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Semin Respir Crit Care Med 2000; 21(4): 313-322
DOI: 10.1055/s-2000-9864
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Hantavirus Pulmonary Syndrome in the Americas: The Early Years

Ali S. Khan1 , Paul T. Kitsutani1,2 , Amy L. Corneli1
  • 1Special Pathogens Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Atlanta, Georgia
  • 2Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
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Publication History

Publication Date:
31 December 2000 (online)

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ABSTRACT

The initial recognition of hantavirus pulmonary syndrome (HPS) as a new disease associated with a cluster of acute respiratory deaths among American Indians in the southwestern United States in 1993 bears little resemblance to the current understanding of this syndrome. HPS is now recognized as a zoonotic disease that has been endemic throughout the Americas for at least 40 years and that is closely linked to population densities and virus dynamics among a specific subfamily of rodents. The classic disease description has also been markedly broadened to include a spectrum of illness that ranges from asymptomatic infection to fulminate cardiorespiratory failure. Clinical variants with hemorrhagic or prominent renal manifestations have also been recognized. Prevention efforts have been targeted at minimizing peri-domestic contact with rodents and their excreta and improving clinical recognition of infection. This paper describes the pathogenesis underlying the profound cardiorespiratory compromise, person-to-person transmission reported in South America, and viable treatment modalities.

