A 58 y.o. male comes in after a week of a viral syndrome. He co shortness of breath

He is a farmer and has a platelet count of 60,000. What do see on the xray?

 The patient had  hantavirus pulmonary syndrome.  Hantavirus is an RNA  hemorrhagic fever virus found in deer mice.  Hantavirus was responsible for the death of Betsy Arakawa, the wife of Gene Hackman.  She  was found dead in her home in Santa Fe in March 2025.

deer mouse

Most of the cases in the US have been in New Mexico. Interestingly,  it presents in two stages. The first stage is flu-like with fevers muscle aches and headaches .(Low platelets can be a clue) This phase can happen 1-8 weeks post exposure.  Within ten days of the flu-like illness severe pulmonary edema and cardiovascular collapse can occur. The mortality of this phase is 30-40%.The virus is thought to block TBK-1 directed interferon allowing the virus to multiply causing endothelial leakage from blood vessels. 

During the Korean war thousands of US troops were affected by a viral illness known as Korean hemorrhagic fever. In 1978 the etiologic  agent of Korean hemorhragic fever was  found in a small rodent near the Hantan river in south Korea.  This is where hantavirus got its name . Old World hantaviruses cause a renal syndrome and New World cause a pulmonary syndrome. In the US, there was an outbreak of hanta virus ( named Sin Nombre, the nameless virus) in the four corners area in 1993.  It is not clear why the virus appears episodically but it is more common in spring and where deer mice are  prevalent.

VIRAL HEMORRHAGIC FEVERS

Arenaviridae-Lass, Junin, Machupo

Filoviridae- Ebola, Marburg

Bunyaviridae-Rift Valley, Crimean-Congo, Hantaan

Flaviviridae-Yellow fever, Dengue

These infectious diseases are classified as category A bioweapons  because they are stable when aerosolized.

FUN FACTS

Theodore Roosevelt signed the first laws restricting immigration

Dengue is increasing in Florida, Texas, Hawaii, Arizona and California. It has been marked by the CDC as a level 1 health alert. There is a vaccine now recommended for those with previous exposure to prevent the second bout which may result in hemorrhagic fever.

the rash of dengue is very fine.

The patient survived with respiratory support and judicious fluid management.

Afzal S, Ali L, Batool A, Afzal M, Kanwal N, Hassan M, Safdar M, Ahmad A, Yang J (12 October 2023). "Hantavirus: an overview and advancements in therapeutic approaches for infection". Front Microbiol. 14: 1233433. doi:10.3389/fmicb.2023.1233433. PMC 1

Jacob AT, Ziegler BM, Farha SM, Vivian LR, Zilinski CA, Armstrong AR, Burdette AJ, Beachboard DC, Stobart CC (9 November 2023). "Sin Nombre Virus and the Emergence of Other Hantaviruses: A Review of the Biology, Ecology, and Disease of a Zoonotic Pathogen". Biology (Basel). 12 (11): 1143. doi:10.3390/biology12111413

Finkbeiner A, Khatib A, Upham et al. A systematic review of the distribution and prevalence of viruses detected in the Peromyscus maniculatus species complex (Rodentia:Cricetidae)bioRxiv cold Spring Harbor Laboratory doi: https://doi.org/10.1101/2024.07.04.602117

Jacob A, Ziegler B, Farha S, et al. Biology 2023 Nov 9;12(11):1413.