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Hantavirus Pulmonary Syndrome

Disease Details

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Description: Hantavirus pulmonary syndrome is a severe, sometimes fatal respiratory disease in humans caused by infection with hantaviruses, typically transmitted through contact with rodent urine, droppings, or saliva.
Type: Hantavirus pulmonary syndrome (HPS) is a viral infection. The virus is not transmitted genetically; instead, humans typically become infected through inhalation of aerosols contaminated with the virus from rodent urine, droppings, or saliva.
Signs And Symptoms: Initially, HPS has an incubation phase of 2–4 weeks, in which patients remain asymptomatic. Subsequently, patients can experience 3–5 days of flu-like prodromal phase symptoms, including fever, cough, muscle pain, headache, lethargy, shortness of breath, nausea, vomiting and diarrhea.In the following 5–7 day cardiopulmonary phase, the patient's condition rapidly deteriorates into acute respiratory failure, characterized by the sudden onset of shortness of breath with rapidly evolving pulmonary edema, as well as cardiac failure, with hypotension, tachycardia and shock. In this phase, patients may develop acute respiratory distress syndrome. It is often fatal despite mechanical ventilation and intervention with diuretics.After the cardiopulmonary phase, patients can enter a diuretic phase of 2–3 days characterized by symptom improvement and diuresis. Subsequent convalescence can last months to years.As of 2017, patient mortality in the US from HPS is 36%.
Prognosis: Hantavirus Pulmonary Syndrome (HPS) has a serious prognosis with a high mortality rate. The mortality rate can be 30-40%, depending on the timeliness of medical intervention. Early diagnosis and intensive care, particularly supportive respiratory care, are crucial for improving outcomes.
Onset: The onset of hantavirus pulmonary syndrome (HPS) typically begins with flu-like symptoms, including fever, fatigue, and muscle aches, particularly in the thighs, hips, back, and sometimes shoulders. Early symptoms may also include headaches, dizziness, chills, and abdominal problems such as nausea, vomiting, diarrhea, and abdominal pain. This phase generally lasts about 3 to 5 days. Following this, the disease can progress rapidly to more severe respiratory symptoms, including coughing and shortness of breath, as fluid builds up in the lungs. Prompt medical attention is crucial due to the rapid progression and potential severity of the disease.
Prevalence: Hantavirus Pulmonary Syndrome (HPS) is relatively rare. In the United States, there have been approximately 1,000 confirmed cases since it was first identified in 1993. Cases primarily occur in rural areas in the western part of the country, but the disease is present worldwide. HPS is more common in regions where the primary rodent carriers, such as deer mice, are prevalent.
Epidemiology: Hantavirus pulmonary syndrome was first recognized during the 1993 outbreak in the Four Corners region of the southwestern United States. It was identified by Dr. Bruce Tempest. It was originally called Four Corners disease, but the name was changed to Sin Nombre virus after complaints by Native Americans that the name "Four Corners" stigmatized the region. It has since been identified throughout the United States.
Intractability: Hantavirus Pulmonary Syndrome (HPS) is a serious respiratory disease caused by hantaviruses. The illness progresses rapidly and can be severe, often requiring intensive medical care. While there is no specific cure for HPS, early recognition and supportive treatment, such as mechanical ventilation and management of fluids, can improve outcomes. Therefore, the disease is not considered intractable, but it is challenging to manage and requires prompt medical attention.
Disease Severity: Hantavirus Pulmonary Syndrome (HPS) is a severe and potentially fatal respiratory disease caused by hantaviruses. The disease severity can range from flu-like symptoms to severe respiratory distress and multi-organ failure. HPS has a high mortality rate, often around 30-50%. Early symptoms include fever, fatigue, and muscle aches, which can progress to coughing and shortness of breath as the lungs fill with fluid. Prompt medical attention is crucial for improving the chance of survival.
Healthcare Professionals: Disease Ontology ID - DOID:14472
Pathophysiology: Hantavirus Pulmonary Syndrome (HPS) is caused by hantaviruses, primarily carried by rodents. When humans inhale aerosolized particles of rodent excreta (urine, droppings, saliva) contaminated with hantavirus, the infection can be contracted. Once inside the human body, the virus infects endothelial cells in the lungs, leading to increased vascular permeability. This results in fluid leakage into the alveolar spaces, causing pulmonary edema and respiratory distress. The immune response exacerbates this permeability, leading to severe lung congestion and potential cardiovascular instability.
Carrier Status: Hantavirus Pulmonary Syndrome (HPS) is primarily carried by certain rodent species, most notably the deer mouse in North America. Humans typically become infected through inhalation of virus particles from rodent urine, droppings, or saliva. Human-to-human transmission of HPS is extremely rare.
Mechanism: Hantavirus Pulmonary Syndrome (HPS) is a severe respiratory disease caused by hantaviruses, primarily by the Sin Nombre virus in North America. The mechanism involves initial viral infection through inhalation of aerosolized particles from rodent excreta.

Upon entry, the virus targets endothelial cells, particularly in the lung capillaries. Hantaviruses enter cells via β3 integrins or other receptors and subsequently replicate. The immune response, particularly the overactive innate and adaptive immune responses, contributes significantly to the pathogenesis of HPS. The increased cytokine production and vascular permeability lead to the characteristic pulmonary edema and respiratory distress.

