Hantavirus Pulmonary Syndrome, Renal Insufficiency, and Myositis Associated with Infection by Bayou Hantavirus

Abstract

Hantaviruses are etiologic agents of hemorrhagic fever with renal syndrome, an acute illness characterized by acute renal insufficiency, proteinuria, and hemodynamic instability. Recently, a New World form of hantavirus disease, hantavirus pulmonary syndrome (HPS), was recognized; in this form, pulmonary edema is prominent, but renal insufficiency is generally lacking. HPS cases from the southeastern United States may be exceptional in that they have exhibited both pulmonary and renal manifestations. One case in Louisiana and one case in Florida were linked to infection by the distinct but closely related Bayou and Black Creek Canal hantaviruses, respectively. We report a nonfatal case of HPS caused by Bayou hantavirus that occurred in eastern Texas. Clinical manifestations included pulmonary and renal insufficiency and myositis, which had previously been observed in the patient from Florida. The occurrence of distinctive clinical abnormalities in HPS cases from the southeastern United States supports the concept that there are clinically significant differences between western and southeastern forms of HPS.

Hantaviroses

“…A morte pode ocorrer poucas horas após o início da falência respiratória, mesmo em indivíduos ventilados precocemente; alguns pacientes, entretanto, passam dias, ou mesmo semanas, sob ventilação mecânica, muitos dos quais recuperam-se sem qualquer sequela 2 20 . O envolvimento de outros órgãos na evolução dessa doença pode ocorrer; na infecção causada pelo vírus Bayou, isolado no Texas, além do edema pulmonar, observou-se a presença de insuficiência renal e miosite, esta comprovada pela grande elevação dos níveis de creatinofosfoquinase 24 .…”

Socio-ecology of the marsh rice rat (Oryzomys palustris) and the spatio-temporal distribution of Bayou virus in coastal Texas

“…Unlike P. maniculatus, O. palustris normally does not invade human dwellings or co-habit with humans; rather, its behavioural ecology is one of a semi-aquatic, solitary species. Its riparian marsh-grassland as opposed to suburbia occupancy is likely one reason why BAYV occurrence in humans has remained low; however, it is possible that at least some HPS cases caused by BAYV are misdiagnosed and therefore underreported, as the complex symptoms of BAYV-HPS can involve multiple body systems either sequentially or simultaneously (Hjelle et al, 1996). For the handful of BAYV-HPS cases identified clinically, there is insufficient evidence to determine whether or not infections were acquired through occupational or recreational exposure to O. palustris and/or their excreta.…”

“…For the handful of BAYV-HPS cases identified clinically, there is insufficient evidence to determine whether or not infections were acquired through occupational or recreational exposure to O. palustris and/or their excreta. Nevertheless, among BAYV-HPS patients, two noticeable commonalities are outdoor activities (near permanent water and dense grasses) during which large amounts of airborne dirt were inhaled repeatedly over time, and also fishing in areas with household refuse and visible rodents (Hjelle et al, 1996;Torrez-Martinez et al, 1998). Minimally, Gulf Coast fishermen and landfill laborers could be at particular risk in areas where their activities fall within the habitat range and preferences of O. palustris (Wolfe, 1982(Wolfe, , 1985McIntyre et al, 2009).…”

Hantaviruses as emergent zoonoses

“…The involvement of other organs in the disease evolution may be due to Bayou virus, isolated in Texas, which evolves, in addition to pulmonary edema, renal failure and myositis (14). Bleeding has been rarely reported in these cases, but there are changes in clotting, which does not lead, however to disseminated intravascular coagulation (27).…”