HANTAVIRUS-PULMONARY-SYNDROME - THE 4 CORNERS DISEASE

OBJECTIVE: To review the epidemiology, pathogenesis, clinical features , diagnosis, and treatment of hantavirus infections, focusing on the r ecent outbreak of hantavirus pulmonary syndrome in the US. DATA SOURCE S: A MEDLINE search (1966 to present) of English language literature p ertaining to hantaviruses was performed. Additional literature was obt ained from reference lists of pertinent articles identified through th e search. STUDY SELECTION AND DATA EXTRACTION: All articles were consi dered for possible inclusion in the review. Pertinent information, as judged by the authors, was selected for discussion. DATA SYNTHESIS: He morrhagic fever with renal syndrome (HFRS) has long been recognized in Eurasia and is the predominant disease manifestation of hantavirus in fection worldwide. Hantavirus pulmonary syndrome (HBS) recently has be en described in the US and exhibits greater pulmonary involvement and mortality than HFRS. Historically, 4 hantavirus serotypes (Hantaan, Se oul, Puumala, Prospect Hill) are recognized; however, additional serot ypes have been proposed as distinct serogroups, including the serotype responsible for HPS in the Four Comers area: the Four Comers virus (F CV). Phylogenetic analysis shows that FCV is most closely related to P rospect Hill virus, another hantavirus previously isolated in the US t hat has not yet been identified with human disease. Additional hantavi rus serotypes isolated in the US may provide insight into the prevalen ce of hantavirus infection and disease in this country. Inhalation of aerosolized virus is the predominant mechanism of hantavirus infection . Diagnosis is based primarily on clinical findings and serologic evid ence of hantavirus antibody or direct evidence in clinical tissue spec imens. Limited clinical studies evaluating ribavirin as a therapeutic modality demonstrated that the agent improves clinical outcome in HFRS . However, the role of ribavirin in the treatment of HPS remains to be determined. CONCLUSIONS: Hantavirus infections are becoming increasin gly recognized as a cause of disease worldwide. Recognition of hantavi rus disease in the US suggests enzoonosis of pathogenic hantaviruses. In the absence of a well-established cure, early diagnosis is imperati ve so that aggressive supportive care can be initiated.