For health professionals: Hantavirus infection

Get detailed information on hantaviruses, how to test for infections, case classification and the treatment options.

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What health professionals need to know about hantavirus infection

Health professionals in Canada are advised to be vigilant. The recognition, reporting and prompt investigation of patients with symptoms of hantavirus infection is vital. Infection with a hantavirus is mainly associated with direct contact with rodents or their droppings and urine.

Laboratory testing

Diagnosis of hantavirus pulmonary syndrome or haemorrhagic fever with renal syndrome is confirmed by laboratory testing. Of the following diagnostic markers, 1 or more must be positive:

  • presence of hantavirus-specific IgM or rising titers of IgG
  • presence of hantavirus RNA by RT-PCR
  • positive immunohistochemistry for hantavirus antigen

The National Microbiology Laboratory is the only laboratory in Canada that conducts diagnostic testing for hantavirus infections in humans.

Case classification

The 2 main types of diseases caused by a hantavirus are:

  1. haemorrhagic fever with renal syndrome
  2. hantavirus pulmonary syndrome

Haemorrhagic fever with renal syndrome

Haemorrhagic fever with renal syndrome can be a mild, moderate or severe disease, depending upon which hantavirus you are infected with. The clinical course can be divided into 5 phases:

  1. prodrome (or febrile)
  2. hypotensive
  3. oliguric
  4. diuretic
  5. convalescent

The prodrome phase begins with:

  • high fever
  • chills
  • headache
  • blurred vision
  • malaise
  • anorexia

These symptoms are followed by:

  • abdominal or lumbar pain
  • gastrointestinal symptoms
  • facial flushing
  • petechiae
  • erythematous rash

This phase typically lasts 3 to 7 days.

The hypotensive phase lasts from several hours to many days. It is characterized by the sudden onset of hypotension, which may progress to shock and haemorrhagic manifestations.

The oliguric phase typically lasts 3 to 7 days. During this time, blood pressure may return to normal or become high, and urinary output falls quickly. Severe haemorrhage may occur. Spontaneous diuresis indicates the beginning of recovery.

Hantavirus pulmonary syndrome

Hantavirus pulmonary syndrome has 4 clinical phases:

  1. prodrome
  2. cardiopulmonary
  3. diuresis
  4. convalescence

The prodrome phase typically lasts 3 to 6 days and is characterized by fever, myalgia and malaise. Other symptoms include:

  • headache
  • dizziness
  • abdominal pain
  • gastrointestinal symptoms

This is followed by the rapidly progressive cardiopulmonary phase, which is characterized by:

  • non-cardiogenic pulmonary edema
  • hypoxemia and cough
  • pleural effusion
  • gastrointestinal symptoms
  • tachypnea and tachycardia
  • myocardial depression
  • cardiogenic shock

Hypotension and oligouria may also occur during this phase.

The diuresis phase involves rapid clearance of pulmonary edema and resolution of fever and shock.

Treatment

Treatment with antiviral ribavirin improves the outcome of haemorrhagic fever with renal syndrome. But this has not been investigated for hantavirus pulmonary syndrome. Treatment is supportive.

Furthermore, an extracorporeal CO2 elimination system should be considered for hantavirus pulmonary syndrome patients. This is to prevent life-threatening pulmonary edema and cardiogenic shock.

 
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