For the integrated multidisciplinary approach to patient care

Return to the Southern Medical Journal

Current User S2 Access Level: -1 ()
CAN NOT ACCESS LEVEL 2
Review Article

Hantavirus Pulmonary Syndrome: A Concise Clinical Review

Donald C. Vinh MD, FRCPC, John M. Embil MD, FRCPC
Volume: 102 Issue: 6 June, 2009

Abstract:

Abstract:In 1978, hantaviruses were first described as the etiological agent of hemorrhagic fever with renal syndrome (HFRS) in Korea. Since then, numerous related, enveloped, negative-stranded RNA viruses have been identified, forming the genus Hantavirus within the family Bunyaviridae. These pathogens are distributed worldwide and thus can be classified, on the basis of phylogenetic origins, into Old World viruses or New World viruses (ie North, Central, and South America). Similarly, these viruses cause two major types of syndromes, corresponding respectively to their phylogenies: the original HFRS or the more recently described hantavirus pulmonary syndrome (HPS). As the hantavirus pulmonary syndrome is the primary hantaviral disease in North America, it will thus be the focus of this review.

Article:

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

Images:

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

References:

References1. Lee HW, Baek LJ, Johnson KM. Isolation of hantaan virus, the etiologic agent of Korean hemorrhagic fever, from wild urban rats. J Infect Dis 1982;146:638–644.LeeHW]]BaekLJ]]JohnsonKMIsolation of hantaan virus, the etiologic agent of Korean hemorrhagic fever, from wild urban rats.J Infect Dis1982146638-6442. Smithee L, Bos J, Mallonee S, et al. Update on hantavirus in Oklahoma: are we missing cases? J Okla State Med Assoc 2007;100:145–148.SmitheeL]]BosJ]]MalloneeS&etal;Update on hantavirus in Oklahoma: are we missing cases?J Okla State Med Assoc2007100145-1483. Zuo SQ, Zhang PH, Jiang JF, et al. Seoul virus in patients and rodents from Beijing, China. Am J Trop Med Hyg 2008;78:833–837.ZuoSQ]]ZhangPH]]JiangJF&etal;Seoul virus in patients and rodents from Beijing, China.Am J Trop Med Hyg200878833-8374. Hofmann J, Meisel H, Klempa B, et al. Hantavirus outbreak, Germany, 2007. Emerg Infect Dis 2008;14:850–852.HofmannJ]]MeiselH]]KlempaB&etal;Hantavirus outbreak, Germany, 2007.Emerg Infect Dis200814850-8525. Pettersson L, Boman J, Juto P, et al. Outbreak of Puumala virus infection, Sweden. Emerg Infect Dis 2008;14:808–810.PetterssonL]]BomanJ]]JutoP&etal;Outbreak of Puumala virus infection, Sweden.Emerg Infect Dis200814808-8106. Klempa B, Tkachenko EA, Dzagurova TK, et al. Hemorrhagic fever with renal syndrome caused by 2 lineages of dobrava hantavirus, Russia. Emerg Infect Dis 2008;14:617–625.KlempaB]]TkachenkoEA]]DzagurovaTK&etal;Hemorrhagic fever with renal syndrome caused by 2 lineages of dobrava hantavirus, Russia.Emerg Infect Dis200814617-6257. Verity R, Prasad E, Grimsrud K, et al. Hantavirus pulmonary syndrome in Northern Alberta, Canada: clinical and laboratory findings for 19 cases. Clin Infect Dis 2000;31:942–946.VerityR]]PrasadE]]GrimsrudK&etal;Hantavirus pulmonary syndrome in Northern Alberta, Canada: clinical and laboratory findings for 19 cases.Clin Infect Dis200031942-9468. Johnson KM. The discovery of hantaan virus: comparative biology