Semin Respir Crit Care Med 2021; 42(06): 822-827
DOI: 10.1055/s-0041-1733803
Review Article

Hantavirus

Raúl Riquelme
1   Puerto Montt Hospital, San Sebastian University, Puerto Montt, Chile
› Author Affiliations

Abstract

Hantaviruses are tri-segmented lipid-enveloped RNA viruses belonging to the Bunyaviridae family. Human infection corresponds to a zoonosis associated with two different clinical syndromes: hemorrhagic fever with renal syndrome that occurs in Asia and Europe and hantavirus cardiopulmonary syndrome (HCPS) that occurs in the North America, Central America and South America. The major pathogenic mechanisms in HCPS include (1) direct microvascular endothelial injury leading to increased capillary permeability and the development of noncardiogenic pulmonary edema and acute respiratory distress syndrome, and (2) exaggerated host immune response leading to secondary organ damage. The incubation period for this disease is quite long (6–39 days, median: 18 days); however, rapid progression to respiratory failure and shock can occur highlighting the importance of high index of clinical suspicion. Management revolves around high-quality supportive care. Various management and preventative strategies are currently being explored and warrant further examination to improve the overall outlook following infection with hantavirus.



Publication History

Article published online:
16 December 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Lee HW, Lee PW, Johnson KM. Isolation of the etiologic agent of Korean hemorrhagic fever. J Infect Dis 1978; 137 (03) 298-308
  • 2 Schmaljohn C, Hjelle B. Hantaviruses: a global disease problem. Emerg Infect Dis 1997; 3 (02) 95-104
  • 3 Nichol ST, Spiropoulou CF, Morzunov S. et al. Genetic identification of a hantavirus associated with an outbreak of acute respiratory illness. Science 1993; 262 (5135): 914-917
  • 4 Murúa R, Navarrete M, Cádiz R. et al. [Hantavirus pulmonary syndrome: current situation among rodent reservoirs and human population in the 10th region, Chile]. Rev Med Chil 2003; 131 (02) 169-176
  • 5 Kruger DH, Moraes Figueiredo LT, Song JW, Klempa B. Hantaviruses-globally emerging pathogens. J Clin Virol 2015; 64: 128-136
  • 6 Padula PJ, Edelstein A, Miguel SD, López NM, Rossi CM, Rabinovich RD. Hantavirus pulmonary syndrome outbreak in Argentina: molecular evidence for person-to-person transmission of Andes virus. Virology 1998; 241 (02) 323-330
  • 7 Martínez-Valdebenito C, Calvo M, Vial C. et al. Person-to-person household and nosocomial transmission of Andes hantavirus, Southern Chile, 2011. Emerg Infect Dis 2014; 20 (10) 1629-1636
  • 8 Alonso DO, Pérez-Sautu U, Bellomo CM. et al. Person-to-person transmission of Andes Virus in hantavirus pulmonary syndrome, Argentina, 2014. Emerg Infect Dis 2020; 26 (04) 756-759
  • 9 Ferres M, Vial P, Marco C. et al; Andes Virus Household Contacts Study Group. Prospective evaluation of household contacts of persons with hantavirus cardiopulmonary syndrome in chile. J Infect Dis 2007; 195 (11) 1563-1571
  • 10 Riquelme R, Rioseco ML, Bastidas L. et al. Hantavirus pulmonary syndrome, Southern Chile, 1995-2012. Emerg Infect Dis 2015; 21 (04) 562-568
  • 11 Figueiredo LTM, Souza WM, Ferrés M, Enria DA. Hantaviruses and cardiopulmonary syndrome in South America. Virus Res 2014; 187 (July): 43-54
  • 12 Saggioro FP, Rossi MA, Duarte MI. et al. Hantavirus infection induces a typical myocarditis that may be responsible for myocardial depression and shock in hantavirus pulmonary syndrome. J Infect Dis 2007; 195 (10) 1541-1549
  • 13 Riquelme R, Riquelme M, Torres A. et al. Hantavirus pulmonary syndrome, southern Chile. Emerg Infect Dis 2003; 9 (11) 1438-1443
  • 14 Kitsutani PT, Denton RW, Fritz CL. et al. Acute Sin Nombre hantavirus infection without pulmonary syndrome, United States. Emerg Infect Dis 1999; 5 (05) 701-705
  • 15 Baró M, Vergara J, Navarrete M. Hantavirus en Chile: revisión y análisis de casos desde 1975. Rev Med Chil 1999; 127 (12) 1513-1523
  • 16 Guía clínica de prevención, diagnóstico y tratamiento del síndrome cardiopulmonar por hantavirus. Ministerio de Salud de Chile; . Accessed June 30, 2021 at: https://diprece.minsal.cl/programas-de-salud/programas-enfermedades-transmisibles/dengue-chikungunya-otras/hanta/
  • 17 Wernly JA, Dietl CA, Tabe CE. et al. Extracorporeal membrane oxygenation support improves survival of patients with Hantavirus cardiopulmonary syndrome refractory to medical treatment. Eur J Cardiothorac Surg 2011; 40 (06) 1334-1340
  • 18 Macneil A, Nichol ST, Spiropoulou CF. Hantavirus pulmonary syndrome. Virus Res 2011; 162 (1-2): 138-147
  • 19 Huggins JW, Hsiang CM, Cosgriff TM. et al. Prospective, double-blind, concurrent, placebo-controlled clinical trial of intravenous ribavirin therapy of hemorrhagic fever with renal syndrome. J Infect Dis 1991; 164 (06) 1119-1127
  • 20 Chapman LE, Mertz GJ, Peters CJ. et al; Ribavirin Study Group. Intravenous ribavirin for hantavirus pulmonary syndrome: safety and tolerance during 1 year of open-label experience. Antivir Ther 1999; 4 (04) 211-219
  • 21 Mertz GJ, Miedzinski L, Goade D. et al; Collaborative Antiviral Study Group. Placebo-controlled, double-blind trial of intravenous ribavirin for the treatment of hantavirus cardiopulmonary syndrome in North America. Clin Infect Dis 2004; 39 (09) 1307-1313
  • 22 Vial PA, Valdivieso F, Ferres M. et al; Hantavirus Study Group in Chile. High-dose intravenous methylprednisolone for hantavirus cardiopulmonary syndrome in Chile: a double-blind, randomized controlled clinical trial. Clin Infect Dis 2013; 57 (07) 943-951
  • 23 Vial PA, Valdivieso F, Calvo M. et al; Hantavirus Study Group in Chile. A non-randomized multicentre trial of human immune plasma for treatment of hantavirus cardiopulmonary syndrome caused by Andes virus. Antivir Ther 2015; 20 (04) 377-386
  • 24 Liu R, Ma H, Shu J. et al. Vaccines and therapeutics against hantaviruses. Front Microbiol 2020; 10: 2989
  • 25 Garrido JL, Prescott J, Calvo M. et al. Two recombinant human monoclonal antibodies that protect against lethal Andes hantavirus infection in vivo. Sci Transl Med 2018; 10 (468) eaat6420