Hantavirus: Cause, Symptoms, Signs, Investigations, Treatment, Prevention.

Hantavirus

Enveloped RNA bunyaviruses- hosted naturally in rodents, moles, and shrews.

Transmitted by rodents.

Aerosols of virus-contaminated rodent urine and feces are main mode of transmission.

Occupation is the main risk factor: animal trappers, forestry workers, farmers, laboratory personnel, and military personnel.

two clinical syndromes:

Hemorrhagic fever with renal syndrome (HFRS): mild to severe illness.

Hantavirus pulmonary syndrome (HPS) or hantavirus cardiopulmonary syndrome: Severe- 40% mortality rate.

Hantavirus Symptoms And Signs:

Vascular leakage is the hallmark of disease.

Hemorrhagic fever with renal syndrome (HFRS):

as mild, moderate, or severe illness.

Incubation period- 2- to 3-weeks.

five distinct phases: febrile period, hypotension, oliguria, diuresis, and convalescence phase.

Various degrees of kidney involvement seen.

Thromboembolic phenomena .

A secondary hemophagocytic lymphohistiocytosis.

Pulmonary edema usually occurs in oliguric and diuretic phase.

Encephalitis and pituitary involvement.

persistent hematuria, proteinuria, or hypertension up to 35 months after infection.

Smoking appears to exacerbate the viremia, and bradycardia can also be prominent.

Hantavirus pulmonary syndrome (HPS) or hantavirus cardiopulmonary syndrome:

The clinical course- a febrile prodrome, a cardiopulmonary stage, oliguric and diuretic phase, then convalescence.

Incubation period- 14- to 17-day, then a prodromal phase,

lasting 3–6 days,

myalgia, malaise, sudden onset of fever with chills, abdominal pain along with diarrhea, nausea, & headache.

Cardiopulmonary phase- acute onset of pulmonary edema.

Cough, abdominal pain & above symptoms.

In severe cases- significant myocardial depression.

Acute kidney injury and myositis. In some HPS survivors- sequelae include neuropsychological impairments.

Hantavirus Investigations:

Indirect fluorescent assay & enzyme immunoassay- for IgM or low-avidity IgG virus-specific antibodies.

Quantitative RT-PCR.

A plaque reduction neutralization test- gold standard serologic assay.

Elevated hematocrit due to Hemoconcentration.

Leukocytosis (as high as 90,000 cells/mcL in HPS)- shift to left, in both HFRS and HPS.

Peripheral blood smear- may show atypical lymphocyte & or immunoblast.

Early thrombocytopenia.

Elevation in lactate dehydrogenase, serum lactate, and hepatocellular enzymes.

Decrease in serum albumin in HPS.

Urine show proteinuria in 50%.

Renal involvement may show increase in urea and creatinine.

Hantavirus Differential Diagnosis:

Acute febrile syndrome seen with early HPS or HFRS, requires differentiation from dengue, scrub typhus, leptospirosis.

And HPS from other respiratory infections caused by Chlamydia, Legionella, and Mycoplasma.

And Coxsackievirus infection in differential diagnosis.

Hantavirus Treatment:

Treatment is supportive and symptomatic.

Tablet Paracetamol 500 mg sos for fever and myalgia.

Careful monitoring of vital signs required.

Cardiorespiratory support with vasopressors may be needed;

extracorporeal membrane oxygenation may be in severe HPS.

I/V ribavirin is used in (Hantaan virus) HFRS with some success in decreasing severity of kidney injury.

Effectiveness in HPS is not established.

Hantavirus Prevention:

Main mode of transmission aerosols of virus-contaminated rodent urine and feces.

So prevention is eradication of rodents in houses and avoidance of exposure.

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