Cardiopulmonary manifestations of hantavirus pulmonary syndrome.
OBJECTIVE
To describe the clinical characteristics of a group of patients infected with the newly recognized hantavirus in the Southwestern United States.


METHODS
Case series.


METHODS
Tertiary referral center.


METHODS
All patients with confirmed hantavirus infection admitted to the University of New Mexico Hospital between May 1, 1993 and January 1, 1994.


METHODS
Records of patients with hantavirus infection were reviewed to collect all pertinent clinical data.


RESULTS
Pulmonary disease in these patients was characterized by hypoxemia covering a wide range of severity. The cause of hypoxemia was an increased permeability (noncardiac) pulmonary edema which could be differentiated from hydrostatic (cardiac) pulmonary edema by its association with low pulmonary artery occlusion pressures and increased protein content of edema fluid. Hemodynamic measurements in severe cases showed a shock state characterized by a low cardiac index (range 1.6 to 3.0 L/min/min2), a low stroke volume index (range 10.5 to 29 mL/m2), and high systemic vascular resistance index (range 1,653 to 2,997 dyne.sec/cm5.m2). Progression to death was associated with worsening cardiac dysfunction unresponsive to treatment and causing oxygen debt and lactic acidosis.


CONCLUSIONS
The two major life-threatening pathophysiologic changes in Hantavirus Pulmonary Syndrome are increased permeability pulmonary edema, and an atypical form of septic shock caused by myocardial depression and hypovolemia.
Hallin
G W
GW
Department of Medicine, University of New Mexico Hospital, Albuquerque 87131, USA.
Simpson
S Q
SQ
Crowell
R E
RE
James
D S
DS
Koster
F T
FT
Mertz
G J
GJ
Levy
H
H
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D005260:Female; D018804:Hantavirus Pulmonary Syndrome / Q000150:complications* / Q000401:mortality / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D000860:Hypoxia / Q000821:virology; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000821:virology*; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000821:virology*; D015996:Survival Rate