Hantavirus pulmonary syndrome in the Americas: The early years

The initial recognition of hantavirus pulmonary syndrome (HPS) as a new dis ease associated with a cluster of acute respiratory deaths among American I ndians in the southwestern United States in 1993 bears little resemblance t o the current understanding of this syndrome. HPS is now recognized as a zo onotic disease that has been endemic throughout the Americas for at least 4 0 years and that is closely linked to population densities and virus dynami cs among a specific subfamily of rodents. The classic disease description h as also been markedly broadened to include a spectrum of illness that range s from asymptomatic infection to fulminate cardiorespiratory failure. Clini cal variants with hemorrhagic or prominent renal manifestations have also b een recognized, Prevention efforts have been targeted at minimizing peri-do mestic contact with rodents and their excreta and improving clinical recogn ition of infection. This paper describes the pathogenesis underlying the pr ofound cardiorespiratory compromise, person-to-person transmission reported in South America, and viable treatment modalities.