Hantavirus infection natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2], Aditya Ganti M.B.B.S. [3]
Overview
If hantavirus infection left untreated, it may result in multi-organ failure and death. Possible complications include, acute encephalomyelitis, Pituitary hemorrhage, Glomerulonephritis, Pulmonary edema, acute respiratory distress syndrome, Disseminated intravascular coagulation, Thrombocytopenia, and shock. Its prognosis depends on the extent of the diseases. The hantavirus cardiopulmonary syndrome (HCPS) has 38% mortality rate but, hemorrhagic fever with renal syndrome (HFRS) has a better prognosis with 1 to 15% mortality rate.[1][2][3]
Natural History
- Within 24 hours of initial evaluation, most patients develop some degree of hypotension and progressive evidence of pulmonary edema and hypoxia, usually requiring mechanical ventilation.
- The patients with fatal infections appear to have severe myocardial depression which can progress to sinus bradycardia with subsequent electromechanical dissociation, ventricular tachycardia or fibrillation.
- Hemodynamic compromise occurs a median of 5 days after symptom onset--usually dramatically within the first day of hospitalization.
- In contrast to HFRS, overt hemorrhage occurs rarely in HPS, although hemorrhage is occasionally seen in association with disseminated intravascular coagulation.
- If left untreated hantavirus infection may cause multiple organ failure and death.
Complications
Complications that can develop as a result of Hantavirus infection depends on the type of infection and can be summarized in the following table.[4]
| Type of hantavirus infection | Complications |
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| Hemorrhagic fever with renal syndrome (HFRS) |
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| Hantavirus cardiopulmonary syndrome (HCPS) |
Prognosis
The overall prognosis of hantavirus infection depends on the clinical syndrome. The hantavirus cardiopulmonary syndrome (HCPS) has 38% mortality rate. Hemorrhagic fever with renal syndrome (HFRS) has better prognosis than hantavirus cardiopulmonary syndrome (HCPS). Depending upon which virus is causing the HFRS, death occurs in less than 1% to as many as 15% of patients. Fatality ranges from 5-15% for HFRS caused by Hantaan virus, and it is less than 1% for disease caused by Puumala virus.[1][2][3]
References
- ↑ 1.0 1.1 Crowley MR, Katz RW, Kessler R, Simpson SQ, Levy H, Hallin GW, Cappon J, Krahling JB, Wernly J (1998). "Successful treatment of adults with severe Hantavirus pulmonary syndrome with extracorporeal membrane oxygenation". Crit. Care Med. 26 (2): 409–14. PMID 9468181.
- ↑ 2.0 2.1 Mertz GJ, Hjelle B, Crowley M, Iwamoto G, Tomicic V, Vial PA (2006). "Diagnosis and treatment of new world hantavirus infections". Curr. Opin. Infect. Dis. 19 (5): 437–42. doi:10.1097/01.qco.0000244048.38758.1f. PMID 16940866.
- ↑ 3.0 3.1 Levy H, Simpson SQ (1994). "Hantavirus pulmonary syndrome". Am. J. Respir. Crit. Care Med. 149 (6): 1710–3. doi:10.1164/ajrccm.149.6.8004332. PMID 8004332.
- ↑ Jiang H, Zheng X, Wang L, Du H, Wang P, Bai X (2017). "Hantavirus infection: a global zoonotic challenge". Virol Sin. 32 (1): 32–43. doi:10.1007/s12250-016-3899-x. PMID 28120221.