Symptoms Of Hantavirus Pulmonary Syndrome

October 25, 2023

Hantavirus pulmonary syndrome (HPS) is a life-threatening illness caused by the genus hantaviruses. The case fatality rate ranges from thirty-five to fifty percent. There are five pathogenic hantaviruses responsible for disease in the United States: Sin Nombre hantavirus, New York virus, Monongahela virus, Black Creek Canal virus, and Bayou virus. Sin Nombre hantavirus causes most cases in the United States. Deer mice are the primary reservoir for Sin Nombre virus. Cotton rats, rice rats, and the white-footed mouse also carry the pathogen. Individuals become ill after inhaling or otherwise coming into contact with contaminated rodent droppings or saliva. Over ninety-six of cases in the United States were in states west of the Rocky mountains. The virus is transmitted among rats who bite each other but does not cause disease in the rodent. Reveal the symptoms of hantavirus pulmonary syndrome now.

Fever And Chills

After inhaling or ingesting products contaminated with hantavirus, there is an incubation period of one to eight weeks. During this time, the virus spreads throughout the body but does not cause symptoms. The acute stage of the disease usually begins after two to three weeks. The first three to six days are the febrile stage, characterized by fever and chills and flu-like symptoms. Fever and chills are always present with the disease. The fever is usually between 101and 104 degrees Fahrenheit. The body's immune system reacts to the virus with a widespread inflammatory response that produces fever, chills, and muscle aches. Patients with a fever greater than 101 degrees Fahrenheit after possible exposure to rodent droppings should be tested for hantavirus. Two patients in West Virginia presented with fevers of 102.7 and 102.9 degrees Fahrenheit, typical during the first few days of the illness. In a 2009 case, a nine-year-old girl diagnosed with Sin Nombre hantavirus infection had a fever of 103.8 degrees Fahrenheit. Chills and flu-like symptoms were present in each case.

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An early sign of infection by hantavirus is fatigue. Following incubation, the symptomatic period of the disease begins, with typical viral symptoms of fatigue, malaise, and fever. As hantavirus pulmonary syndrome worsens, the second stage of the illness known as the cardiopulmonary stage begins. During this time the virus causes the capillaries in the lungs to leak fluid into the alveoli. This produces acute respiratory distress syndrome, a type of non-cardiogenic pulmonary edema. A protein-rich liquid moves from the blood into the alveoli of the lungs making gas exchange difficult. This requires ventilatory support to prevent internal drowning. The fluid-filled lungs are ineffective at oxygenating the body tissues leading to extreme weakness on top of other symptoms.

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Muscle Aches

Another symptom present in all cases of hantavirus pulmonary syndrome is muscle aches. The larger muscles, such as the thighs and back, are most affected. Muscle aches occur in the early stages of infection, along with fever, chills, and tiredness. Myalgia (muscle pain), can range from mild to severe and may be difficult to distinguish from typical influenza symptoms. Muscle pain is not caused by the virus but by the immune system's response. The hantavirus triggers the production of interleukins to help fight the infection. Interleukins are key modulators of the immune response, stimulating division of macrophages and other white blood cells. Muscle pain and fever are a side effect of the inflammatory response to the virus. Interleukin-1 causes the fever that accompanies muscle pain. The fever and muscle pains occur primarily in the first week of the acute disease. This phase is known as the febrile prodrome.

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In the early stages of hantavirus pulmonary syndrome, over half of patients complain of dizziness. This typically manifests in the first week of acute illness onset. This is usually accompanied by a severe headache, muscle pain, fever, and weakness. This symptom may be a result of mild hypoxia as the virus begins to affect the lungs' ability to adequately perfuse the brain with oxygen. Hantavirus pulmonary syndrome also causes a sudden drop in blood pressure. In cases where a patient complains of flu-like symptoms along with feeling light-headed, a thorough history should be taken, with a focus on possible rodent exposure. Occasional feelings of faintness or unsteadiness may progress to loss of consciousness after a few days due to cardiogenic shock in the untreated patient.

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According to the Centers for Disease Control, approximately half of all patients experience diarrhea, nausea, and vomiting. Gastrointestinal symptoms usually occur early in the course of the disease. Loose stools occur when excessive fluid is secreted into the intestinal lumen or when there is a decreased ability to re-absorb the liquid in the large colon. Infectious diarrhea typically occurs when viruses damage the gut's epithelium, reducing its ability to remove water from the stool. Hemorrhagic fevers like hantavirus pulmonary syndrome also infect the vascular epithelium of the capillaries and alter their permeability. As a result, the microvasculature becomes leaky, and water moves from the blood to the lumen of the intestine. The increased water, combined with a reduced ability to absorb it, causes hypermotility and watery bowel movements.

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