and serendipity in a world at war. J Infect Dis 2004;190:1708–1710.JohnsonKMThe discovery of hantaan virus: comparative biology and serendipity in a world at war.J Infect Dis20041901708-17109. Zeier M, Handermann M, Bahr U, et al. New ecological aspects of hantavirus infection: a change of a paradigm and a challenge of prevention–a review. Virus Genes 2005;30:157–180.ZeierM]]HandermannM]]BahrU&etal;New ecological aspects of hantavirus infection: a change of a paradigm and a challenge of prevention–a review.Virus Genes200530157-18010. Klein SL, Calisher CH. Emergence and persistence of hantaviruses. Curr Top Microbiol Immunol 2007;315:217–252.KleinSL]]CalisherCHEmergence and persistence of hantaviruses.Curr Top Microbiol Immunol2007315217-25211. Arai S, Bennett SN, Sumibcay L, et al. Phylogenetically distinct hantaviruses in the masked shrew (Sorex cinereus) and dusky shrew (Sorex monticolus) in the United States. Am J Trop Med Hyg 2008;78:348–351.AraiS]]BennettSN]]SumibcayL&etal;Phylogenetically distinct hantaviruses in the masked shrew (Sorex cinereus) and dusky shrew (Sorex monticolus) in the United States.Am J Trop Med Hyg200878348-35112. Mills JN, Corneli A, Young JC, et al. Hantavirus pulmonary syndrome—United States: updated recommendations for risk reduction. Centres for Disease Control and Prevention. MMWR Recomm Rep 2002;51(RR-9):1–12.MillsJN]]CorneliA]]YoungJC&etal;Hantavirus pulmonary syndrome—United States: updated recommendations for risk reduction. Centres for Disease Control and Prevention.MMWR Recomm Rep200251RR-91-1213. Martinez VP, Bellomo C, San Juan J, et al. Person-to-person transmission of andes virus. Emerg Infect Dis 2005;11:1848–1853.MartinezVP]]BellomoC]]San JuanJ&etal;Person-to-person transmission of andes virus.Emerg Infect Dis2005111848-185314. Reynolds S, Galanis E, Krajden M, et al. Imported fatal hantavirus pulmonary syndrome. Emerg Infect Dis 2007;13:1424–1425.ReynoldsS]]GalanisE]]KrajdenM&etal;Imported fatal hantavirus pulmonary syndrome.Emerg Infect Dis2007131424-142515. Drebot MA, Gavrilovskaya I, Mackow ER, et al. Genetic and serotypic characterization of Sin Nombre-like viruses in Canadian Peromyscus maniculatus Mice. Virus Res 2001;75:75–86.DrebotMA]]GavrilovskayaI]]MackowER&etal;Genetic and serotypic characterization of Sin Nombre-like viruses in Canadian Peromyscus maniculatus Mice.Virus Res20017575-8616. Monroe MC, Morzunov SP, Johnson AM, et al. Genetic diversity and distribution of Peromyscus-borne hantaviruses in North America. Emerg Infect Dis 1999;5:75–86.MonroeMC]]MorzunovSP]]JohnsonAM&etal;Genetic diversity and distribution of Peromyscus-borne hantaviruses in North America.Emerg Infect Dis1999575-8617. Plyusnin A, Vapalahti O, Vaheri A. Hantaviruses: genome structure, expression and evolution. J Gen Virol 1996;77:2677–2687.PlyusninA]]VapalahtiO]]VaheriAHantaviruses: genome structure, expression and evolution.J Gen Virol1996772677-268718. Gavrilovskaya IN, Shepley M, Shaw R, et al. beta3 Integrins mediate the cellular entry of hantaviruses that cause respiratory failure. Proc Natl Acad Sci U S A 1998;95:7074–7079.GavrilovskayaIN]]ShepleyM]]ShawR&etal;beta3 Integrins mediate the cellular entry of hantaviruses that cause respiratory failure.Proc Natl Acad Sci U