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UPDATE ON HANTAVIRUS PULMONARY SYNDROME (HPS).

The CDC has published the first detailed reports that identify and describe the hantavirus outbreak (see Journal Watch accession number 930622001). Forty-two cases leading to 26 deaths have now been confirmed. Most cases have occurred in healthy young adults from New Mexico and Arizona, although cases have been identified as far north as North Dakota and as far east as Louisiana. The initial symptoms were fever, myalgias, and other nonspecific flu-like symptoms, followed within days by the sudden onset of dyspnea that sometimes rapidly progressed to respiratory failure (resembling adult respiratory distress syndrome), shock, and death. Leukocytosis was common and occasional patients had mild renal insufficiency.

The causative agent is a new species of hantavirus, a rodent-borne RNA virus carried primarily by the deer mouse; one of the most abundant small mammals in North America. Like other known hantaviruses, this virus does not appear to spread from person to person. Other hantaviruses cause hemorrhagic fever with renal syndrome. This virus infects the endothelial tissue of many organs, and presumably the infection of pulmonary vessel endothelium leads to extravasation of fluid into the lung interstitium.

Comment: This is another impressive piece of detective work by the CDC; they rapidly identified the likely culprit and then used molecular biology to definitively identify the virus. However, it is still unclear how this virus infects humans, why most cases have occurred in the southwest U.S., whether antivirals will prove effective, and whether these first cases are the beginning of what could be a nationwide epidemic.

— ALK

Published in Journal Watch General Medicine November 30, 1993

Citation(s):

Hughes JM et al. Hantavirus pulmonary syndrome: an emerging infectious disease. Science 1993 Nov 5 262 850-851.

• Medline abstract (Free)

Nichol ST et al. Genetic identification of a hantavirus associated with an outbreak of acute respiratory illness. Science 1993 Nov 5 262 914-917.

• Medline abstract (Free)