CLINICAL-FEATURES THAT DIFFERENTIATE HANTAVIRUS PULMONARY SYNDROME FROM 3 OTHER ACUTE RESPIRATORY ILLNESSES

To elucidate the early clinical characteristics of hantavirus pulmonar y syndrome (HPS), we compared the clinical features of 24 cases of HPS with those of cases of bacteremic pneumococcal pneumonia(n = 30), inf luenza (n = 33), or unexplained adult respiratory distress syndrome (A RDS, n = 21). On admission, patients with HPS were less likely than ou tpatients with influenza to have reported sore throat (OR = 0.02, P < .01) and cough (OR = 0.1, P = .01) and were less likely than patients with pneumococcal pneumonia to have lobar infiltrates detected by ches t roentgenography (OR = 0, P < .01). Multivariate discriminant analysi s revealed that three clinical characteristics at admission (dizziness , nausea or vomiting, and absence of cough) and three initial laborato ry abnormalities (low platelet count, low serum bicarbonate level, and elevated hematocrit level) served to identify all patients with HPS a nd to exclude HPS in at least 80% of patients with unexplained ARDS. T hese findings warrant further study and should facilitate the early re cognition of patients with HPS, who may benefit from early critical-ca re intervention.