S A1998957074-707919. Gavrilovskaya IN, Brown EJ, Ginsberg MH, et al. Cellular entry of hantaviruses which cause hemorrhagic fever with renal syndrome is mediated by beta3 integrins. J Virol 1999;73:3951–3959.GavrilovskayaIN]]BrownEJ]]GinsbergMH&etal;Cellular entry of hantaviruses which cause hemorrhagic fever with renal syndrome is mediated by beta3 integrins.J Virol1999733951-395920. Rowe RK, Pekosz A. Bidirectional virus secretion and nonciliated cell tropism following andes virus infection of primary airway epithelial cell cultures. J Virol 2006;80:1087–1097.RoweRK]]PekoszABidirectional virus secretion and nonciliated cell tropism following andes virus infection of primary airway epithelial cell cultures.J Virol2006801087-109721. Jin M, Park J, Lee S, et al. Hantaan virus enters cells by clathrin-dependent receptor-mediated endocytosis. Virology 2002;294:60–69.JinM]]ParkJ]]LeeS&etal;Hantaan virus enters cells by clathrin-dependent receptor-mediated endocytosis.Virology200229460-6922. Kanerva M, Mustonen J, Vaheri A. Pathogenesis of puumala and other hantavirus infections. Rev Med Virol 1998;8:67–86.KanervaM]]MustonenJ]]VaheriAPathogenesis of puumala and other hantavirus infections.Rev Med Virol1998867-8623. Geimonen E, Neff S, Raymond T, et al. Pathogenic and nonpathogenic hantaviruses differentially regulate endothelial cell responses. Proc Natl Acad Sci U S A 2002;99:13837–13842.GeimonenE]]NeffS]]RaymondT&etal;Pathogenic and nonpathogenic hantaviruses differentially regulate endothelial cell responses.Proc Natl Acad Sci U S A20029913837-1384224. Stoltz M, Ahlm C, Lundkvist A, et al. Lambda Interferon (IFN-lambda) in serum is decreased in hantavirus-infected patients, and in vitro-established infection is insensitive to treatment with all IFNs and inhibits ifn-gamma-induced nitric oxide production. J Virol 2007;81:8685–8691.StoltzM]]AhlmC]]LundkvistA&etal;Lambda Interferon (IFN-lambda) in serum is decreased in hantavirus-infected patients, and in vitro-established infection is insensitive to treatment with all IFNs and inhibits ifn-gamma-induced nitric oxide production.J Virol2007818685-869125. Mori M, Rothman AL, 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.MoriM]]RothmanAL]]KuraneI&etal;High levels of cytokine-producing cells in the lung tissues of patients with fatal hantavirus pulmonary syndrome.J Infect Dis1999179295-30226. Terajima M, Hayasaka D, Maeda K, et al. Immunopathogenesis of hantavirus pulmonary syndrome and hemorrhagic fever with renal syndrome: do CD8+ T cells trigger capillary leakage in viral hemorrhagic fevers? Immunol Lett 2007;113:117–120.TerajimaM]]HayasakaD]]MaedaK&etal;Immunopathogenesis of hantavirus pulmonary syndrome and hemorrhagic fever with renal syndrome: do CD8+ T cells trigger capillary leakage in viral hemorrhagic fevers?Immunol Lett2007113117-12027. Saggioro FP, Rossi MA, Duarte MI, et al. Hantavirus infection induces a typical myocarditis that may be responsible for myocardial depression and shock in hantavirus pulmonary syndrome. J Infect Dis 2007;195:1541–1549.SaggioroFP]]RossiMA]]DuarteMI&etal;Hantavirus infection induces a typical myocarditis that may be responsible for myocardial depression and shock in hantavirus pulmonary syndrome.J Infect