Hantavirus

Question 1

What are the basic characteristics of Hantavirus?

Answer 1

Spherical, lipid enveloped particles; negative RNA

(Bunyviridae family)

Question 2

Is hantavirus segmented?

Answer 2

Yes. It’s trisegmented

Question 3

What are the different segments of the virus?

Answer 3

1. Nucleocapsid protein
2. RNA-dep RNA polymerase
3. G1/G2 envelope proteins

Question 4

How is the virus transmitted?

Answer 4

It’s airborne and transmitted through breathing air containing aerosolized rosent saliva, urine, and feces.

NOT transmitted human-human

Question 5

What is the epidemiology?

Answer 5

Rural USA( farms, fields, forrests). Several hantaviruses can cause HPS; each virus is carried by a specific rodent

Question 6

What diseases can the virus cause?

Answer 6

HPS, which is severe and sometimes fatal respiratory disease

Question 7

What is the process of HPS disease?

Answer 7

1. Inhaled rodent saliva/urine/feces
2. Viral load recruits lymphoblasts +macros to pulm tissue
3. Activated immune cells -> increase cytokine release
4. endothelium is activated
5. increased capillary permeability, which leads to pulm edema

Question 8

What’s the presentation?

Answer 8

Flu like symptoms, which can cause life threatening pneumonia

Question 9

How many stages of the disease are there?

Answer 9

Two.

1. Rapid onset of pulm edema; increased viremia at onset of disease and flu like illness
2. Respiratory failure and cardiogenic shock; cough, SOB, fluid accumulation, decreased BP

Question 10

How do you make the Dx?

Answer 10

Early phase is often confused with influenza. Rural rodent exposure is key +tetrad:

1. Thrombocytopenia
2. Leukocytosis (left shift)
3. Abnormal lymphoblasts
4. increased HCT b/c of ultraflitration into the lungs
5. (less important) serological testing (IgM and IgG) or RT PCR

Question 11

What is the Tx?

Answer 11

No tx, cure, or vaccine. Give supportive care. Even though the pts are hypotensive, don’t give fluids! Give B1-adrenergic cardiostimulation to increase BP