What are the symptoms of Hantavirus pulmonary syndrome (HPS)?

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Symptoms of Hantavirus Pulmonary Syndrome (HPS)

Overview of Hantavirus Pulmonary Syndrome (HPS)

Hantavirus Pulmonary Syndrome (HPS) is a severe respiratory disease caused by hantaviruses, which are transmitted to humans primarily through contact with infected rodent excreta. The disease is characterized by a rapid progression from flu-like symptoms to severe respiratory distress and has a high mortality rate .

Initial Symptoms: Prodromal Phase

Flu-like Symptoms

The initial phase of HPS, known as the prodromal phase, typically presents with non-specific flu-like symptoms. These include fever, chills, myalgia (muscle pain), headache, and gastrointestinal symptoms such as nausea and vomiting . These symptoms can easily be mistaken for other viral infections, making early diagnosis challenging.

Hematological Features

During the prodromal phase, common laboratory findings include thrombocytopenia (low platelet count), hemoconcentration, neutrophilic leukocytosis (increased white blood cells with a left shift), and reactive lymphocytes . Elevated levels of aspartate aminotransferase and lactate dehydrogenase are also frequently observed.

Progression to Respiratory Distress

Respiratory Symptoms

As the disease progresses, patients typically develop severe respiratory symptoms. The most common presenting symptoms include cough and dyspnea (difficulty breathing). These symptoms often signal the transition to the cardiopulmonary phase, where respiratory failure becomes imminent.

Pulmonary Edema and ARDS

HPS is characterized by noncardiogenic pulmonary edema, which leads to acute respiratory distress syndrome (ARDS). This condition is marked by bilateral interstitial pulmonary infiltrates and respiratory compromise, often requiring supplemental oxygen or mechanical ventilation . High-resolution computed tomography (HRCT) findings in HPS patients often show ground-glass opacities and smooth interlobular septal thickening.

Severe Cases and Complications

Cardiovascular and Renal Involvement

In severe cases, HPS can lead to cardiovascular complications such as tachycardia (rapid heart rate) and hypotension (low blood pressure), necessitating inotropic support. Mild to moderate renal failure is also observed in some patients, although it is less prominent compared to the respiratory symptoms.

Mortality and Long-term Sequelae

HPS has a high mortality rate, with some studies reporting fatality rates as high as 36%. Survivors may experience long-term sequelae, including persistent respiratory and cardiovascular issues.

Conclusion

Hantavirus Pulmonary Syndrome is a severe and often fatal disease characterized by a rapid progression from flu-like symptoms to severe respiratory distress. Early recognition and supportive care in an intensive care unit are crucial for improving patient outcomes. Despite its rarity, the high mortality rate and potential for severe complications make HPS a significant public health concern.