anthrax (Bacillus anthracis)
- Brucellosis (Brucella species)
- Q fever (C. burnetti)
- Pasteurellosis (Pasteurella multocida)
- Melioidosis (Burkholderia pseudomallei)
- Rocky Mountain Spotted Fever (R. rickettsii)
- Pulmonic Plague (Yersinia pestis)
- Influenza A
- Hantavirus
LA County Guidelines (for Yosemite outbreak)
Physicians with Patients Presenting with Concerns or Symptoms of Hantavirus Pulmonary Syndrome (HPS) after Visit to Yosemite National Park, June through August 2012.
- If a patient presents with concerns or non-specific symptoms well after 6 weeks from their stay in Yosemite, the patient most likely does not have hantavirus infection and testing for hantavirus infection is not indicated.
- If a patient presents with non-specific symptoms within 6 weeks of their stay in Yosemite and hantavirus infection is not suspected, the patient should be followed as clinically indicated, but testing for hantavirus infection is not indicated.
- If a patient presents with fever and mild symptoms suspicious for early hantavirus infection within 6 weeks of their stay in Yosemite, then a complete blood count (CBC) and chemistry panel should be done at baseline and hantavirus serology should be requested.
- If a patient presents with fever, shortness of breath, and other symptoms suggestive of HPS within 6 weeks of their stay in Yosemite, or if the patient in #3 above progresses to having symptoms and laboratory results suggestive of HPS, the patient should be transferred to a hospital emergency department for full evaluation.
- In California, hantavirus infections are reportable. Suspect cases in LA County should be reported to Acute Communicable Disease Control immediately so that we may assist with diagnostic testing.
Call 213-240-7941 (business hours) or 213-974-1234 (after hours) to speak to the duty physician.
Treatment
- Supportive care is the main form of treatmetn
- Aggressive respiratory support including early intubation and mechanical ventilation for HPS
- Hemodynamic support with early vasopressor administration
- Consider ECMO for refractory cases
References
These are abbreviated public health recommendations. Please see the full state guidance document at [1]