Hantavirus Cardiopulmonary Syndrome

ABSTRACT

Hantavirus cardiopulmonary syndrome (HCPS) is caused by infection with multiple types of hantaviruses throughout the Americas. All strains induce a pulmonary capillary leak syndrome with cardiogenic shock in severe cases, and almost all strains have an overall mortality rate of 35%. Some strains in South America are commonly associated with either mild disease without pulmonary edema or severe disease with pulmonary hemorrhage. Early recognition during the thrombocytopenic prodrome phase and transport to intensive care improve survival, due to very rapid progression of respiratory failure and shock in some patients. Limited fluid replacement, early inotropic therapy, and mechanical ventilation also improve survival. Extracorporeal membrane oxygenation (ECMO) has been life saving for patients with refractory shock. Ribavirin does not appear to reduce mortality, but hyperimmune serum offers a promising future therapy because survival is correlated with higher neutralizing antibody titers at admission.

Hantavirus - pulmonary edema - cardiogenic shock - thrombocytopenia - extracorporeal membrane oxygenation

REFERENCES

• 1 Koster F, Levy H. Hantavirus cardiopulmonary syndrome: a new twist to an established pathogen. In: Fong IW, Alibek K New and Evolving Infections of the 21st Century. New York; Kluwers Academic/Plenum Publishers 2006: 151-170
• 2 Mertz G J, Hjelle B, Crowley M R, Iwamoto G, Tomicic V, Vial C P. Diagnosis and treatment of new world hantavirus infections.  Curr Opin Infect Dis. 2006;  19 437-442
• 3 Khaiboullina S F, Morzunov S, St Jeor S C. Hantaviruses: molecular biology, evolution and pathogenesis.  Curr Mol Med. 2005;  5 773-790
• 4 Nichol S T, Spiropoulou C F, Morzunov S et al.. Genetic identification of a novel hantavirus associated with an outbreak of acute respiratory illness in the Southwestern United States.  Science. 1993;  262 914-917
• 5 Figueiredo L TM, Moreli M L, Campos G M, Sousa R LM. Hantaviruses in Sao Paulo State, Brazil.  Emerg Infect Dis. 2003;  9 891-892
• 6 Rosa E S, Mills J N, Padula P J et al.. Newly recognized hantaviruses associated with hantavirus pulmonary syndrome in northern Brazil: partial genetic characterization of viruses and serologic implication of likely reservoirs.  Vector Borne Zoonotic Dis. 2005;  5 11-19
• 7 Levis S, Garcia J, Pini N et al.. Hantavirus pulmonary syndrome in northwestern Argentina: circulation of Laguna Negra virus associated with Calomys callosus .  Am J Trop Med Hyg. 2004;  71 658-663
• 8 Schmaljohn C S. Molecular biology of hantaviruses. In: Elliott RM The Bunyaviridae. New York; Plenum Press 1996: 63-86
• 9 Tsai T F. Hemorrhagic fever with renal syndrome: mode of transmission to humans.  Lab Anim Sci. 1987;  37 428-430
• 10 Yates T, Mills J N, Parmenter C A et al.. The ecology and evolutionary history of an emergent disease: hantavirus pulmonary syndrome.  BioScience. 2002;  52 989-998
• 11 Hjelle B, Torrez-Martinez N, Koster F T et al.. Epidemiologic linkage of rodent and human hantavirus genomic sequences in case investigations of hantavirus pulmonary syndrome.  J Infect Dis. 1996;  173 781-786
• 12 Douglass R J, Kuenzi A J, Williams C Y, Douglass S J, Mills J N. Removing deer mice from buildings and the risk for human exposure to Sin Nombre virus.  Emerg Infect Dis. 2003;  9 390-392
