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Hantavirus Pulmonary Syndrome (HPS)

Dr Healthism
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  • 24 Feb, 2019 8:08 pm
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Hantavirus pulmonary syndrome (HPS) is one of two potentially fatal syndromes of zoonotic origin caused by species of hantavirus. These include Black Creek Canal virus (BCCV), New York virus (NYV), Monongahela virus (MGLV), Sin Nombre virus (SNV), and certain other members of Hantavirus genera that are native to the United States and Canada. Specific rodents are the principal hosts of the hantaviruses including the hispid cotton rat (Sigmodon hispidus) in southern Florida, which is the principal host of Black Creek Canal virus., The deer mouse (Peromyscus maniculatus) in Canada and the Western United States is the principal host of Sin Nombre virus. The white-footed mouse (Peromyscus leucopus) in the eastern United States is the principal host of New York virus. In South America, the Oligoryzomys longicaudatus and other species of the genus Oligoryzomys have been documented as the reservoir for Andes virus.

Signs and symptoms
Prodromal symptoms are flu-like ones, such as fever, cough, myalgia, headache, lethargy, and shortness of breath, which rapidly deteriorates into acute respiratory failure. It is characterized by the sudden onset of shortness of breath with rapidly evolving pulmonary edema; it is often fatal despite mechanical ventilation and intervention with potent diuretics. It has a fatality rate of 36%.

Transmission

The hispid cotton rat, indigenous to southern Florida, is the carrier of the Black Creek Canal virus
Transmission by aerosolized rodent excreta still remains the only known way the virus is transmitted to humans. In general, droplet and/or fomite transfer has not been shown in the hantaviruses in either the pulmonary or hemorrhagic forms.

Diagnosis
According to Kevin Litman-Navarro, “HPS can be easy to overlook because its early symptoms are very similar to the flu. Infected patients suffer from fatigue, fever, and muscle aches often accompanied by headaches, dizziness and gastrointestinal problems in the weeks following exposure. About a week after the initial symptoms subsided, the second phase of the disease sets in, and patients experience severe coughing and shortness of breath as the lungs fill with fluid. In the later stages of HPS, the lungs are severely damaged, resulting in a fatality rate of about 38 percent.”

Prevention
Rodent control in and around the home or dwellings remains the primary prevention strategy, as well as eliminating contact with rodents in the workplace and at campsites. Closed storage sheds and cabins are often ideal sites for rodent infestations. Airing out of such spaces prior to use is recommended. People are advised to avoid direct contact with rodent droppings and wear a mask while cleaning such areas to avoid inhalation of aerosolized rodent secretions.

Treatment
There is no cure or vaccine for HPS. Treatment involves supportive therapy, including mechanical ventilation with supplemental oxygen during the critical respiratory-failure stage of the illness. Early recognition of HPS and admission to an intensive care setting offers the best prognosis.

Epidemiology
Hantavirus pulmonary syndrome was first recognized during the 1993 outbreak in the Four Corners region of the southwestern United States. It was identified by Dr. Bruce Tempest. It was originally called Four Corners disease, but the name was changed to Sin Nombre virus after complaints by Native Americans that the name “Four Corners” stigmatized the region. It has since been identified throughout the United States.

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