hantavirus pulmonary syndrome in babies

  • 10 min read
  • Feb 21, 2020

Hantavirus Pulmonary Syndrome! - By Dr. Radhika A (Md) | Lybrate
Hantavirus Pulmonary Syndrome! – By Dr. Radhika A (Md) | Lybrate

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Hantavirus pulmonary syndrome (HPS) is a contagious disease were reported with a high case-fatality rate, is transmitted to humans by exposure to rodents. Every year, 20-40 HPS cases occurred in the United States; cases in people aged <17 years make up less than 7% of the cases, and cases in children aged <10 years was very rare. CDC received reports of five pediatric cases of HPS occurs for 16 May-25 November 2009, among children aged 6-14 years old from Arizona, California, Colorado, and Washington. Three of the children aged <10 years, and all five have exposure to rats. This report summarizes the five cases, including clinical findings and means the possibility of a hantavirus infection. Thrombocytopenia, elevated white blood cell (WBC) count, and pulmonary infiltrates were observed in all five children; elevated hematocrit was observed in three. One child died, and three of the four children who required mechanical ventilation recovered during hospitalized. HPS physicians should consider in the differential diagnosis for children with acute respiratory distress described, especially if exposure to rodents have recently noted. public health agencies should promote preventive measures, including rodent control in a residential area and a playground, and children should be advised to avoid contact with rodents and areas of infestation.

Case 1

On May 16, the 6-year-old boy who lives in Colorado went to a Texas hospital with a 2 day history of diarrhea and shortness of breath. At the initial examination, the child has cyanotic lips and nail beds, with cold extremities. his pulse was 163, and the body temperature is 101 ° F (38.3 ° C). Soon after arriving at the hospital, the child becomes apnea and had no palpable pulse. Chest compressions has begun, and the child was intubated and ventilated. A chest radiograph revealed bilateral infiltrates, and blood analysis demonstrated increased hematocrit, increased WBC count, and thrombocytopenia (). Within 2 hours of admission to hospital, the child died of apparent heart failure secondary to shock. Child has been treated with intravenous fluids, ceftriaxone, epinephrine, atropine, and albuterol. The diagnosis work at the time of the boy’s death shock and sepsis caused by pneumonia.

An enzyme-linked immunosorbant assay (ELISA) carried out by the Colorado Department of Public Health and the Environment revealed the Sin Nombre hantavirus – specific serum immunoglobulin M (IgM). An environmental assessment carried out in the child’s home in Colorado found rodent droppings and nesting materials under the bed and in the bushes in front of the house where the child was playing.

Case 2

On June 7, a 14-year-olds go to the emergency department of Washington with a 5-day history of shortness of breath, chest pain, cough, and fever. Once inside, the child has a fever of 103 ° F (39.4 ° C), pulse 100, and the breathing rate varied between 40 and 60. He thrombocytopenic and had elevated WBC with atypical lymphocytosis (). A chest radiograph revealed bilateral interstitial infiltrates. No details were given regarding the treatment or suspicion of HPS.

Because of worsening respiratory distress and hypoxia, intubated and mechanically ventilated for approximately 24 hours. He improved and was discharged home on the 13th serum ELISA detected Sin Nombre hantavirus – specific IgM in Washington State Public Health Laboratory. An environmental assessment follow-up found rodent feces contamination in corn container that youths reportedly hand-grinding 8 days before the onset of illness.

Case 3

On July 12, a 6-year-old boy went to the emergency department with a history Colorado 5 days of fever (up to 103 ° F [39.4 ° C]), facial rash erythematous, and myalgia. Having entered the boy pulse was 120, the respiratory rate 48, and oxygen saturation 72% on room air. Dyspnea clear with coarse breath sounds, wheezing and crackles on auscultation. raised WBC count, and thrombocytopenia recorded (). A chest radiograph revealed bilateral diffuse pulmonary infiltrates with pleural effusion. HPS is suspected, and the child was treated with intravenous fluids, ceftri, Axone, and azithromycin

The child was intubated and mechanically ventilated from July 12 to July 20; he was discharged on July 22 Serum ELISA conducted by the Colorado Department of Public Health and the Environment revealed the Sin Nombre hantavirus IgM positive. Family members reported that approximately 10 days prior to hospitalization of children being bitten on the finger by a mouse. During the environmental assessment, evidence of rodent infestation was observed in the outer buildings and abandoned vehicles but not inside the house.

