Abstract

To the Editor: We appreciate Markogiannakis' letter regarding hantavirus pulmonary syndrome (HPS) and his kind comments about our summary of Texas HPS cases.¹ Since our paper was published six additional cases have been reported in Texas involving three different viral variants: Sin Nombre (three cases); Bayou (two cases); Seoul (one case). Both Bayou cases and the Seoul case were the first fatalities due to those variants recorded in Texas. HPS is often fatal despite high technology treatment. Fortunately it is rare and most doctors will never see a case. From 1993 through 2009, slightly more than 500 US cases were been reported to the Centers for Disease Control and Prevention (CDC).² As noted by Markogiannnakis, HPS is difficult to diagnose early because the prodrome mimicks a non-specific viral illness. In our series, one-third of patients were seen by a physician and sent home only to return one or two days later with severe respiratory failure.¹ Though we are not aware of evidence that early treatment improves mortality, several physicians of patients in our series were deeply saddened to have sent their patient home with reassurance when in fact they had a potentially fatal illness. Clinical clues suggesting early HPS may be (a) a short febrile illness accompanied by both respiratory and gastrointestinal symptoms; (b) thrombocytopenia, especially in combination with an increased number of polymorphonuclear band forms ("bandemia"); and (c) recent exposure to rodents or rodent droppings.¹ The disease occurs sporadically. Our ability to anticipate outbreaks is improving but still rudimentary.^3,4 We agree that physicians practicing in areas where hantavirus is endemic should advise their patients to minimize contact with rodents and avoid activities that might aerosolize hantavirus particles in rodent excreta. The CDC offers specific recommendations in their "Seal up! Trap up! Clean up!" education campaign.⁵