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Environmental Medicine Integrating a Missing Element into Medical Education (1995) / Chapter Skim
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Case Study 17: Hantavirus Pulmonary Syndrome: A Clinical Description of 17 Patients with a Newly Recognized Disease
Pages 395-401

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From page 395...
... , 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.
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From page 396...
... However, 30 to 40 percent of patients have minimal illness, and in only 20 to 30 percent is the illness moderate or severe.5~7 Respiratory symptoms are generally not pronounced, and pulmonary involvement has not been a prominent feature of the known hantaviral syndromes.8 Several species of rodents in the United States have been shown to be infected with hantaviruses. Although seroprevalence studies have detected antibodies to hantaviruses in a small percentage of people in the United States, there were no reports of acute illness resulting from hantavirus infection acquired in North America before the outbreak of cases described in this report.9 ~0 METHODS The case definition of acute, unexplained respiratory distress syndrome consisted of either of the following findings in any patient presenting afterJanuary 1, 1993: unexplained adult respiratory distress syndrome or radiographic evidence of acute, bilateral, interstitial pulmonary infiltrates with hypoxemia (arterial oxygen saturation, less than 90 percent while the patient is breathing room air)
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From page 397...
... 14 HANTAVIRUS PULMONARY SYNDROME—DUCHIN ET AL. white-cell count was 65,300 per cubic millimeter, with 45 percent segmented neutrophils and 27 percent band forms.
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From page 398...
... Two surviving patients who were initially in positive balance underwent spontaneous diuresis during their recovery. Hemodynamic and pulmonary deterioration paralleled the development of metabolic acidosis, rising serum lactate dehydrogenase levels, declining serum albumin levels, prolongation of the prothrombin time and the partial-thromboplastin time, and de .
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From page 399...
... There is evidence of a widespread increase in vascular endothelial permeability in patients with hemorrhagic fever with renal syndrome.~5 i6 Whether the pulmonary edema associated with hantavirus pulmonary syndrome is a manifestation of a localized pulmonary process or of a more widespread increase in vascular permeability is unclear. The absence of edema in other tissue on clinical examination and at autopsy suggests Figure 2.
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From page 400...
... An understanding of the pathophysiology of hantavirus infection, especially the mechanisms underlying the increase in pulmonary and systemic endothelial permeability and vascular tone, may lead to targeted therapeutic interventions. Although data are being collected on the role of immunologic therapy and mediators of inflammation and vascular function in patients with the adult respiratory distress syndrome and septic shock,24 little information has been published on this approach to the treatment of hantavirus infection.25 26 In one controlled study of patients who had hemorrhagic fever with renal syndrome, intravenous administration of the antiviral agent ribavirin reduced mortality when the drug was given early in the course of the illness.27 Since June 4, 1993, intravenous ribavirin has been available through an investigational protocol to treat patients with possible hanta.
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From page 401...
... MMWR Morb Mortal Wkly Rep 1994;43:45-8. Hantavirus infection—southwestern United States: interim recom~nendations for risk reduction.
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Key Terms

  • renal syndrome
  • hantavirus infection
  • hantavirus pulmonary
  • respiratory distress
  • pulmonary edema

  • distress syndrome
  • lactate dehydrogenase
  • pulmonary syndrome
  • adult respiratory
  • cubic millimeter

  • serum lactate
  • abdominal pain
  • epidemic hemorrhagic
  • blood pressure
  • chest radiograph

  • blood urea
  • platelet count
  • mmwr morb
  • rapidly progressive
  • morb mortal

  • mortal wkly
  • wkly rep
  • oxygen saturation
  • dehydrogenase concentration
  • viral antigen

  • severe hemorrhagic
  • band forms
  • respiratory rate
  • mexico office
  • indian health


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