The case 4

On July 12, a 9 year old girl who lives in Arizona goes to New Mexico hospital with chest pain and shortness of breath. Symptoms began with abdominal discomfort on July 6, followed by headache, vomiting, and myalgia. Upon examination, her temperature was 99.9 ° F (37.7 ° C), and the pulse is 162. Laboratory findings included thrombocytopenia, elevated hematocrit, and an increase in WBC count (). A chest radiograph revealed interstitial infiltrates spread. During transport to a tertiary care facility for further treatment, the child’s temperature reaches 103.8 ° F (39.9 ° C). HPS is suspected, and the girl was treated with intravenous fluids, ceftriaxone, and vancomycin.

Because of the worsening signs of pulmonary distress, she was intubated and received artificial lung therapy for 4 days. He remained on a ventilator until July 22 and hospitalized until August 5. Serum was tested with a commercial immunoblot test revealed the Sin Nombre hantavirus immunoglobulin G (IgG). Evidence of rodents found in three residence frequented by girls in Arizona :. Single family homes, grandparents house and summer house where he played in a dugout basement has a hole of rats

Case 5

on 25 November, a teenage boy 13-year-old went to the emergency department with a history California 5 days of fever (maximum 102.6 ° F [39.2 ° C]), cough, vomiting posttussive, diarrhea, and abdominal pain. Physical examination revealed a soft chest, with crackles and decreased breath sounds in the lower lobe of the lung, and respiratory rate of 30. Laboratory findings included an increase in WBC, elevated hematocrit, and thrombocytopenia (). Chest radiography revealed diffuse interstitial opacities with pleural effusion. Treatment includes intravenous fluids, ceftriaxone, clindamycin and azithromycin. Patients receiving oxygen by nasal cannula and was discharged home on December 3rd.

The test for hantavirus requested on the 4th day of hospitalization. Serum submitted to commercial diagnostic laboratories, and Sin Nombre hantavirus antibodies IgM and IgG was detected by immunoblot assay. extensive renovations ongoing home when sick youth, including removal and replacement of floor and wall. Three mice stuck in the kitchen and garage youth about 3 months before the onset of the disease, but the patient had no known direct or indirect contact with rodents

The report by :. C Levy, MS, Arizona Department of Health svcs. K Gain, MS, Land and Environment Southeast, Prowers County; V Crocco, Chaffee County Environmental Health Dept; J Brown, MSN, Prowers County Nursing Svc; E Lawaczeck, DVM, W Ray, M Miller, MS, M Klaber, MS, A Doussette, MS, Colorado Department of Public Health and Environment. C Ralston, Benton-Franklin Health District; N Marsden-Haug, MPH, Washington State Department of Health. C. Fritz, DVM, California Dept. of Public Health. C Watson, MSN, Nevada County Public Health Dept A MacNeil, PhD, J Mills, PhD, PE Rollin, MD, S Nichol, PhD, Special Pathogens Bur, Div of Viral and Disease Rickettsial, National Center for Zoonotic Vector-Borne, and Disease enteric; B KNUST, DVM, EIS Officer, CDC.

HPS was first described in 1993 and has become a national disease * should be reported since 1995. On December 18, 2009, a total of 537 cases of HPS have been reported to CDC, with a case-fatality rate of 36%. Of all the confirmed cases, <7% occurred in children aged <17 years, and only four cases occurred in children aged <10 years, including two children aged 6 years and a 9 year old boy described in this report (four cases in children aged 8 years). Despite reports of HPS in people aged <17 years is rare, clinical disease from pediatric patients in this report are similar to those observed in adults. HPS typically have 2-10 day prodrome with nonspecific symptoms of the virus, and the acute respiratory phase often begins suddenly (2). In all five cases are summarized in this report, children had the disease for 2-6 days before the onset of acute respiratory symptoms. Thrombocytopenia and an increase in the number of WBC was observed in all five cases, and three children had elevated hematocrit; Hematological signs is comparable with a typical HPS in adult patients (3,4). A previous review of 12 cases of pediatric HPS in New Mexico found thrombocytopenia in 100% and an increase in the number of WBC and hemokonsentrasi in 27% of cases (5).

