What are the clinical manifestations of Hantavirus pulmonary syndrome (HPS)?

Updated: Mar 24, 2021
  • Author: Zab Mosenifar, MD, FACP, FCCP; Chief Editor: John J Oppenheimer, MD  more...
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Hantavirus pulmonary syndrome (HPS) has an incubation period of 9-35 days.

HPS is characterized by four clinical phases, as follows:

  • Prodrome

  • Noncardiogenic pulmonary edema/adult respiratory distress syndrome and shock

  • Diuresis

  • Convalescence

Fever and myalgia are prominent in almost all phases and precede the onset of respiratory symptoms by 1-10 days. Cough and upper respiratory symptoms are uncommon, in contrast to many of the other viral prodromes to pneumonia. These patients often complain of severe back and hip pain, and they develop nausea, vomiting, abdominal pain, and diarrhea. Dry cough and shortness of breath herald the development of pulmonary edema.

Onset and rapid progression of cough, shortness of breath, fever, and hypotension herald the cardiopulmonary phase of the disease. Progressive pulmonary edema and respiratory failure can occur in 80-90% of patients within two days of hospitalization. The interval between the onset of dyspnea and respiratory failure requiring ventilatory support may be a few hours. The earliest indication is hypoxemia.

In addition to the rapidly progressive, fulminant, and often fatal form of HPS, there is also a limited, less severe form associated with mild interstitial edema and minimal airspace disease.

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