Dis20071951541-154928. Lähdevirta J. Nephropathia epidemica in Finland. A clinical histological and epidemiological study. Ann Clin Res 1971;3:1–54.LähdevirtaJNephropathia epidemica in Finland. A clinical histological and epidemiological study.Ann Clin Res197131-5429. Sommer AI, Traavik T, Mehl R, et al. Hemorrhagic fever with renal syndrome (nephropathia epidemica) in Norway: seroepidemiology 1981–1985. Scand J Infect Dis 1988;20:267–274.SommerAI]]TraavikT]]MehlR&etal;Hemorrhagic fever with renal syndrome (nephropathia epidemica) in Norway: seroepidemiology 1981–1985.Scand J Infect Dis198820267-27430. Mustonen J, Helin H, Pietilä K, et al. Renal biopsy findings and clinicopathologic correlations in nephropathia epidemica. Clin Nephrol 1994;41:121–126.MustonenJ]]HelinH]]PietiläK&etal;Renal biopsy findings and clinicopathologic correlations in nephropathia epidemica.Clin Nephrol199441121-12631. Niklasson B, Hellsten G, LeDuc J. Hemorrhagic fever with renal syndrome: a study of sequelae following nephropathia edidemica. Arch Virol 1994;137:241–247.NiklassonB]]HellstenG]]LeDucJHemorrhagic fever with renal syndrome: a study of sequelae following nephropathia edidemica.Arch Virol1994137241-24732. Collan Y, Mihatsch MJ, Lähdevirta J, et al. Nephropathia epidemica: mild variant of hemorrhagic fever with renal syndrome. Kidney Int Suppl 1991;35;S62–S71.CollanY]]MihatschMJ]]LähdevirtaJ&etal;Nephropathia epidemica: mild variant of hemorrhagic fever with renal syndrome.Kidney Int Suppl199135S62-S7133. Kulagin CM, Fedorova H, Ketiladze EC. Laboratory outbreak of hemorrhagic fever with a renal syndrome (clinico-epidemiological characteristics). J Microbiol Epidemiol Immunol 1962;33:121–126.KulaginCM]]FedorovaH]]KetiladzeECLaboratory outbreak of hemorrhagic fever with a renal syndrome (clinico-epidemiological characteristics).J Microbiol Epidemiol Immunol196233121-12634. Powell GM. Hemorrhagic fever: a study of 300 cases. Medicine (Baltimore) 1954;33:97–153.PowellGMHemorrhagic fever: a study of 300 cases.Medicine (Baltimore)19543397-15335. Muranyi W, Bahr U, Zeier M, et al. Hantavirus infection. J Am Soc Nephrol 2005;16:3669–3679.MuranyiW]]BahrU]]ZeierM&etal;Hantavirus infection.J Am Soc Nephrol2005163669-367936. Ferluga D, Vizjak A. Hantavirus nephropathy. J Am Soc Nephrol 2008;19:1653–1658.FerlugaD]]VizjakAHantavirus nephropathy.J Am Soc Nephrol2008191653-165837. Lee JS. Clinical features of hemorrhagic fever with renal syndrome in Korea. Kidney Int Suppl 1991;35:S88–S93.LeeJSClinical features of hemorrhagic fever with renal syndrome in Korea.Kidney Int Suppl199135S88-S9338. Cosgriff TM. Mechanisms of disease in hantavirus infection: pathophysiology of hemorrhagic fever with renal syndrome. Rev Infect Dis 1991;13:97–107.CosgriffTMMechanisms of disease in hantavirus infection: pathophysiology of hemorrhagic fever with renal syndrome.Rev Infect Dis19911397-10739. Nuutinen H, Vuoristo M, Färkkilä M, et al. Hemorrhagic gastropathy in epidemic nephropathy. Gastrointest Endosc 1992;38:476–480.NuutinenH]]VuoristoM]]FärkkiläM&etal;Hemorrhagic gastropathy in epidemic nephropathy.Gastrointest Endosc199238476-48040. Pärssinen O, Klemetti A, Rossi-Rautiainen E, et al. Ophthalmic manifestations of epidemic nephropathy. Acta Ophthalmol (Copenh) 