Hantavirus pulmonary syndrome

A clinical description of 17 patients with a newly recognized disease

Jeffrey S. Duchin, Frederick T. Koster, C. J. Peters, Gary L. Simpson, Bruce Tempest, Sherif R. Zaki, Thomas Ksiazek, Pierre E. Rollin, Stuart Nichol, Edith T. Umland, Ronald L. Moolenaar, Susan E. Reef, Kurt B. Nolte, Margaret M. Gallaher, Jay C. Butler, Robert F. Breiman

Research output: Contribution to journalArticle

508 Citations (Scopus)

Abstract

Background. In May 1993 an outbreak of severe respiratory illness occurred in the southwestern United States. A previously unknown hantavirus was identified as the cause. In Asia hantaviruses are associated with hemorrhagic fever and renal disease. They have not been known as a cause of human disease in North America. Methods. We analyzed clinical, laboratory, and autopsy data on the first 17 persons with confirmed infection from this newly recognized strain of hantavirus. Results. The mean age of the patients was 32.2 years (range, 13 to 64); 61 percent were women, 72 percent were Native American, 22 percent white, and 6 percent Hispanic. The most common prodromal symptoms were fever and myalgia (100 percent), cough or dyspnea (76 percent), gastrointestinal symptoms (76 percent), and headache (71 percent). The most common physical findings were tachypnea (100 percent), tachycardia (94 percent), and hypotension (50 percent). The laboratory findings included leukocytosis (median peak cell count, 26,000 per cubic millimeter), often with myeloid precursors, an increased hematocrit, thrombocytopenia (median lowest platelet count, 64,000 per cubic millimeter), prolonged prothrombin and partial-thromboplastin times, an elevated serum lactate dehydrogenase concentration, decreased serum protein concentrations, and proteinuria. Rapidly progressive acute pulmonary edema developed in 15 of the 17 patients (88 percent), and 13 patients, all of whom had profound hypotension, died (case fatality rate, 76 percent). Increases in the hematocrit and partial- thromboplastin time were predictive of death. Conclusions. Infection with a newly described hantavirus causes the hantavirus pulmonary syndrome, which is characterized by a brief prodromal illness followed by rapidly progressive, noncardiogenic pulmonary edema.

Original languageEnglish (US)
Pages (from-to)949-955
Number of pages7
JournalNew England Journal of Medicine
Volume330
Issue number14
DOIs
StatePublished - Apr 7 1994
Externally publishedYes

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Hantavirus Pulmonary Syndrome
Hantavirus
Partial Thromboplastin Time
Pulmonary Edema
Hematocrit
Hypotension
Fever
Southwestern United States
Prodromal Symptoms
Tachypnea
North American Indians
Myalgia
Leukocytosis
Prothrombin
North America
Infection
Platelet Count
Proteinuria
L-Lactate Dehydrogenase
Hispanic Americans

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Duchin, J. S., Koster, F. T., Peters, C. J., Simpson, G. L., Tempest, B., Zaki, S. R., ... Breiman, R. F. (1994). Hantavirus pulmonary syndrome: A clinical description of 17 patients with a newly recognized disease. New England Journal of Medicine, 330(14), 949-955. https://doi.org/10.1056/NEJM199404073301401

Hantavirus pulmonary syndrome : A clinical description of 17 patients with a newly recognized disease. / Duchin, Jeffrey S.; Koster, Frederick T.; Peters, C. J.; Simpson, Gary L.; Tempest, Bruce; Zaki, Sherif R.; Ksiazek, Thomas; Rollin, Pierre E.; Nichol, Stuart; Umland, Edith T.; Moolenaar, Ronald L.; Reef, Susan E.; Nolte, Kurt B.; Gallaher, Margaret M.; Butler, Jay C.; Breiman, Robert F.

In: New England Journal of Medicine, Vol. 330, No. 14, 07.04.1994, p. 949-955.

