Two Atypical Cases of Hantavirus Infection: Experience from a Tertiary Care Unit in Sri Lanka

Hantaviruses are a large family of enveloped viruses with two medically important families Cricetidae and Muridae which are known to cause rodent-borne diseases worldwide. Some strains cause clinical syndromes with multiorgan involvement in humans such as hantavirus haemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS), which is also known as hantavirus pulmonary syndrome. Clinical differentiation of this infection from other endemic infections in Sri Lanka such as leptospirosis and rickettsial infections is extremely difficult due to overlapping clinical and epidemiologic features such as exposure to rodents and farming. Here, we report two serologically confirmed cases of hantavirus infection from Sri Lanka with different presentation. The first patient had a combination of HCPS and HFRS. The second patient was treated for HPS complicated with acute respiratory distress syndrome (ARDS). Both had a significant clinical, biochemical, and radiological response with early initiation of corticosteroids. However, further studies are required to assess whether steroids hasten the recovery of severe hantavirus infections. We believe that hantavirus infection is an important emerging disease in the country and should be considered as a differential diagnosis in patients presenting with an acute febrile illness as well as in patients presenting with ARDS. Early diagnosis and prompt treatment improve prognosis.