Children infected with hantavirus can develop severe disease, similar to adults. Antivirus has not been proven effective in the treatment of HPS (6); Therefore, medical intervention consists primarily of supportive care. respiratory distress requiring mechanical ventilation was observed in four cases described in this report, similar to the trends observed nationally (4). In case 1, the child died of apparent heart failure secondary to shock. Although tests of heart function can not be obtained, abnormally low cardiac index and stroke volume with an increase in vascular resistance have been reported previously in the case of HPS and considered to be an important cause of death in people with HPS (7). In four cases, patients receiving extracorporeal membrane oxygenation therapy, which may be beneficial for patients who need a good HPS oxygenation and circulatory support (8).

Hantaviruses transmitted from rodent host into humans through inhalation of infectious aerosols of rodent feces or direct inoculation into the damaged skin. In North America, Sin Nombre virus is the most common cause of HPS, and the reservoir is the deer (Peromyscus maniculatus). HPS greatest number of diseases have occurred in the southwestern United States, although cases have been reported in 31 countries. Some rodent species are distributed throughout the United States has been identified as a reservoir for hantaviruses, many of which have been associated with HPS. All patients in this report had evidence of rodents in and around their homes, including places where the patient in case 1 and 4 playable. Patients in the 2 possible cases exposed by hand-grinding corn contaminated; in the case of 5 patients may have been exposed to rodent-contaminated areas or aerosols containing the virus during the renovation of his house. Means the possibility of transmission of hantavirus to the patient in case 3 is a rat bite, previously reported in two pediatric cases (9). There is no evidence of person-to-person transmission of hantavirus in the United States.

When CDC’s recommendations to reduce the risk of hantavirus infection include trapping and does not include rats and using personal protective equipment when handling potentially infected rodents or rodent infestation disturb the area. Recommended cleaning materials including household disinfectant or bleach solution (). rat control programs should include outbuildings and places where children play. educational efforts aimed at parents and children, including how to recognize the signs of rodent infestation and take the proper precautions, it is recommended. Although the reason for the rare occurrence of HPS in children remain unknown, the case in this report serves as a reminder that children are susceptible to hantavirus infection. Further information is available from the CDC.

* A clinical cases of HPS is defined by the CDC as a disease in previously healthy people with an acute febrile respiratory illness and thrombocytopenia, characterized by diffuse bilateral interstitial edema that radiography may mimic acute respiratory distress syndrome, with compromises breathing requiring supplemental oxygen and / or autopsy examination showed noncardiogenic pulmonary edema without an identifiable cause. A confirmed case of hantavirus require specific detection of IgM or IgG, positive reverse transcription – polymerase chain reaction results in a clinical specimen, or the detection of antigens by immunohistochemistry (1).

What is already known about this topic?

Hantavirus pulmonary syndrome (HPS) is a rare but severe disease that can occur after contact with infected rodents or mice-infested area.

What is added by this report?

Despite reports of HPS is rare in children, five pediatric cases in the report confirms that children can suffer severe morbidity and clinical course similar to that of adu, LTS

What are the implications for public health practice

HPS should be considered in children with acute respiratory distress described, especially if exposure to rodent noted ?; preventive measures including rodent control in residential and play areas and teach children to avoid contact with rodents or infestation area.

TABLE. Cases of hantavirus pulmonary syndrome, the selected patient and clinical characteristics of the four countries — 2009

characteristics

Case 1

Case 2 < p> Case 3

The case 4

Case 5

State of residence

Colorado

Washington

Colorado

Arizona

California

the patient’s age (years)

6

14

6

9

13

The day of disease onset to hospital

2

5

5

6

5

Days in hospital

1

6

11

25

8

The number of white blood cells, the maximum (x 109 / L) (reference range : 4 –11 x 109 / L)

57

25

15

38

27

hematocrit maximum (%) (reference range *: male, 36% – 47%; women, 35% – 45%)

55

39

33

52

63

Minimum platelets (x 109 / L) (reference range: 150-400 x 109 / L)

40

19

56

24

39

X-rays to infiltrate

Yes

Yes

Yes

Yes < / p>

Yes

Result

Dead

Fully recovered

Fully recovered

Fully recovered

Fully recovered

* for people aged 10 –18 years.

The use of trade names and commercial sources for the identification and does not imply endorsement by the US Department of
Health and Human Services.

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This conversion may result in character translation or format errors in the HTML version.
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The Government Printing Office (GPO), Washington, DC 20402-9371;
phone: (202) 512-1800. , Contact GPO for current prices

Date last reviewed: 12/23/2009

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