Volume 17, Number 7—July 2011
CME ACTIVITY - Research
Hantavirus Pulmonary Syndrome, United States, 1993–2009
Table 3
Characteristic | No. patients reporting characteristic/no. patients for whom data were available for that characteristic (%) |
p value† | ||
---|---|---|---|---|
All | Died | Survived | ||
Fever | 356/397 (90) | 116/132 (88) | 239/264 (91) | 0.414 |
Thrombocytopenia‡ | 405/418 (97) | 131/134 (98) | 273/283 (96) | 0.477 |
Increased hematocrit‡ | 261/389 (67) | 103/130 (79) | 157/258 (61) | <0.001 |
Increased creatinine level‡ | 120/286 (42) | 54/93 (58) | 66/193 (34) | <0.001 |
Increased leukocyte count‡ | 169/234 (72) | 72/83 (87) | 96/150 (64) | <0.001 |
Chest radiograph showing unexplained bilateral infiltrates or suggestive of ARDS | 390/406 (96) | 135/141 (96) | 255/265 (96) | 0.812 |
Need for supplemental oxygen | 390/405 (96) | 134/135 (99) | 255/269 (95) | 0.025 |
Intubation of patient | 265/430 (62) | 129/139 (93) | 135/290 (47) | <0.001 |
*HPS, hantavirus pulmonary syndrome; ARDS, acute respiratory distress syndrome.
†By χ2 test for difference in the proportion of HPS case-patients with a clinical characteristic who died and those who survived.
‡Based on qualitative data (yes or no) regarding clinical characteristic from case investigation form. For a small number of case-patients for whom qualitative data were incomplete, but for whom laboratory values were available, qualitative values were assigned on the basis of described clinical cutoff values (24).
References
- Centers for Disease Control and Prevention. Outbeak of acute illness—southwestern United States, 1993. MMWR Morb Mortal Wkly Rep. 1993;42:421–4.PubMedGoogle Scholar
- Nichol ST, Spiropoulou CF, Morzunov S, Rollin PE, Ksiazek TG, Feldmann H, Genetic identification of a hantavirus associated with an outbreak of acute respiratory illness. Science. 1993;262:914–7. DOIPubMedGoogle Scholar
- Ksiazek TG, Peters CJ, Rollin PE, Zaki S, Nichol S, Spiropoulou C, Identification of a new North American hantavirus that causes acute pulmonary insufficiency. Am J Trop Med Hyg. 1995;52:117–23.PubMedGoogle Scholar
- Childs JE, Ksiazek TG, Spiropoulou CF, Krebs JW, Morzunov S, Maupin GO, Serologic and genetic identification of Peromyscus maniculatus as the primary rodent reservoir for a new hantavirus in the southwestern United States. J Infect Dis. 1994;169:1271–80. DOIPubMedGoogle Scholar
- Peters CJ, Khan AS. Hantavirus pulmonary syndrome: the new American hemorrhagic fever. Clin Infect Dis. 2002;34:1224–31. DOIPubMedGoogle Scholar
- Monroe MC, Morzunov SP, Johnson AM, Bowen MD, Artsob H, Yates T, Genetic diversity and distribution of Peromyscus-borne hantaviruses in North America. Emerg Infect Dis. 1999;5:75–86. DOIPubMedGoogle Scholar
- Song JW, Baek LJ, Gajdusek DC, Yanagihara R, Gavrilovskaya I, Luft BJ, Isolation of pathogenic hantavirus from white-footed mouse (Peromyscus leucopus). Lancet. 1994;344:1637. DOIPubMedGoogle Scholar
- Hjelle B, Lee SW, Song W, Torrez-Martinez N, Song JW, Yanagihara R, Molecular linkage of hantavirus pulmonary syndrome to the white-footed mouse, Peromyscus leucopus: genetic characterization of the M genome of New York virus. J Virol. 1995;69:8137–41.PubMedGoogle Scholar
