In May 1993, a pulmonary disease syndrome with novel clinical and epidemiologic features was identified in the southwestern United States. Healthy young adults developed a febrile prodrome followed by the rapid onset of often lethal acute respiratory distress. Although an infectious disease was suspected, intensive investigations initially failed to identify the causative agent. Multiple specialized microbiology laboratories in a national reference center applied classic serologic and culture methods as well as recently developed molecular biological techniques to samples collected from field investigations of the patients. Serologic tests detected the presence of an active immune response to a hantavirus. Reverse transcription and polymerase chain reaction amplification of RNA extracted from human tissues used primers designed from sequences of known hantaviruses to demonstrate genomic sequences of a novel hantavirus. Immunohistochemistry showed the presence of hantavirus antigens in the endothelium of lung tissues from patients and provided a final pathogenetic link to this group of viruses. These methods were concordantly positive in virtually all samples available from 18 patients with compatible clinical histories identified between January and July 1993. Tests of control subjects and searches for other agents in identified cases were negative. A newly recognized hantavirus causes a novel syndrome of acute pulmonary edema and shock; the pathogenesis is related to the presence of virus antigens in the pulmonary capillaries. This virus may be an important cause of severe and fatal disease presenting as adult respiratory distress syndrome in otherwise healthy persons. The Centers for Disease Control in collaboration with state and local health departments has begun a national surveillance program to determine the incidence of this newly described disease and is coordinating longitudinal and wider geographic studies of the natural history virus-rodent relationship.
- Emerging disease
- Hantavirus pulmonary syndrome
- Peromyscus maniculatus
ASJC Scopus subject areas
- Infectious Diseases