KEYWORD

epidemiology - hantavirus pulmonary syndrome - Sin Nombre virus - transmission

REFERENCES

  • 1 Centers for Disease Control and Prevention. Outbreak of acute illness-Southwestern United States, 1993.  MMWR Morb Mortal Wkly Rep . 1993;  42 421-424
    PubMedGoogle Scholar
  • 2 Centers for Disease Control and Prevention. Update: outbreak of hantavirus infection-Southwestern United States, 1993.  MMWR Morb Mortal Wkly Rep . 1993;  42 477-479
    PubMedGoogle Scholar
  • 3 Centers for Disease Control and Prevention. Update: Outbreak of hantavirus infection-Southwestern United States, 1993.  MMWR Morb Mortal Wkly Rep . 1993;  42 517-519
    PubMedGoogle Scholar
  • 4 Nichol S T, Spiropoulou C F, Morzunov S. Genetic identification of a hantavirus associated with an outbreak of acute respiratory illness.  Science . 1993;  262 914-917
    PubMedGoogle Scholar
  • 5 Hjelle B, Jenison S, Torrez-Martinez N. A novel hantavirus associated with an outbreak of fatal respiratory disease in the southwestern United States: Evolutionary relationships to known hantaviruses.  J Virol . 1994;  68 592-596
    PubMedGoogle Scholar
  • 6 Centers for Disease Control and Prevention. Update: Hantavirus pulmonary syndrome-United States, 1993.  MMWR Morb Mortal Wkly Rep . 1993;  42 816-820
    PubMedGoogle Scholar
  • 7 Centers for Disease Control and Prevention. Update: Hantavirus pulmonary syndrome-United States, 1999.  MMWR Morb Mortal Wkly Rep . 1999;  48 521-525
    PubMedGoogle Scholar
  • 8 da Silva V M, Vasconcelos M J, Hidalgo N T. Hantavirus pulmonary syndrome. Report of the first three cases in Sao Paulo, Brazil.  Rev Inst Med Trop S Paulo . 1997;  39 231-234
    PubMedGoogle Scholar
  • 9 Johnson A M, Bowen M D, Ksiazek T G. Laguna Negra virus associated with HPS in western Paraguay and Bolivia.  Virology . 1997;  238 115-127
    CrossrefPubMedGoogle Scholar
  • 10 Williams R J, Bryan R T, Mills J N. An outbreak of hantavirus pulmonary syndrome in western Paraguay.  Am J Trop Med Hyg . 1997;  57 274-282
    PubMedGoogle Scholar
  • 11 Centers for Disease Control and Prevention. Hantavirus pulmonary syndrome-Chile, 1997.  MMWR Morb Mortal Wkly Rep . 1997;  46 949-951
    PubMedGoogle Scholar
  • 12 Toro J, Vega J D, Khan A S. An outbreak of hantavirus pulmonary syndrome, Chile, 1997.  Emerg Infect Dis . 1998;  4 687-694
    PubMedGoogle Scholar
  • 13 Khan A S, Gaviria M, Rollin P E. Hantavirus pulmonary syndrome in Florida: Association with the newly identified Black Creek Canal virus.  Am J Med . 1996;  100 46-48
    CrossrefPubMedGoogle Scholar
  • 14 Khan A S, Spiropoulou C F, Morzunov S. A fatal illness associated with a new hantavirus in Louisiana.  J Med Virol . 1995;  46 281-286
    PubMedGoogle Scholar
  • 15 Rollin P E, Ksiazek T G, Elliott L H. Isolation of black creek canal virus, a new hantavirus from Sigmodon hispidus in Florida.  J Med Virol . 1995;  46 35-39
    PubMedGoogle Scholar
  • 16 Monroe M C, Morzunov S P, Johnson A M. Genetic diversity and distribution of Peromyscus-borne hantaviruses in North America.  Emerg Infect Dis . 1999;  5 75-86
    PubMedGoogle Scholar
  • 17 Levis S, Morzunov S P, Rowe J E. Genetic diversity and epidemiology of hantaviruses in Argentina.  J Infect Dis . 1998;  177 529-538
    PubMedGoogle Scholar
  • 18 Padula P J, Edelstein A, Miguel S D. Hantavirus pulmonary syndrome outbreak in Argentina: Molecular evidence for person-to-person transmission of Andes virus.  Virology . 1998;  241 323-330
    CrossrefPubMedGoogle Scholar
  • 19 Childs J E, Ksiazek T G, Spiropoulou C F. Serologic and genetic identification of Peromyscus maniculatus as the primary rodent reservoir for a new hantavirus in the southwestern United States.  J Infect Dis . 1994;  169 1271-1280
    PubMedGoogle Scholar
  • 20 Duchin J S, Koster F T, Peters C J. Hantavirus pulmonary syndrome: A clinical description of 17 patients with a newly recognized disease.  N Engl J Med . 1994;  330 949-955
    CrossrefPubMedGoogle Scholar
  • 21 Moolenaar R L, Dalton C, Lipman H B. Clinical features that differentiate hantavirus pulmonary syndrome from three other acute respiratory illnesses.  Clin Infect Dis . 1995;  21 643-649
    PubMedGoogle Scholar
  • 22 Hallin G W, Simpson S Q, Crowell R E. Cardiopulmonary manifestations of hantavirus pulmonary syndrome.  Crit Care Med . 1996;  24 252-258
    CrossrefPubMedGoogle Scholar
  • 23 Hopkins R O, Larson-Lohr V, Weaver L K, Bigler E D. Neuropsychological impairments following hantavirus pulmonary syndrome.  J Int Neuropsycholog Soc . 1998;  4 190-196
    PubMedGoogle Scholar
  • 24 Javer A R, Elliott H F, Longridge N S. Hantavirus infection: A possible cause of delayed sensorineural hearing loss.  Otolaryngol Head Neck Surg . 1998;  118 697-701
    PubMedGoogle Scholar
