title: Hantavirus pulmonary syndrome: a clinical description of 17 patients with a newly recognized disease. The Hantavirus Study Group.
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.
authors.affiliation: Childhood and Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333.
authors.forename: J S
authors.initials: JS
authors.lastname: Duchin
authors.forename: F T
authors.initials: FT
authors.lastname: Koster
authors.forename: C J
authors.initials: CJ
authors.lastname: Peters
authors.forename: G L
authors.initials: GL
authors.lastname: Simpson
authors.forename: B
authors.initials: B
authors.lastname: Tempest
authors.forename: S R
authors.initials: SR
authors.lastname: Zaki
authors.forename: T G
authors.initials: TG
authors.lastname: Ksiazek
authors.forename: P E
authors.initials: PE
authors.lastname: Rollin
authors.forename: S
authors.initials: S
authors.lastname: Nichol
authors.forename: E T
authors.initials: ET
authors.lastname: Umland
mesh_terms: D000293:Adolescent; D000328:Adult; D002044:Bunyaviridae Infections / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D004196:Disease Outbreaks; D005260:Female; D006476:Orthohantavirus; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D015206:Southwestern United States / Q000453:epidemiology; D013577:Syndrome