Volume 5, Number 5—October 1999
Dispatch
Acute Sin Nombre Hantavirus Infection without Pulmonary Syndrome, United States
Table
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 |
Symptoms | |||||
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.
References
- 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
- Centers for Disease Control and Prevention. Outbreak of acute illness-southwestern United States, 1993. MMWR Morb Mortal Wkly Rep. 1993;42:421–4.PubMedGoogle Scholar
- 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;173:1297–303.PubMedGoogle 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. N Engl J Med. 1994;330:949–55. DOIPubMedGoogle 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
- 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
- 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
- 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;172:729–33.PubMedGoogle Scholar
- Lee HW, van der Groen G. Hemorrhagic fever with renal syndrome. Prog Med Virol. 1989;36:62–102.PubMedGoogle Scholar
- Settergren B. Nephropathia epidemica (hemorrhagic fever with renal syndrome) in Scandinavia. Rev Infect Dis. 1991;13:736–44.PubMedGoogle Scholar
- 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;14:1108–10. DOIPubMedGoogle Scholar
- 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.
- 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
- 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
- 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;171:864–70.PubMedGoogle 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
- 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;238:380–90. DOIPubMedGoogle Scholar
- 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.
- 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;95:7074–9. DOIPubMedGoogle Scholar
Page created: December 15, 2010
Page updated: December 15, 2010
Page reviewed: December 15, 2010
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.