  • 25 Wells R M, Sosa Estani S, Yadon Z E. An unusual hantavirus outbreak in southern Argentina: Person-to-person transmission?.  Emerg Infect Dis . 1997;  3 171-174
    PubMedGoogle Scholar
  • 26 Shefer A M, Tappero J W, Bresee J S. Hantavirus pulmonary syndrome in California: Report of two cases and investigation.  Clin Infect Dis . 1994;  19 1105-1109
    PubMedGoogle Scholar
  • 27 Kitsutani P T, Denton R W, Fritz C L. Acute Sin Nombre hantavirus infection without pulmonary syndrome, United States.  Emerg Infect Dis . 1999;  5 701-705
    PubMedGoogle Scholar
  • 28 Zavasky D M, Hjelle B, Peterson M C. Acute infection with Sin Nombre hantavirus without pulmonary edema.  Clin Infect Dis . 1999;  29 64-66
    PubMedGoogle Scholar
  • 29 Steier K J, Clay R. Hantavirus pulmonary syndrome (HPS): Report of first case in Louisiana.  J Am Osteopath Assoc . 1993;  93 1286-1289
    PubMedGoogle Scholar
  • 30 Hjelle B, Goade D, Torrez-Martinez N. Hantavirus pulmonary syndrome, renal insufficiency, and myositis associated with infection by Bayou hantavirus.  Clin Infect Dis . 1996;  23 495-500
    PubMedGoogle Scholar
  • 31 Ketai L H, Williamson M R, Telepak R J. Hantavirus pulmonary syndrome: Radiographic findings in 16 patients.  Radiology . 1994;  191 665-668
    PubMedGoogle Scholar
  • 32 Ketai L H, Kelsey C A, Jordan K. Distinguishing hantavirus pulmonary syndrome from acute respiratory distress syndrome by chest radiography: Are there different radiographic manifestations of increased alveolar permeability?.  J Thorac Imag . 1998;  13 172-177
    PubMedGoogle Scholar
  • 33 Nolte K B, Feddersen R M, Foucar K. Hantavirus pulmonary syndrome in the United States: A pathological description of a disease caused by a new agent.  Hum Pathol . 1995;  26 110-120
    CrossrefPubMedGoogle Scholar
  • 34 Zaki S R, Greer P W, Coffield L M. Hantavirus pulmonary syndrome.  Pathogenesis of an emerging infectious disease. Am J Pathol . 1995;  146 552-579
    PubMedGoogle Scholar
  • 35 Ksiazek T G, Peters C J, Rollin P E. Identification of a new North American hantavirus that causes acute pulmonary insufficiency.  Am J Trop Med Hyg . 1995;  52 117-123
    PubMedGoogle Scholar
  • 36 Hjelle B, Jenison S, Torrez-Martinez N. 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
    PubMedGoogle Scholar
  • 37 Chu Y K, Jennings G, Schmaljohn A. Cross-neutralization of hantaviruses with immune sera from experimentally infected animals and from hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome patients.  J Infect Dis . 1995;  172 1581-1584
    PubMedGoogle Scholar
  • 38 Hjelle B, Spiropoulou C F, Torrez-Martinez N. Detection of Muerto Canyon virus RNA in peripheral blood mononuclear cells from patients with hantavirus pulmonary syndrome.  J Infect Dis . 1994;  170 1013-1017
    PubMedGoogle Scholar
  • 39 Schwarz T F, Zaki S R, Morzunov S, Peters C J, Nichol S T. Detection and sequence confirmation of Sin Nombre virus RNA in paraffin-embedded human tissues using one-step RT-PCR.  J Virol Methods . 1995;  51 349-356
    CrossrefPubMedGoogle Scholar
  • 40 Zaki S R, Khan A S, Goodman R A. Retrospective diagnosis of hantavirus pulmonary syndrome, 1978-1993; Implications for emerging infectious diseases.  Arch Pathol Lab Med . 1996;  120 134-139
    PubMedGoogle Scholar
  • 41 Zaki S R. Hantavirus-associated diseases. In: Connor DH, Chandler FW, Schwartz DA, Manz HJ, Lack EE, eds. The Pathology of Infectious Diseases Norwalk, CT: Appleton and Lange 1997: 125-136
    Google Scholar
  • 42 Mori M, Rothman A L, Kurane I. High levels of cytokine-producing cells in the lung tissues of patients with fatal hantavirus pulmonary syndrome.  J Infect Dis . 1999;  179 295-302
    CrossrefPubMedGoogle Scholar
  • 43 Horvath C J, Ferro T J, Jesmok G. Recombinant tumor necrosis factor increases pulmonary vascular permeability independent of neutrophils.  Proc Natl Acad Sci USA . 1988;  85 9219-9223
    PubMedGoogle Scholar
  • 44 Saxon R R, Klein J S, Bar M H. Pathogenesis of pulmonary edema during interleukin-2 therapy: Correlation of chest radiographic and clinical findings in 54 patients.  Am J Roentgenol . 1991;  156 281-285
    PubMedGoogle Scholar
  • 45 Simpson S Q, Mapel V, Koster F T. Evidence for lymphocyte activation in the hantavirus pulmonary syndrome.  Chest . 1995;  106 97S
    PubMedGoogle Scholar
  • 46 Simpson S Q, Mapel V, Koster F T. Evidence for tumor necrosis factor activation in the hantavirus pulmonary syndrome.  Crit Care Med . 1996;  24 A26
    PubMedGoogle Scholar
  • 47 Ennis F A, Cruz J, Spiropoulou C F. Hantavirus pulmonary syndrome: CD8+ and CD4+ cytotoxic T lymphocytes to epitopes on Sin Nombre virus nucleocapsid protein isolated during acute illness.  Virology . 1997;  238 380-390