• 13 CDC . Hantavirus pulmonary syndrome-United States: updated recommendations for risk reduction.  MMWR Recomm Rep. 2002;  51(RR-9) 1-13
• 14 Vitek C R, Breiman R F, Ksiazek T G et al.. Evidence against person-to-person transmission of hantavirus to health care workers.  Clin Infect Dis. 1996;  22 824-826
• 15 Wells R M, Young J C, Williams R J et al.. Hantavirus transmission in the United States.  Emerg Infect Dis. 1997;  3 361-365
• 16 Enria D, Padula P, Segura E L et al.. Hantavirus pulmonary syndrome in Argentina: possibility of person to person transmission.  Medicina (B Aires). 1996;  56 709-711
• 17 Martinez V P, Bellomo C, San Juan J et al.. Person-to-person transmission of Andes virus.  Emerg Infect Dis. 2005;  11 1848-1853
• 18 Toro J, Vega J D, Khan A S et al.. An outbreak of hantavirus pulmonary syndrome, Chile, 1997.  Emerg Infect Dis. 1998;  4 687-694
• 19 Xiao R, Yang S, Koster F, Ye C, Stidley C, Hjelle B. Sin Nombre viral RNA load in patients with the hantavirus cardiopulmonary syndrome.  J Infect Dis. 2006;  194 1403-1409
• 20 Xu Z Y, Guo C S, Wu Y L, Zhang X W, Liu K. Epidemiological studies of hemorrhagic fever with renal syndrome: analysis of risk factors and mode of transmission.  J Infect Dis. 1985;  152 137-144
• 21 St. Jeor S C. Three-week incubation period for hantavirus infection.  Pediatr Infect Dis J. 2004;  23 974-975
• 22 Khan A S, Khabbaz R F, Armstrong L R et al.. Hantavirus pulmonary syndrome: the first 100 cases.  J Infect Dis. 1996;  173 1297-1303
• 23 Young J C, Hansen G R, Graves T K et al.. The incubation period of hantavirus pulmonary syndrome.  Am J Trop Med Hyg. 2000;  62 714-717
• 24 Vial P A, Valdivieso F, Mertz G et al.. Incubation period of hantavirus cardiopulmonary syndrome.  Emerg Infect Dis. 2006;  12 1271-1273
• 25 Duchin J S, Koster F T, Peters C J et al.. Hantavirus pulmonary syndrome: a clinical description of 17 patients with a newly recognized disease.  N Engl J Med. 1994;  330 949-955
• 26 Hallin G W, Simpson S Q, Crowell R E et al.. Cardiopulmonary manifestations of hantavirus pulmonary syndrome.  Crit Care Med. 1996;  24 252-258
• 27 Koster F, Foucar K, Hjelle B et al.. Rapid presumptive diagnosis of hantavirus cardiopulmonary syndrome by peripheral blood smear review.  Am J Clin Pathol. 2001;  116 665-672
• 28 Zavasky D M, Hjelle B, Peterson M C, Denton R W, Reimer L. Acute infection with Sin Nombre hantavirus without pulmonary edema.  Clin Infect Dis. 1999;  29 664-666
• 29 Ketai L H, Williamson M R, Telepak R J et al.. Hantavirus pulmonary syndrome: radiographic findings in 16 patients.  Radiology. 1994;  191 665-668
• 30 Riquelme R, Riquelme M, Torres A et al.. Hantavirus pulmonary syndrome, Southern Chile.  Emerg Infect Dis. 2003;  9 1438-1443
• 31 Peterson M C, Bastian B V, Tatton J A. Radiologic findings of the hantavirus pulmonary syndrome.  West J Med. 1996;  164 76-77
• 32 Boroja M, Barrie J R, Raymond G S. Radiographic findings in 20 patients with hantavirus pulmonary syndrome correlated with clinical outcome.  AJR Am J Roentgenol. 2002;  178 159-163
• 33 Ketai L H, Kelsey C A, Jordan K et al.. Distinguishing hantavirus pulmonary syndrome from acute respiratory distress syndrome by chest radiography: are there different radiographic manifestations of increased alveolar permeability?.  J Thorac Imaging. 1998;  13 172-177