1993;71:114–118.PärssinenO]]KlemettiA]]Rossi-RautiainenE&etal;Ophthalmic manifestations of epidemic nephropathy.Acta Ophthalmol (Copenh)199371114-11841. Mäkelä S, Ala-Houhala I, Mustonen J, et al. Renal function and blood pressure five years after puumala virus—induced nephropathy. Kidney Int 2000;58:1711–1718.MäkeläS]]Ala-HouhalaI]]MustonenJ&etal;Renal function and blood pressure five years after puumala virus—induced nephropathy.Kidney Int2000581711-171842. Peters CJ, Simpson GL, Levy H. Spectrum of hantavirus infection. Hemorrhagic fever with renal syndrome in hantavirus pulmonary syndrome. Annu Rev Med 1999;50:531–545.PetersCJ]]SimpsonGL]]LevyHSpectrum of hantavirus infection. Hemorrhagic fever with renal syndrome in hantavirus pulmonary syndrome.Annu Rev Med199950531-54543. Young JC, Hansen GR, Graves TK, et al. The incubation period of hantavirus pulmonary syndrome. Am J Trop Med Hyg 2000;62:714–717.YoungJC]]HansenGR]]GravesTK&etal;The incubation period of hantavirus pulmonary syndrome.Am J Trop Med Hyg200062714-71744. Hallin GW, Simpson SQ, Crowell RE, et al. Cardiopulmonary manifestations of hantavirus pulmonary syndrome. Crit Care Med 1996;24:252–258.HallinGW]]SimpsonSQ]]CrowellRE&etal;Cardiopulmonary manifestations of hantavirus pulmonary syndrome.Crit Care Med199624252-25845. Moolenaar RL, Dalton C, Lipman HB, et al. Clinical features that differentiate hantavirus, pulmonary syndrome from three other acute respiratory illnesses. Clin Infect Dis 1995;21:643–649.MoolenaarRL]]DaltonC]]LipmanHB&etal;Clinical features that differentiate hantavirus, pulmonary syndrome from three other acute respiratory illnesses.Clin Infect Dis199521643-64946. Zaki SR, Greer PW, Coffield LM, et al. Hantavirus pulmonary syndrome. Pathogenesis of an emerging infectious disease. Am J Pathol 1995;146:552–579.ZakiSR]]GreerPW]]CoffieldLM&etal;Hantavirus pulmonary syndrome. Pathogenesis of an emerging infectious disease.Am J Pathol1995146552-57947. Duchin JS, Koster FT, Peters CJ, et al. Hantavirus pulmonary syndrome: a clinical description of 17 patients with a newly recognized disease. The Hantavirus study group. N Engl J Med 1994;330:949–955.DuchinJS]]KosterFT]]PetersCJ&etal;Hantavirus pulmonary syndrome: a clinical description of 17 patients with a newly recognized disease. The Hantavirus study group.N Engl J Med1994330949-95548. Ketai LH, Williamson MR, Telepak RJ, et al. Hantavirus pulmonary syndrome: radiographic findings in 16 patients. Radiology 1994;191:665–668.KetaiLH]]WilliamsonMR]]TelepakRJ&etal;Hantavirus pulmonary syndrome: radiographic findings in 16 patients.Radiology1994191665-66849. Khan AS, Khabbaz RF, Armstrong LR, et al. Hantavirus pulmonary syndrome: the first 100 us cases. J Infect Dis 1996;173:1297–1303.KhanAS]]KhabbazRF]]ArmstrongLR&etal;Hantavirus pulmonary syndrome: the first 100 us cases.J Infect Dis19961731297-130350. Warner GS. Hantavirus illness in humans: review and update. South Med J 1996;89:264–271.WarnerGSHantavirus illness in humans: review and update.South Med J199689264-27151. Lee HW, Lee PW, Johnson KM. Isolation of the etiologic agent of Korean hemorrhagic fever. 1978. J Infect Dis 2004;190:1711–1721.LeeHW]]LeePW]]JohnsonKMIsolation of the etiologic agent of Korean hemorrhagic fever. 