Chapter 96 : Hantaviruses

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Hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS) are rodent-borne zoonoses caused by certain members of the virus family , genus . Both syndromes are characterized by a febrile prodrome, thromobocytopenia, leakage of fluid from capillaries, and shock. Early diagnosis is critical to the successful management of HFRS and HPS, and—in the case of HPS caused by Andes virus—implementation of appropriate isolation procedures to prevent virus transmission to health care providers. Laboratory assays for evidence of hantaviral infections in HFRS cases and HPS cases during the acute phase of illness should include μ-capture enzyme-linked immunosorbent assay (ELISA) for anti-hantavirus IgM, ELISA for anti-hantavirus IgG, and RT-PCR assays for hantaviral RNA. Immunohistochemistry assays for hantaviral antigens in lung and other solid tissues often reveal widespread infection in the endothelium of the microvasculature. The results of assays for hantaviral RNA should be supported by the results of tests for hantavirus-specific antibodies or antigen. The proper controls for μ-capture ELISA, IgG ELISA, and immunohistochemistry assays are essential for correct interpretation of the results of these assays. Local laboratories usually do not have direct access to these materials. Thus, diagnostic testing is often limited to federal laboratories, reference laboratories, and a small number of commercial laboratories. Recovery from severe disease is absolutely dependent upon carefully managed supportive care, in particular the judicious administration of intravenous fluids during the hypotensive phase in HFRS and the cardiopulmonary phase in HPS.

Citation: Fulhorst C, Bowen M. 2015. Hantaviruses, p 1660-1668. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch96
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Electron micrograph of negatively stained Sin Nombre virus (2% phosphotungstic acid stain, pH 6.5). Courtesy of Charles Humphrey, Centers for Disease Control and Prevention. doi:10.1128/9781555817381.ch96.f1

Citation: Fulhorst C, Bowen M. 2015. Hantaviruses, p 1660-1668. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch96
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Image of FIGURE 2

Photomicrograph of human lung tissue showing hantaviral antigen in pulmonary microvasculature, with hantaviral antigen stained in red by using immunohistochemistry. Courtesy of Sherif Zaki, Centers for Disease Control and Prevention. doi:10.1128/9781555817381.ch96.f2

Citation: Fulhorst C, Bowen M. 2015. Hantaviruses, p 1660-1668. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch96
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Hantaviral species associated with human disease

Citation: Fulhorst C, Bowen M. 2015. Hantaviruses, p 1660-1668. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch96

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