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Volume 5, Number 5—October 1999

Acute Sin Nombre Hantavirus Infection without Pulmonary Syndrome, United States

Paul T. Kitsutani*Comments to Author , Robert W. Denton†, Curtis L. Fritz‡, Robert A. Murray§, Randall L. Todd¶#, W. John Pape**, J. Wyatt Frampton††, Joni C. Young*, Ali S. Khan*, Clarence J. Peters*, and Thomas G. Ksiazek*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Bishop, California, USA; ‡California Department of Health Services, Sacramento, California, USA; §California Department of Health Services, Berkeley, California, USA; ¶Bureau of Disease Control and Intervention Services, Carson City, Nevada, USA; #Nevada State Health Division, Carson City, Nevada, USA; **Colorado Department of Public Health & Environment, Denver, Colorado, USA; and ††Utah Department of Health, Salt Lake City, Utah, USA

Main Article


Characteristics of five acute cases of Sin Nombre Virus infection without pulmonary syndrome, 1993–1999

Case 1 1993 Case 2 1998 Case 3 1999 Case 4 1998a Case 5 1993b
Age (yr) 38 36 19 32 4
Sex M F M M M
Race White White White White American Indian
State Nevada California Colorado Utah New Mexico
Hospitalized No No Yes Yes No
Fever +c + + + +
Headache + + +
Malaise + +
Myalgia + + + +
Cough + + + +
Shortness of breath +
Chest/substernal pain +
Sore throat + NRd
Nausea/vomiting + + + NR
Dizziness + + NR
Photophobia +
Abdominal pain NR
Diarrhea NR
Arthralgia + NR
Vital signs
Max temp (ºF) 102.5 104.0 103.1 102.8 100.6
Blood pressure normal normal normal normal NR
Lowest O2 sat. (RAe) 85% 94% 89.9% 94% NR
Laboratory results
Highest Hct (%) 47.0 44.7 50.2 44.4 40.2
Highest WBC 9,100 8,000 10,200 7,300 NRf
% seg. neutrophils 68 40 39 88
% bands 9 30 24
% lymphocytes 19 14 20 7
% atypical lymphocytes NR 4 NR NR
Lowest platelet (/mm3) 127,000 115,000 28,000 163,000 NRg
Highest SGOTh (U/L) NR 81 NR 26 NR
Highest LDHi (U/L) NR 337 488 240 NR
Lowest albumin (g/dL) NR 3.1 NR 4.3 NR
Chest X-ray 2-cm granuloma normal Mild left lower lobe infiltrate normal NR
Anti-SNVj antibody
IgM positive positive positive positive positive
IgG positive positive positive positive positive

aObtained from Zavasky D-M, Hjelle B, Peterson M, et al. Acute infection with Sin Nombre hantavirus without pulmonary edema. Clin Infect Dis, in press.
bObtained from Armstrong et al., 1995 (12).
c+, present; -, absent.
dNR = not recorded or obtained.
eRA = room air.
fPatient did not have leukocytosis.
gPatient did not have thrombocytopenia.
hSGOT = serum glutamic oxalacetic acid.
iLDH = lactic dehydrogenase.
jSNV = Sin Nombre virus.

Main Article

  1. 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;5:7586. DOIPubMedGoogle Scholar
  2. Centers for Disease Control and Prevention. Outbreak of acute illness-southwestern United States, 1993. MMWR Morb Mortal Wkly Rep. 1993;42:4214.PubMedGoogle Scholar
  3. Khan  AS, Khabbaz  RF, Armstrong  LR, Holman  RC, Bauer  SP, Graber  J, Hantavirus pulmonary syndrome: the first 100 U.S. cases. J Infect Dis. 1996;173:1297303.PubMedGoogle Scholar
  4. 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. N Engl J Med. 1994;330:94955. DOIPubMedGoogle Scholar
  5. Hallin  GW, Simpson  SQ, Crowell  RE, James  DS, Koster  FT, Mertz  GJ, Cardiopulmonary manifestations of hantavirus pulmonary syndrome. Crit Care Med. 1996;24:2528. DOIPubMedGoogle Scholar
  6. 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;146:55279.PubMedGoogle Scholar
  7. 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;26:11020. DOIPubMedGoogle Scholar
  8. Simonsen  L, Dalton  MJ, Breiman  RF, Hennessy  T, Umland  ET, Sewell  CM, Evaluation of the magnitude of the 1993 hantavirus outbreak in the southwestern United States. J Infect Dis. 1995;172:72933.PubMedGoogle Scholar
  9. Lee  HW, van der Groen  G. Hemorrhagic fever with renal syndrome. Prog Med Virol. 1989;36:62102.PubMedGoogle Scholar
  10. Settergren  B. Nephropathia epidemica (hemorrhagic fever with renal syndrome) in Scandinavia. Rev Infect Dis. 1991;13:73644.PubMedGoogle Scholar
  11. Armstrong  LR, Bryan  RT, Sarisky  J, Khan  AS, Rowe  T, Ettestad  PJ, Mild hantaviral disease caused by Sin Nombre virus in a four-year-old child. Pediatr Infect Dis J. 1995;14:110810. DOIPubMedGoogle Scholar
  12. Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. MMWR Morb Mortal Wkly Rep. 1997;46(RR-10):16.
  13. 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;52:11723.PubMedGoogle Scholar
  14. Wells  RM, Young  J, Williams  RJ, Armstrong  LR, Busico  K, Khan  AS, Hantavirus transmission in the United States. Emerg Infect Dis. 1997;3:3615. DOIPubMedGoogle Scholar
  15. Zeitz  PS, Butler  JC, Cheek  JE, Samuel  MC, Childs  JE, Shands  LA, A case-control study of hantavirus pulmonary syndrome during an outbreak in the southwestern United States. J Infect Dis. 1995;171:86470.PubMedGoogle Scholar
  16. Ketai  LH, Williamson  MR, Telepak  RJ, Levy  H, Koster  FT, Nolte  KB, Hantavirus pulmonary syndrome: radiographic findings in 16 patients. Radiology. 1994;191:6658.PubMedGoogle Scholar
  17. Ennis  FA, Cruz  J, Spiropoulou  CF, Waite  D, Peters  CJ, Nichol  ST, Hantavirus pulmonary syndrome: CD8+ and CD4+ cytotoxic T lymphocytes to epitopes on Sin Nombre virus nucleocapsid protein isolated during acute illness. Virology. 1997;238:38090. DOIPubMedGoogle Scholar
  18. Simpson  SQ, Mapel  V, Koster  FT, Montoya  J, Bice  DE, Williams  AJ. Evidence for lymphocyte activation in the hantavirus pulmonary syndrome. Chest. 1995;106:97S.
  19. Gavrilovskaya  IN, Shepley  M, Shaw  R, Ginsberg  MH, Mackow  ER. ß3 integrins mediate the cellular entry of hantaviruses that cause respiratory failure. Proc Natl Acad Sci U S A. 1998;95:70749. DOIPubMedGoogle Scholar

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