- Rhodes LV III, Huang C, Sanchez AJ, Nichol ST, Zaki SR, Ksiazek TG, Hantavirus pulmonary syndrome associated with Monongahela virus, Pennsylvania. Emerg Infect Dis. 2000;6:616–21. DOIPubMedGoogle Scholar
- Morzunov SP, Feldmann H, Spiropoulou CF, Semenova VA, Rollin PE, Ksiazek TG, A newly recognized virus associated with a fatal case of hantavirus pulmonary syndrome in Louisiana. J Virol. 1995;69:1980–3.PubMedGoogle Scholar
- Ksiazek TG, Nichol ST, Mills JN, Groves MG, Wozniak A, McAdams S, Isolation, genetic diversity, and geographic distribution of Bayou virus (Bunyaviridae: hantavirus). Am J Trop Med Hyg. 1997;57:445–8.PubMedGoogle Scholar
- Torrez-Martinez N, Bharadwaj M, Goade D, Delury J, Moran P, Hicks B, Bayou virus-associated hantavirus pulmonary syndrome in eastern Texas: identification of the rice rat, Oryzomys palustris, as reservoir host. Emerg Infect Dis. 1998;4:105–11. DOIPubMedGoogle Scholar
- Rollin PE, Ksiazek TG, Elliott LH, Ravkov EV, Martin ML, Morzunov S, Isolation of Black Creek Canal virus, a new hantavirus from Sigmodon hispidus in Florida. J Med Virol. 1995;46:35–9. DOIPubMedGoogle Scholar
- Khan AS, Gaviria M, Rollin PE, Hlady WG, Ksiazek TG, Armstrong LR, Hantavirus pulmonary syndrome in Florida: association with the newly identified Black Creek Canal virus. Am J Med. 1996;100:46–8. DOIPubMedGoogle Scholar
- Vitek CR, Breiman RF, Ksiazek TG, Rollin PE, McLaughlin JC, Umland ET, Evidence against person-to-person transmission of hantavirus to health care workers. Clin Infect Dis. 1996;22:824–6. DOIPubMedGoogle Scholar
- Wells RM, Young J, Williams RJ, Armstrong LR, Busico K, Khan AS, Hantavirus transmission in the United States. Emerg Infect Dis. 1997;3:361–5. DOIPubMedGoogle Scholar
- Enría D, Padula P, Segura EL, Pini N, Edelstein A, Posse CR, Hantavirus pulmonary syndrome in Argentina. Possibility of person to person transmission. Medicina (B Aires). 1996;56:709–11.PubMedGoogle Scholar
- Chaparro J, Vega J, Terry W, Vera JL, Barra B, Meyer R, Assessment of person-to-person transmission of hantavirus pulmonary syndrome in a Chilean hospital setting. J Hosp Infect. 1998;40:281–5. DOIPubMedGoogle Scholar
- Martinez VP, Bellomo C, San Juan J, Pinna D, Forlenza R, Elder M, Person-to-person transmission of Andes virus. Emerg Infect Dis. 2005;11:1848–53.PubMedGoogle Scholar
- Young JC, Hansen GR, Graves TK, Deasy MP, Humphreys JG, Fritz CL, The incubation period of hantavirus pulmonary syndrome. Am J Trop Med Hyg. 2000;62:714–7.PubMedGoogle Scholar
- Khan AS, Khabbaz RF, Armstrong LR, Holman RC, Bauer SP, Graber J, Hantavirus pulmonary syndrome: the first 100 US cases. J Infect Dis. 1996;173:1297–303. DOIPubMedGoogle Scholar
- Duchin JS, Koster FT, Peters CJ, Simpson GL, Tempest B, Zaki SR, Hantavirus pulmonary syndrome: a clinical description of 17 patients with a newly recognized disease. The Hantavirus Study Group. N Engl J Med. 1994;330:949–55. DOIPubMedGoogle Scholar
- Nolte KB, Feddersen RM, Foucar K, Zaki SR, Koster FT, Madar D, Hantavirus pulmonary syndrome in the United States: a pathological description of a disease caused by a new agent. Hum Pathol. 1995;26:110–20. DOIPubMedGoogle Scholar
- Zaki SR, Greer PW, Coffield LM, Goldsmith CS, Nolte KB, Foucar K, Hantavirus pulmonary syndrome. Pathogenesis of an emerging infectious disease. Am J Pathol. 1995;146:552–79.PubMedGoogle Scholar
