So, because it is probably freshest
in people's memories,
we'll talk about the hantaviruses first.
So keeping in mind, again, inhalation
of infected rodent urine or feces
is the mechanism of exposure to this.
The mortality for these and perhaps
why it is so fixed in our minds,
the mortality is significant. It's at least
half of the patients, up to 50%.
Hantavirus causes 2 very severe illnesses:
pulmonary syndrome and hemorrhagic
And why or how one patient gets
one versus the other,
probably has to do with their
but also, the tropism of the virus.
Does it primarily affect
pulmonary tissue, or does it primarily
affect endothelial or vascular tissue?
For hantavirus pulmonary syndrome,
incubation is 1-3 weeks,
but for hemorrhagic fever, it may be
all the way up to 6 weeks,
depending on viral load of the exposure.
Diagnosis with both can be PCR,
but the further out one gets from
the less likely one is to find RNA which
is detected by that PCR.
So, in hantavirus hemorrhagic fever,
we look for a 4-fold rise in immunoglobulin
especially if one can do acute and
convalescence serology testing.
Clinical manifestations are
different, of course.
Hantavirus pulmonary syndromes starts
with that flu-like illness,
which we talked about,
followed by a sudden onset
of respiratory failure.
And we're not just talking a little
shortness of breath,
but feeling a bit like, "I can't
catch my breath,"
and then rapidly evolving pulmonary edema.
The one patient that I've managed
was a 19-year-old young man
who acquired this from sweeping
up a closet up in upstate Arizona,
and he describes exactly that. One minute,
he's feeling just a little flu-like,
and the next minute he was
gasping for breath.
It makes sense if there's a sudden
release of pulmonary edema.
In hantavirus hemorrhagic fever,
the flu-like illness is followed, then,
by intense headaches,
severe myalgias, especially back
and abdominal pain,
along with nausea. And then the
patients a rapidly progressive --
experience a rapidly progressive low
blood pressure with acute shock,
vascular leakage, the hemorrhage
that we talked about,
and then not just acute kidney failure,
but in fact, multi organ failure.
So, as you can imagine, at that process,
similar to other hemorrhagic fever viruses
that we've talked about in other sessions,
Ebola virus, Lassa fever virus,
the mortality can be really quite high.