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Hantavirus infections in the United States: diagnosis and treatment
Definitive diagnosis of acute hantavirus infection requires demonstration of specific IgG and IgM antibodies and a compatible clinical course; most persons with acute illness will also have viral RNA in PBMC which can be detected after RT-PCR amplification. Characteristic hematologic and hemodynamic findings are helpful in establishing a presumptive diagnosis of HPS in persons with cardiopulmonary symptoms and signs while awaiting the results of serologic testing and PCR. Diagnosis during the prodromal phase is difficult although very limited data suggest that most these patients also have hantavirus IgG and IgM antibodies. Patients with suspected hantavirus infection should be treated in a critical care unit, as sudden hemodynamic deterioration can occur at any time. Hemodynamic monitoring is encouraged in patients with cardiopulmonary symptoms and signs, and inotropic support and vasopressors should be used rather than fluids. An uncontrolled study of ribavirin therapy was inconclusive and a placebo-controlled trial is therefore planned. The latter study aims to enroll persons with prodromal findings and early cardiopulmonary disease.
Definitive diagnosis of acute hantavirus infection requires demonstration of specific IgG and IgM antibodies and a compatible clinical course; most persons with acute illness will also have viral RNA in PBMC which can be detected after RT-PCR amplification. Characteristic hematologic and hemodynamic findings are helpful in establishing a presumptive diagnosis of HPS in persons with cardiopulmonary symptoms and signs while awaiting the results of serologic testing and PCR. Diagnosis during the prodromal phase is difficult although very limited data suggest that most these patients also have hantavirus IgG and IgM antibodies. Patients with suspected hantavirus infection should be treated in a critical care unit, as sudden hemodynamic deterioration can occur at any time. Hemodynamic monitoring is encouraged in patients with cardiopulmonary symptoms and signs, and inotropic support and vasopressors should be used rather than fluids. An uncontrolled study of ribavirin therapy was inconclusive and a placebo-controlled trial is therefore planned. The latter study aims to enroll persons with prodromal findings and early cardiopulmonary disease.