• 34 Hjelle B, Jenison S, Torrez-Martinez N et al.. Rapid and specific detection of Sin Nombre virus antibodies in patients with hantavirus pulmonary syndrome by a strip immunoblot assay suitable for field diagnosis.  J Clin Microbiol. 1997;  35 600-608
• 35 Zaki S R, Khan A S, Goodman R A et al.. Retrospective diagnosis of hantavirus pulmonary syndrome, 1978-1993: implications for emerging infectious diseases.  Arch Pathol Lab Med. 1996;  120 134-139
• 36 Hjelle B. Virus detection and identification with genetic tests. In: Lee HW, Calisher CH, Schmaljohn CS Manual of Hemorrhagic Fever with Renal Syndrome and Hantavirus Pulmonary Syndrome. Seoul; WHO Collaborating Center for Virus Reference and Research (Hantaviruses) 1999: 132-137
• 37 Ramos M M, Overturf G, Crowley M R, Rosenberg R B, Hjelle B. Infection with Sin Nombre hantavirus: clinical presentation and outcome in children and adolescents.  Pediatrics. 2001;  108 E27
• 38 Pai R K, Bharadwaj M, Levy H et al.. Absence of infection of a neonate after possible exposure to Sin Nombre hantavirus in breast milk.  Clin Infect Dis. 1999;  29 1577-1579
• 39 Levy H, Simpson S Q. Hantavirus pulmonary syndrome.  Am J Respir Crit Care Med. 1994;  149 1710-1713
• 40 Crowley M R, Katz R W, Kessler R et al.. Successful treatment of adults with severe hantavirus pulmonary syndrome with extracorporeal membrane oxygenation.  Crit Care Med. 1998;  26 409-414
• 41 Rosenberg R B, Waagner D C, Romano M J, Kanase H N, Young R B. Hantavirus pulmonary syndrome treated with inhaled nitric oxide.  Pediatr Infect Dis J. 1998;  17 749-752
• 42 Adhikari N, Granton J T. Inhaled nitric oxide for acute lung injury: no place for NO?.  JAMA. 2004;  291 1629-1631
• 43 Hickman-Davis J M, McNicholas-Bevensee C M, Davis I C et al.. Reactive species mediate inhibition of alveolar type II sodium transport during mycoplasma infection.  Am J Respir Crit Care Med. 2006;  173 334-344
• 44 Huggins J W, Hsiang C M, Cosgriff T M et al.. Prospective, double-blind, concurrent, placebo-controlled clinical trial of intravenous ribavirin therapy of hemorrhagic fever with renal syndrome.  J Infect Dis. 1991;  164 1119-1127
• 45 Mertz G J, Miedzinski L, Goade D et al.. Placebo-controlled, double blind trial of intravenous ribavirin for hantavirus cardiopulmonary syndrome in North America.  Clin Infect Dis. 2004;  39 1307-1313
• 46 Bharadwaj M, Nofchissey R, Goade D, Koster F, Hjelle B. Humoral immune responses in the hantavirus cardiopulmonary syndrome.  J Infect Dis. 2000;  182 43-48
• 47 Valdivieso F, Vial C P, Ferres M G et al.. Neutralizing antibodies in survivors of Sin Nombre and Andes hantavirus infection.  Emerg Infect Dis. 2006;  12 166-168
• 48 Zaki S R, Greer P W, Coffield L M et al.. Hantavirus pulmonary syndrome: pathogenesis of an emerging infectious disease.  Am J Pathol. 1995;  146 552-579
• 49 Nolte K B, Feddersen R M, Foucar K et al.. Hantavirus pulmonary syndrome in the United States: a pathological description of a disease caused by a new agent.  Hum Pathol. 1995;  26 110-120
• 50 Green W, Feddersen R, Yousef O et al.. Tissue distribution of hantavirus antigen in naturally infected humans and deer mice.  J Infect Dis. 1998;  177 1696-1700
• 51 Sundstrom J B, McMullan L K, Spiropoulou C F et al.. Hantavirus infection induces the expression of RANTES and IP-10 without causing increased permeability in human lung microvascular endothelial cells.  J Virol. 2001;  75 6070-6085