- Hallin GW, Simpson SQ, Crowell RE, James DS, Koster FT, Mertz GJ, Cardiopulmonary manifestations of hantavirus pulmonary syndrome. Crit Care Med. 1996;24:252–8. DOIPubMedGoogle Scholar
- Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. MMWR Recomm Rep. 1997;46:1–55.PubMedGoogle Scholar
- Zaki SR, Albers RC, Greer PW, Coffield LM, Armstrong LR, Khan AS, Retrospective diagnosis of a 1983 case of fatal hantavirus pulmonary syndrome. Lancet. 1994;343:1037–8. DOIPubMedGoogle Scholar
- Zaki SR, Khan AS, Goodman RA, Armstrong LR, Greer PW, Coffield LM, Retrospective diagnosis of hantavirus pulmonary syndrome, 1978–1993: implications for emerging infectious diseases. Arch Pathol Lab Med. 1996;120:134–9.PubMedGoogle Scholar
- Schwarcz SK, Shefer AM, Zaki SR. Retrospective diagnosis of a fatal case of the hantavirus pulmonary syndrome, 1980. West J Med. 1996;164:348–50.PubMedGoogle Scholar
- Frampton JW, Lanser S, Nichols CR. Sin Nombre virus infection in 1959. Lancet. 1995;346:781–2. DOIPubMedGoogle Scholar
- Nerurkar VR, Song JW, Song KJ, Nagle JW, Hjelle B, Jenison S, Genetic evidence for a hantavirus enzootic in deer mice (Peromyscus maniculatus) captured a decade before the recognition of hantavirus pulmonary syndrome. Virology. 1994;204:563–8. DOIPubMedGoogle Scholar
- Nichol S. Genetic analysis of hantaviruses and their host relationships. In: Saluzzo J, Dodet B, editors. Factors in the emergence and control of rodent-borne viral diseases: San Francisco: Elsevier; 1999. p. 99–109.
- Mills JN, Amman BR, Glass GE. Ecology of hantaviruses and their hosts in North America. Vector Borne Zoonotic Dis. 2010;10:563–74. DOIPubMedGoogle Scholar
- Ramos MM, Overturf GD, Crowley MR, Rosenberg RB, Hjelle B. Infection with Sin Nombre hantavirus: clinical presentation and outcome in children and adolescents. Pediatrics. 2001;108:E27. DOIPubMedGoogle Scholar
- Centers for Disease Control and Prevention. Hantavirus pulmonary syndrome in five pediatric patients—four states, 2009. MMWR Morb Mortal Wkly Rep. 2009;58:1409–12.PubMedGoogle Scholar
- Vapalahti K, Virtala AM, Vaheri A, Vapalahti O. Case–control study on Puumala virus infection: smoking is a risk factor. Epidemiol Infect. 2010;138:576–84. DOIPubMedGoogle Scholar
- Koster F, Foucar K, Hjelle B, Scott A, Chong YY, Larson R, Rapid presumptive diagnosis of hantavirus cardiopulmonary syndrome by peripheral blood smear review. Am J Clin Pathol. 2001;116:665–72. DOIPubMedGoogle Scholar
- Crowley MR, Katz RW, Kessler R, Simpson SQ, Levy H, Hallin GW, Successful treatment of adults with severe hantavirus pulmonary syndrome with extracorporeal membrane oxygenation. Crit Care Med. 1998;26:409–14. DOIPubMedGoogle Scholar
- Dietl CA, Wernly JA, Pett SB, Yassin SF, Sterling JP, Dragan R, Extracorporeal membrane oxygenation support improves survival of patients with severe hantavirus cardiopulmonary syndrome. J Thorac Cardiovasc Surg. 2008;135:579–84. DOIPubMedGoogle Scholar
- Ketai LH, Williamson MR, Telepak RJ, Levy H, Koster FT, Nolte KB, Hantavirus pulmonary syndrome: radiographic findings in 16 patients. Radiology. 1994;191:665–8.PubMedGoogle Scholar
Page created: August 15, 2011
Page updated: August 15, 2011
Page reviewed: August 15, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.