Infection with Sin Nombre hantavirus: Clinical presentation and outcome inchildren and adolescents

Objective. Sin Nombre hantavirus (SNV) is the leading causative agent of ha ntavirus cardiopulmonary syndrome (HCPS) in the United States and Canada. R elatively few cases of HCPS have involved children. This report describes t he clinical characteristics of a series of pediatric cases of SNV infection in the United States and Canada from 1993 through March 2000. Methods. We analyzed clinical and laboratory data on 13 patients who were l ess than or equal to 16 years old with SNV infection from 1993 through Marc h 2000 identified from a database at the University of New Mexico. Results. The patients ranged from 10 to 16 years of age, with a median of 1 4. Fifty-four percent were female. Fifty-four percent were Native American. The most common prodromal symptoms were fever, headache, and cough or dysp nea (100%); nausea or vomiting (90%); and myalgia (80%). The most common ph ysical findings at admission were tachypnea (67%) and fever (56%); hypotens ion was seen in 33% of patients. On admission, all patients manifested thro mbocytopenia (median platelet count: 67000/mm(3)) and elevated lactate dehy drogenase (median level: 1243 IU/L), and >85% of patients had elevated leve ls of serum aspartate aminotransferase, alanine aminotransferase, and hypoa lbuminemia. Leukocytosis and hemoconcentration were seen in less than one t hird of patients at admission. HCPS developed in 12 of the 13 patients (92% ), and 4 of those 12 died (33% case-fatality ratio). The majority of HCPS p atients (8 of 12 [67%]) were critically ill and required mechanical ventila tion. Extracorporeal membrane oxygenation was used in 2 patients, 1 of whom survived. An elevated prothrombin time (greater than or equal to 14 second s) at admission was predictive of mortality. Conclusions. Infection with SNV in children and adolescents causes HCPS wit h a clinical course and mortality rate similar to that described in adults. We believe that early recognition of HCPS in children and adolescents and appropriate referral to tertiary care centers that are experienced with HCP S are important in reducing mortality.