Hantavirus Disease and COVID-19

Evaluation of the Hantavirus 5-Point Screen in 139 COVID-19 Patients

Allison K. Joyce, MSc; Tarrah T. Oliver; Aaron D. Kofman, MD; Donna L. Talker; Shahrokh Safaeian; Deniz Peker Barclift, MD; Adam J. Perricone, MD, PhD; Shawn M. D'Andrea, MD; Amy N. Whitesell, MPH; Del Yazzie, MPH; Jeannette Guarner, MD; Mozafar Saleki, MS; Glynnis B. Ingall, MD, PhD; Mary J. Choi, MD; Ramona Antone-Nez, MPH

Disclosures

Am J Clin Pathol. 2022;157(3):470-475. 

In This Article

Results

A total of 143 participants were enrolled in the project, 72 at TMC and 71 at Emory. Three individuals from TMC were later excluded from the analysis because their COVID-19 molecular tests were negative at the time of their sample collection for the screen. One individual from Emory was excluded from the analysis because their peripheral blood smear was uninterpretable. These exclusions resulted in 139 participants included in the project. At TMC, 69 screens were done on 69 unique individuals. Of these, 18 had an additional platelet count performed on a sample that was collected within 12 to 24 hours of the initial screen. At Emory, 70 screens were done on 70 unique individuals. Of these, 13 had an additional platelet count performed on a sample that was collected within 12 to 24 hours of the initial screen.

The two populations differed across demographics, comorbidities, clinical presentation, and outcome Table 1. The sex distribution was similar at both sites, with 50% male at TMC and 56% male at Emory. Age and race differed between the two populations. The TMC cohort was 100% American Indian and had a mean age of 53 years. Emory represented a slightly older (mean age, 61 years), largely African American (85%) population. The significant differences in comorbidities between the two groups were as follows: patients seeking treatment at TMC were more likely to be obese (63% vs 44% at Emory) and have preexisting liver disease (15% vs 0% at Emory). The Emory cohort had higher rates of hypertension (61% vs 42% at TMC), lung disease (17% vs 3% at TMC), and kidney disease (21% vs 2% at TMC). With regards to clinical presentation at the time of sample collection, 87% of participants at TMC had respiratory symptoms. In the Emory cohort, 76% of participants had respiratory symptoms at the time of presentation. In the TMC cohort, 46% of individuals had an oxygen saturation less than 90%, compared with 12% at Emory. However, individuals at Emory were more likely to be treated with invasive ventilation (41% vs 20% at TMC), and one individual received ECMO.

The scores received on the hantavirus 5-point screen differed slightly between the two groups Figure 1. The mean score from 69 individuals from TMC was 1.48 (median, 1.00; range, 1.00–4.00). The mean score from 70 individuals from Emory was 2.00 (median, 2.00; range, 0.00–4.00). None of the 139 individuals in the project positive for COVID-19 received a score of 5 on the hantavirus 5-point screen. One individual at TMC and two individuals at Emory received a score of 4. The individual from TMC had thrombocytopenia, elevated hemoglobin/hematocrit, a left shift on neutrophils, and absence of significant toxic granulation of the neutrophils. The two individuals from Emory had thrombocytopenia, a left shift on neutrophils, absence of significant toxic granulation of the neutrophils, and immunoblasts and plasma cells more than 10% of lymphoid cells. For the individual at TMC, it was believed their clinical presentation was not consistent with hantavirus, and therefore hantavirus serologies were not sent. Hantavirus serologies were also not sent for the two individuals at Emory, as hantavirus is not endemic to Georgia and the individuals had not recently traveled. Statistical tests were done to compare the average score each cohort of the patients with COVID-19 received on the screen to a hypothesized value of 4, which would indicate high risk for HCPS. A one-sample sign test was done for the skewed TMC population, and a one-sample t test was done for the normally distributed Emory population. Both statistical tests returned a P value less than .0001, indicating very strong statistical evidence that the score patients with COVID-19 receive on the hantavirus screen is different from the score patients with HCPS receive.

Figure 1.

Hantavirus 5-point screen score frequencies from two populations of patients with coronavirus disease 2019.

There were several notable differences in the criteria met on the screen between TMC and Emory Figure 2. The most common criterion of the screen met at both institutions was absence of significant toxic granulation, seen in 100% of individuals at TMC and 80% at Emory. Thrombocytopenia was seen in 30% of both cohorts. Elevated hemoglobin and hematocrit were rarely seen in either cohort, with 4% at TMC and 0% at Emory. The TMC cohort demonstrated fairly low rates of the remaining two criteria: with 7% of participants having left shift and 3% having immunoblasts and plasma cells more than 10% of lymphoid cells. This was distinctive from the Emory cohort, in which 51% of participants had left shift and 39% with immunoblasts and plasma cells more than 10% of lymphoid cells.

Figure 2.

Hantavirus 5-point screen criteria frequencies from two populations of patients with coronavirus disease 2019.

The median platelet count was similar between the TMC (185 × 109/L) and Emory cohorts (183 × 109/L) Table 2. Among individuals with thrombocytopenia, the median platelet count was 107 × 109/L at TMC and 123 × 109/L at Emory. In total, 31 participants had a repeat platelet count performed 12 to 24 hours after the hantavirus screen. Of these, the median platelet count was 180 × 109/L and 208 × 109/L at TMC and Emory, respectively. None of the thrombocytopenic individuals in either the TMC or Emory cohort demonstrated a 20% or higher drop in the repeat platelet count performed 12 to 24 hours after the initial screen.

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