    CrossrefPubMedGoogle Scholar
  • 48 Calisher C H. History, classification, and taxonomy of viruses in the family Bunyaviridae. In: Elliot RM, ed. The Bunyaviridae New York: Plenum Press, 1996: 177
    Google Scholar
  • 49 Gavrilovskaya I N, Shepley M, Shaw R. β3 integrins mediate the cellular entry of hantaviruses that cause respiratory failure.  Proc Natl Acad Sci USA . 1998;  95 7074-7079
    CrossrefPubMedGoogle Scholar
  • 50 Li D, Schmaljohn A L, Anderson K, Schmaljohn C S. Complete nucleotide sequences of the M and S segments of two hantavirus isolates from California: Evidence for reassortment in nature among viruses related to hantavirus pulmonary syndrome.  Virology . 1995;  206 973-983
    CrossrefPubMedGoogle Scholar
  • 51 Mills J N, Ksiazek T G, Ellis B A. Patterns of association with host and habitat: Antibody reactive with Sin Nombre virus in small mammals in the major biotic communities of the southwestern United States.  Am J Trop Med Hyg . 1997;  56 273-284
    PubMedGoogle Scholar
  • 52 Crowley M, Katz R, Kessler R. Successful treatment of adults with severe hantavirus pulmonary syndrome with extracorporeal membrane oxygenation.  Crit Care Med . 1998;  26 409-414
    PubMedGoogle Scholar
  • 53 Chapman L E, Mertz G J, Peters C J. Intravenous ribavirin for hantavirus pulmonary syndrome: Safety and tolerance during one year of open label experience.  Antiviral Ther . 1999;  4 211-219
    PubMedGoogle Scholar
  • 54 Rosenberg R B, Waagner D C, Romano M J. Hantavirus pulmonary syndrome treated with inhaled nitric oxide.  Pediatr Infect Dis J . 1998;  17 749-752
    CrossrefPubMedGoogle Scholar
  • 55 Tahirkheli N k, Greipp P R. Treatment of the systemic capillary leak syndrome with terbutaline and theophylline. A case series.  Ann Intern Med . 1999;  130 905-909
    PubMedGoogle Scholar
  • 56 Glass G E, Johnson J S, Hodenbach G A. Experimental evaluation of rodent exclusion methods to reduce hantavirus transmission to humans in rural housing.  Am J Trop Med Hyg . 1997;  56 359-364
    PubMedGoogle Scholar
  • 57 Torrez-Martinez N T, Bharadwaj M, Goade D. Bayou virus-associated hantavirus pulmonary syndrome in eastern Texas: Identification of the rice rat, Oryzomys palustris, as reservoir host.  Emerg Infect Dis . 1998;  4 105-111
    PubMedGoogle Scholar
  • 58 Ferrer J F, Jonsson C B, Esteban E. High prevalence of hantavirus infection in Indian communities of the Paraguayan and Argentinean Gran Chaco.  Am J Trop Med Hyg . 1998;  59 438-444
    PubMedGoogle Scholar
  • 59 Childs J E, Krebs J W, Ksiazek T G. A household-based, case-control study of environmental factors associated with hantavirus pulmonary syndrome in the southwestern United States.  Am J Trop Med Hyg . 1995;  52 393-397
    PubMedGoogle Scholar
  • 60 Armstrong L R, Zaki S R, Goldoft M J. Hantavirus pulmonary syndrome associated with entering or cleaning rarely used, rodent-infested structures [letter; comment].  J Infect Dis . 1995;  172 1166
    PubMedGoogle Scholar
  • 61 Wells R M, Young J, Williams R J. Hantavirus transmission in the United States.  Emerg Infect Dis. 1997;  3 361-365
    PubMedGoogle Scholar
  • 62 Hjelle B, Torrez-Martinez N, Koster F T. Epidemiologic linkage of rodent and human hantavirus genomic sequences in case investigations of hantavirus pulmonary syndrome.  J Infect Dis . 1996;  173 781-786
    PubMedGoogle Scholar
  • 63 Zeitz P S, Graber J M, Voorhees R A. Assessment of occupational risk for hantavirus infection in Arizona and New Mexico.  J Occup Environ Med . 1997;  39 463-467
    PubMedGoogle Scholar
  • 64 Vitek C R, Breiman R F, Ksiazek T G. Evidence against person-to-person transmission of hantavirus to health care workers.  Clin Infect Dis . 1996;  22 824-826
    PubMedGoogle Scholar
  • 65 Enria D, Padula P, Segura E L. Hantavirus pulmonary syndrome in Argentina: Possibility of person-to-person transmission.  Medicina (B Aires) . 1996;  58 709-711
    PubMedGoogle Scholar
  • 66 Chaparro J J, Vega J, Terry W. Assessment of person-to-person transmission of hantavirus pulmonary syndrome in a Chilean hospital setting.  J Hosp Infect . 1998;  40 281-285
    CrossrefPubMedGoogle Scholar
  • 67 Pini N C, Resa A, del Jesus Laime G. Hantavirus infection in children in Argentina.  Emerg Infect Dis . 1998;  4 85-87
    PubMedGoogle Scholar
  • 68 Song J W, Baek L J, Nagle J W. Genetic and phylogentic analyses of hantaviral sequences amplified from archival tissues of deer mice (Peromyscus maniculatus nubiterrae) captured in the eastern United States.  Arch Virol . 1996;  141 959-967
    CrossrefPubMedGoogle Scholar
  • 69 Schmaljohn C S, Hjelle B. Hantaviruses: A global disease problem.  Emerg Infect Dis . 1997;  3 95-104
    PubMedGoogle Scholar
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