1978.J Infect Dis20041901711-172152. Vaheri A, Vapalahti O, Plyusnin A. How to diagnose hantavirus infections and detect them in rodents and insectivores. Rev Med Virol 2008;18:277–288.VaheriA]]VapalahtiO]]PlyusninAHow to diagnose hantavirus infections and detect them in rodents and insectivores.Rev Med Virol200818277-28853. Li Z, Bai X, Bian H. Serologic diagnosis of hantaan virus infection based on a peptide antigen. Clin Chem 2002;48:645–647.LiZ]]BaiX]]BianHSerologic diagnosis of hantaan virus infection based on a peptide antigen.Clin Chem200248645-64754. Evander M, Eriksson I, Pettersson L, et al. Puumala hantavirus viremia diagnosed by real-time reverse transcriptase PCR using samples from patients with hemorrhagic fever and renal syndrome. J Clin Microbiol 2007;45:2491–2497.EvanderM]]ErikssonI]]PetterssonL&etal;Puumala hantavirus viremia diagnosed by real-time reverse transcriptase PCR using samples from patients with hemorrhagic fever and renal syndrome.J Clin Microbiol2007452491-249755. Centres for Disease Control and Prevention. Facts about Hantavirus: What you Need to Know to Prevent the Disease Hantavirus Pulmonary Syndrome (HPS). Available at: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/HPS_Brochure.pdf. Accessed August 14, 2008.56. Huggins JW, Kim GR, Brand OM, et al. Ribavirin therapy for Hantaan virus infection in suckling mice. J Infect Dis 1986;153:489–497.HugginsJW]]KimGR]]BrandOM&etal;Ribavirin therapy for Hantaan virus infection in suckling mice.J Infect Dis1986153489-49757. Huggins JW, Hsiang CM, Cosgriff TM, 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.HugginsJW]]HsiangCM]]CosgriffTM&etal;Prospective, double-blind, concurrent placebo-controlled clinical trial of intravenous ribavirin therapy of hemorrhagic fever with renal syndrome.J Infect Dis19911641119-112758. Chapman LE, Ellis BA, Koster FT, et al. Discriminators between hantavirus-infected and -uninfected persons enrolled in a trial of intravenous ribavirin for presumptive hantavirus pulmonary syndrome. Clin Infect Dis 2002;34:293–304.ChapmanLE]]EllisBA]]KosterFT&etal;Discriminators between hantavirus-infected and -uninfected persons enrolled in a trial of intravenous ribavirin for presumptive hantavirus pulmonary syndrome.Clin Infect Dis200234293-30459. Chapman LE, Mertz GJ, Peters CJ, et al. Intravenous ribavirin for hantavirus pulmonary syndrome: safety and tolerance during 1 year of open-label experience. Ribavirin study group. Antivir Ther 1999;4:211–219.ChapmanLE]]MertzGJ]]PetersCJ&etal;Intravenous ribavirin for hantavirus pulmonary syndrome: safety and tolerance during 1 year of open-label experience. Ribavirin study group.Antivir Ther19994211-21960. Jonsson CB, Hooper J, Mertz G. Treatment of hantavirus pulmonary syndrome. Antiviral Res 2008;78:162–169.JonssonCB]]HooperJ]]MertzGTreatment of hantavirus pulmonary syndrome.Antiviral Res200878162-16961. Dunst R, Mettang T, Kuhlmann U. Severe thrombocytopenia and response to corticosteroids in a case of nephropathia epidemica. Am J Kidney Dis 1998;31:116–120.DunstR]]MettangT]]KuhlmannUSevere thrombocytopenia and response to corticosteroids in a case of nephropathia epidemica.Am J Kidney Dis199831116-120

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

Permissions