Hantavirus cardiopulmonary syndrome (HCPS) is a rare disease in the US that results from virus transmission to humans through incidental contact with rodent urine or saliva.
Most severe cases are caused by the Sin Nombre virus (SNV).
Epidemiologic history of rodent infestation in or around the dwelling and/or cleaning out of rodent-contaminated enclosed areas are risk factors for hantavirus infection.
Presents as a nonspecific viral illness with fever, headache, myalgias, and often prominent GI symptoms. During the pulmonary phase there is increasing dyspnea and hypoxemia, which can progress rapidly to cardiogenic shock and death.
Although there is no specific treatment or cure, cases must be managed in an ICU setting. Broad-spectrum antibiotic therapy, analgesia, and antipyretics are given while awaiting confirmation of diagnosis.
In the cardiopulmonary phase of the disease, a falling cardiac index with evidence of cardiovascular collapse is an indication for extracorporeal membrane oxygenation (ECMO) support.
Mortality associated with HCPS is up to 50%, due to pulmonary edema and cardiogenic shock.
Peromyscus maniculatus: the deer mouse, vector for Sin Nombre virus (SNV), which causes most cases of hantavirus cardiopulmonary syndrome
CDC Public Health Image Library (PHIL): James Gathany
- exposure to rodent excreta
- GI symptoms
- normal or low oxygen saturation
- lung rales
1st Tests To Order
- IgM and IgG serologies for Sin Nombre virus (SNV)
Other Tests to Consider
- serum lactate
- flow-directed pulmonary artery catheter (Swan-Ganz catheter)
- lung biopsy
- serum viral-RNA load
- neutralizing antibody
sepsis of unknown cause
- empiric antimicrobial therapy
- admission to ICU
confirmed hantavirus infection
- cessation of antibiotic therapy
- supportive care
- extracorporeal membrane oxygenation (ECMO)