Hantavirus Pulmonary Syndrome in Pregnancy

Abstract

This comprehensive case review of hantavirus pulmonary syndrome (HPS) during pregnancy in 5 women characterizes the effect of Sin Nombre virus infection on maternal and fetal outcomes. Histopathologic, serological, and clinical information were evaluated for evidence of vertical transmission. Maternal ages ranged from 20 to 34 years and gestational ages from 13 to 29 weeks. Symptoms, physical findings, and laboratory values other than those related to pregnancy were not noticeably different from those of nonpregnant patients with HPS, although fevers were somewhat lower. One maternal death and 2 fetal losses occurred. Gross, microscopic, and immunohistochemical examination for hantavirus antigen were done on 2 fetal autopsies and 3 placentas showing no evidence of transplacental hantavirus transmission. There was no serological evidence of conversion in the 3 surviving children. Maternal and fetal outcomes of HPS appear similar to those of nonpregnant HPS patients and of pregnant patients with other causes of acute respiratory distress syndrome. No evidence of vertical transmission of Sin Nombre virus was found.

Hantavirus infections by Puumala or Dobrava-Belgrade virus in pregnant women

“…1 This might explain why we have not found severe consequences on the course of pregnancy. In agreement with the comprehensive study in pregnant women infected by North-American SNV 16 we found no evidence for vertical virus transmission for European hantaviruses.…”

“…Interestingly, maternal hantavirus diseases has been initially misdiagnosed as HELLP syndrome in patient P.H. Some reports were published in the available literature describing PUUV, 6,10-12 DOBV, 9 Sin Nombre virus (SNV), 15,16 Hantaan virus (HTNV), [17][18][19] and undifferentiated hantavirus infections 20 in pregnancy. In all cases the pregnant women had serious clinical courses, one died from SNV infection 16 (see below).…”

“…Three other women who were HTNV-infected early in the third trimester of gestation did not achieve full-term pregnancy resulting either in foetal loss, preterm birth with neonatal death, or preterm delivery by Caesarean section. 17 In the most comprehensive study from North America including 5 SNV-infected women 16 with one maternal and 2 foetal deaths, microscopic and immunohistochemical examination for hantavirus antigen was performed on all three placenta tissues and both foetal autopsies but without any evidence of vertical hantavirus transmission. Moreover, there was no serological evidence of SNV infection in the 3 surviving children.…”

Premier cas de fièvre hémorragique avec syndrome rénal au cours de la grossesse en France

“…L'impact de la grossesse au cours de cette infection est difficile à établir du fait de la faible fréquence de cette association. Cependant, l'état physiologique et immunologique de la grossesse ne semble entraîner que peu de variations dans la présentation clinique et l'évolution de la maladie [8].…”

“…La recherche par RT-PCR de l'ARN viral et les examens sérologiques (recherche d'immunoglobulines M anti-Hantavirus sériques de l'enfant ou sur le sang de cordon) confirment parfois la transmission maternofoetale du virus [1]. Les examens macroscopiques et microscopiques du placenta et l'immunohistochimie testant l'antigène de l'Hantavirus sur les tissus foetaux et placentaires ne confirment qu'exceptionnellement l'infection par le virus [8,10]. Il n'y a aucune donnée dans la littérature concernant l'éventualité d'un diagnostic anténatal dans ce contexte.…”