On a molecular level, hantavirus nucleocapsid protein inhibits cellular responses and impairs immune signaling. Viral glycoproteins, G1/G2, are critical for attachment and entry into host cells. Dysregulation of vascular endothelial growth factor (VEGF) and other inflammatory mediators results in increased capillary leakage. The combination of direct viral effects on endothelial cells and the host immune response causes the severe pulmonary symptoms of HPS.
Treatment: There is no cure or vaccine for HPS. Treatment involves supportive therapy, including mechanical ventilation with supplemental oxygen during the critical respiratory-failure stage of the illness. Although ribavirin can be used to treat hantavirus infections, it is not recommended as a treatment for HPS due to unclear clinical efficacy and likelihood of medication side effects. Early recognition of HPS and admission to an intensive care setting offers the best prognosis.
Compassionate Use Treatment: For Hantavirus Pulmonary Syndrome (HPS), there is no specific antiviral treatment that is widely recommended or approved. The primary treatment approach focuses on supportive care, particularly for respiratory and cardiovascular complications. Here are some considerations regarding experimental or off-label treatments:

1. **Ribavirin**: An antiviral medication that has been used experimentally and off-label for treating HPS, particularly during the early stages of the disease. However, its effectiveness is still under investigation and not conclusively proven.

2. **Extracorporeal Membrane Oxygenation (ECMO)**: A supportive treatment considered in severe cases where conventional mechanical ventilation is insufficient. ECMO provides oxygenation outside the body when the lungs are severely compromised.

3. **Corticosteroids**: These have been used in some cases to reduce inflammation and manage severe respiratory distress, but evidence regarding their effectiveness is limited and mixed.

4. **Clinical Trials**: Participation in clinical trials for new treatments or interventions may be an option, and these trials often explore novel therapeutic approaches.

It's crucial to manage HPS in specialized medical centers with the capability to provide intensive care and advanced supportive treatments. Always consult healthcare professionals for the most appropriate management and treatment options.
Lifestyle Recommendations: ### Lifestyle Recommendations for Hantavirus Pulmonary Syndrome

1. **Avoid Rodent Infestations:**
- Seal any holes or gaps in your home where rodents can enter.
- Use traps to control rodent populations.
- Remove food sources that attract rodents, such as uncovered garbage and pet food.

2. **Clean Safely:**
- If you encounter rodent droppings, urine, or nests, use disinfectant before cleaning.
- Wear gloves and avoid sweeping or vacuuming, which can aerosolize the virus. Instead, use wet cleaning methods.

3. **Precaution During Outdoor Activities:**
- When camping or hiking, avoid disturbing rodent nests or burrows.
- Choose campsites away from rodent habitats and elevate sleeping areas.

4. **Farm and Ranch Safety:**
- Store hay, woodpiles, and garbage away from living areas.
- Clean barns, sheds, and outbuildings with proper ventilation and protective gear.

5. **Awareness and Education:**
- Be informed about the symptoms of hantavirus and seek medical attention if you suspect exposure.
- Educate those around you about rodent control and preventive measures.

Implementing these practices can help reduce the risk of contracting hantavirus pulmonary syndrome.
Medication: There is no specific antiviral medication approved for treating hantavirus pulmonary syndrome (HPS). The primary treatment involves supportive care in an intensive care unit (ICU), particularly respiratory support, which may include mechanical ventilation to assist with severe respiratory distress. Early recognition and hospitalization are crucial for improving outcomes.
Repurposable Drugs: Currently, there are no specific antiviral drugs approved for treating hantavirus pulmonary syndrome (HPS). Treatment primarily involves supportive care, including oxygen therapy and mechanical ventilation if needed. Research into potential repurposable drugs is ongoing, with some antivirals like ribavirin being investigated, but their efficacy is not yet confirmed.
Metabolites: There is limited specific information regarding the metabolites directly associated with Hantavirus Pulmonary Syndrome (HPS). HPS is caused by hantaviruses, and the disease primarily affects the lungs, leading to respiratory distress and other severe symptoms. The pathogenesis involves immune responses and vascular leakage rather than distinct metabolic changes documented as characteristic metabolites. Further biochemical research may be required to fully identify and understand the metabolic pathways affected by the disease.
Nutraceuticals: There are no established nutraceuticals for the prevention or treatment of hantavirus pulmonary syndrome (HPS). The primary approach to managing HPS is early diagnosis and supportive care in a medical setting, including mechanical ventilation if necessary. Preventive measures focus on avoiding contact with rodent carriers and their droppings.
Peptides: For hantavirus pulmonary syndrome (HPS):

**Peptides:** The role of peptides in hantavirus pulmonary syndrome is still under investigation. Some peptide-based therapeutics and diagnostic tools are being explored to target specific viral proteins, such as the nucleocapsid protein, to improve treatment and early detection.

**NAN (Nucleic Acid Nanotechnology):** Nucleic acid nanotechnology is being investigated for its potential in diagnosing and treating viral infections, including hantavirus. Techniques like RNA interference (RNAi) and CRISPR/Cas systems may offer future therapeutic approaches by targeting the hantavirus genome, though practical applications are still in the research phase.

Further research is needed in both areas to provide more conclusive and practical solutions for hantavirus pulmonary syndrome.