Research output: Contribution to journalArticle

Duchin, JS, Koster, FT, Peters, CJ, Simpson, GL, Tempest, B, Zaki, SR, Ksiazek, T, Rollin, PE, Nichol, S, Umland, ET, Moolenaar, RL, Reef, SE, Nolte, KB, Gallaher, MM, Butler, JC & Breiman, RF 1994, 'Hantavirus pulmonary syndrome: A clinical description of 17 patients with a newly recognized disease', New England Journal of Medicine, vol. 330, no. 14, pp. 949-955. https://doi.org/10.1056/NEJM199404073301401
Duchin, Jeffrey S. ; Koster, Frederick T. ; Peters, C. J. ; Simpson, Gary L. ; Tempest, Bruce ; Zaki, Sherif R. ; Ksiazek, Thomas ; Rollin, Pierre E. ; Nichol, Stuart ; Umland, Edith T. ; Moolenaar, Ronald L. ; Reef, Susan E. ; Nolte, Kurt B. ; Gallaher, Margaret M. ; Butler, Jay C. ; Breiman, Robert F. / Hantavirus pulmonary syndrome : A clinical description of 17 patients with a newly recognized disease. In: New England Journal of Medicine. 1994 ; Vol. 330, No. 14. pp. 949-955.
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abstract = "Background. In May 1993 an outbreak of severe respiratory illness occurred in the southwestern United States. A previously unknown hantavirus was identified as the cause. In Asia hantaviruses are associated with hemorrhagic fever and renal disease. They have not been known as a cause of human disease in North America. Methods. We analyzed clinical, laboratory, and autopsy data on the first 17 persons with confirmed infection from this newly recognized strain of hantavirus. Results. The mean age of the patients was 32.2 years (range, 13 to 64); 61 percent were women, 72 percent were Native American, 22 percent white, and 6 percent Hispanic. The most common prodromal symptoms were fever and myalgia (100 percent), cough or dyspnea (76 percent), gastrointestinal symptoms (76 percent), and headache (71 percent). The most common physical findings were tachypnea (100 percent), tachycardia (94 percent), and hypotension (50 percent). The laboratory findings included leukocytosis (median peak cell count, 26,000 per cubic millimeter), often with myeloid precursors, an increased hematocrit, thrombocytopenia (median lowest platelet count, 64,000 per cubic millimeter), prolonged prothrombin and partial-thromboplastin times, an elevated serum lactate dehydrogenase concentration, decreased serum protein concentrations, and proteinuria. Rapidly progressive acute pulmonary edema developed in 15 of the 17 patients (88 percent), and 13 patients, all of whom had profound hypotension, died (case fatality rate, 76 percent). Increases in the hematocrit and partial- thromboplastin time were predictive of death. Conclusions. Infection with a newly described hantavirus causes the hantavirus pulmonary syndrome, which is characterized by a brief prodromal illness followed by rapidly progressive, noncardiogenic pulmonary edema.",
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AU - Tempest, Bruce

AU - Zaki, Sherif R.

AU - Ksiazek, Thomas

AU - Rollin, Pierre E.

AU - Nichol, Stuart

AU - Umland, Edith T.

AU - Moolenaar, Ronald L.

AU - Reef, Susan E.

AU - Nolte, Kurt B.

AU - Gallaher, Margaret M.

AU - Butler, Jay C.

AU - Breiman, Robert F.

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N2 - Background. In May 1993 an outbreak of severe respiratory illness occurred in the southwestern United States. A previously unknown hantavirus was identified as the cause. In Asia hantaviruses are associated with hemorrhagic fever and renal disease. They have not been known as a cause of human disease in North America. Methods. We analyzed clinical, laboratory, and autopsy data on the first 17 persons with confirmed infection from this newly recognized strain of hantavirus. Results. The mean age of the patients was 32.2 years (range, 13 to 64); 61 percent were women, 72 percent were Native American, 22 percent white, and 6 percent Hispanic. The most common prodromal symptoms were fever and myalgia (100 percent), cough or dyspnea (76 percent), gastrointestinal symptoms (76 percent), and headache (71 percent). The most common physical findings were tachypnea (100 percent), tachycardia (94 percent), and hypotension (50 percent). The laboratory findings included leukocytosis (median peak cell count, 26,000 per cubic millimeter), often with myeloid precursors, an increased hematocrit, thrombocytopenia (median lowest platelet count, 64,000 per cubic millimeter), prolonged prothrombin and partial-thromboplastin times, an elevated serum lactate dehydrogenase concentration, decreased serum protein concentrations, and proteinuria. Rapidly progressive acute pulmonary edema developed in 15 of the 17 patients (88 percent), and 13 patients, all of whom had profound hypotension, died (case fatality rate, 76 percent). Increases in the hematocrit and partial- thromboplastin time were predictive of death. Conclusions. Infection with a newly described hantavirus causes the hantavirus pulmonary syndrome, which is characterized by a brief prodromal illness followed by rapidly progressive, noncardiogenic pulmonary edema.

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