Makindo Medical Notes.com

Potentially fatal viral infection carried by rodents

About

• Hantaviruses, from the Bunyaviridae family. Single-stranded, enveloped, negative-sense RNA viruses
• Normally carried by rodents, such as rats, mice and voles
• Can cause potentially fatal human infections with either haemorrhage and AKI or Pulmonary syndromes

Aetiology

• Viral zoonoses transmitted via rodents
• Each hantavirus is specific to a different rodent host.
• Once infected the rodent will secrete virus possibly for life
• Transmission via inhalation of infected animal excreta and fluids, such as urine, faeces and saliva
• Any profession with rodent contact is at risk

Viruses

• Haantan virus in E. Asia, particularly in China, Russia, and Korea.
• Puumala virus is found in Scandinavia, western Europe, and Russia.
• Dobrava virus is found primarily in the Balkans
• Seoul virus is found worldwide.
• Saaremaa virus also circulates in northwest Europe.
• Sin Nombre virus, the common cause of HPS in the USA, was discovered in 1993 following a cluster of acute and fatal illness in previously healthy adults

Clinical

• Haemorrhagic fever with renal failure (HFRS): commonest in the Far East and Eastern Europe. Known as Old World hantaviruses (Europe, Asia and Africa)
• Hantavirus pulmonary syndrome (HPS): the southwestern United States and South America. HPS is more common in South America than in North America. New world disease.
• The incubation period is generally 2 to 4 weeks but can range from 2 days to 8 weeks.
• Fever, headache, chills, nausea, vomiting, diarrhoea and abdominal pain, dizziness

Differentials

Investigations

• FBC, U&E, LFTS, CXR, ABG
• Viral serology

Management

• Supportive measures. No known treatments or vaccines for HPS. May need ITU with intubation and ventilation. Early diagnosis improves outcome.
• To help reduce the risk of infection, simple hygiene precautions such as washing your hands after handling rats or their bedding and cage should be applied.

References