• 52 Khaiboullina S F, Netski D M, Krumpe P, St. Jeor S C. Effects of tumor necrosis factor alpha on Sin Nombre virus infection in vitro.  J Virol. 2000;  74 11966-11971
• 53 Niikura M, Maeda A, Ikegami T, Saijo M, Kurane I, Morikawa S. Modifications of endothelial cell functions by Hantaan virus infection: prolonged hyper-permeability induced by TNF-alpha of Hantaan virus-infected endothelial cell monolayers.  Arch Virol. 2004;  149 1279-1292
• 54 Khaiboullina S F, Rizvanov A A, Otteson E, Miyazato A, Maciejewski J, St. Jeor S C. Regulation of cellular gene expression in endothelial cells by Sin Nombre and prospect hill viruses.  Viral Immunol. 2004;  17 234-251
• 55 Kraus A A, Raftery M J, Giese T et al.. Differential antiviral response of endothelial cells after infection with pathogenic and nonpathogenic hantaviruses.  J Virol. 2004;  78 6143-6150
• 56 Geimonen E, Neff S, Raymond T, Kocer S S, Gavrilovskaya I N, Mackow E R. Pathogenic and nonpathogenic hantaviruses differentially regulate endothelial cell responses.  Proc Natl Acad Sci USA. 2002;  99 13837-13842
• 57 Terajima M, Hendershot III J D, Kariwa H et al.. High levels of viremia in patients with the hantavirus pulmonary syndrome.  J Infect Dis. 1999;  180 2030-2034
• 58 Gavrilovskaya I N, Peresleni T, Geimonen E, Mackow E R. Pathogenic hantaviruses selectively inhibit beta3 integrin directed endothelial cell migration.  Arch Virol. 2002;  147 1913-1931
• 59 Raymond T, Gorbunova E, Gavrilovskaya I N, Mackow E R. Pathogenic hantaviruses bind plexin-semaphorin-integrin domains present at the apex of inactive, bent αVβ3 integrin conformers.  Proc Natl Acad Sci USA. 2005;  102 1163-1168
• 60 Larson R S, Brown D C, Ye C, Hjelle B. Peptide antagonists that inhibit Sin Nombre virus and Hantaan virus entry through the β₃-integrin receptor.  J Virol. 2005;  79 7319-7326
• 61 Mori M, Rothman A L, Kurane I et al.. High levels of cytokine-producing cells in the lung tissues of patients with fatal hantavirus pulmonary syndrome.  J Infect Dis. 1999;  179 295-302
• 62 Kilpatrick E D, Terajima M, Koster F, Catalina M D, Ennis F A. Role of specific CD8 + T cells in the severity of a fulminant zoonotic viral hemorrhagic fever, hantavirus pulmonary syndrome.  J Immunol. 2004;  172 3297-3304
• 63 Botten J, Mirowsky K, Kusewitt D et al.. Experimental infection model for Sin Nombre hantavirus in the deer mouse (Peromyscus maniculatus).  Proc Natl Acad Sci USA. 2000;  97 10578-10583
• 64 McElroy A K, Bray M, Reed D S, Schmaljohn C S. Andes virus infection of cynomolgus macaques.  J Infect Dis. 2002;  186 1706-1712
• 65 Hooper J W, Custer D M, Smith J, Wahl-Jensen V. Hantaan/Andes virus DNA vaccine elicits a broadly cross-reactive neutralizing antibody response in nonhuman primates.  Virology. 2006;  347 208-216
• 66 Hooper J W, Larsen T, Custer D M, Schmaljohn C S. A lethal disease model for hantavirus pulmonary syndrome.  Virology. 2001;  289 6-14
• 67 Milazzo M L, Eyzaguirre E J, Molina C P, Fulhorst C F. Maporal viral infection in the Syrian golden hamster: a model of hantavirus pulmonary syndrome.  J Infect Dis. 2002;  186 1390-1395
• 68 Campen M J, Milazzo M L, Fulhorst C F, Obot Akata C J, Koster F. Characterization of shock in a hamster model of hantavirus infection.  Virology. 2006;  356 45-49