From the Research
The diagnostic workup for suspected hantavirus infection should begin with a thorough history focusing on potential rodent exposure, followed by immediate laboratory testing, including a complete blood count, comprehensive metabolic panel, arterial blood gas, chest X-ray, and specific serologic testing for hantavirus IgM and IgG antibodies, as recommended by the most recent study 1. The workup should prioritize identifying patients with severe respiratory symptoms, such as those with a history of rodent exposure or rural/wilderness travel, as they are at higher risk of developing hantavirus cardiopulmonary syndrome (HCPS) 1. Key laboratory tests to order include:
- Complete blood count (CBC) to look for thrombocytopenia, elevated hematocrit, and the presence of immunoblasts
- Comprehensive metabolic panel to assess for hypoalbuminemia and elevated lactate dehydrogenase
- Arterial blood gas to evaluate for hypoxemia
- Chest X-ray to identify bilateral infiltrates
- Specific serologic testing for hantavirus IgM and IgG antibodies PCR testing of blood or tissue may also be performed in specialized laboratories 2. Patients with suspected hantavirus pulmonary syndrome (HPS) should be hospitalized immediately, preferably in an intensive care unit, as respiratory failure can progress rapidly 3. Treatment is primarily supportive, including careful fluid management, oxygen therapy, and mechanical ventilation if needed, with early transfer to a facility with extracorporeal membrane oxygenation (ECMO) capability considered for severe cases 4. The diagnosis should be reported to public health authorities, as hantavirus is a notifiable disease, and early recognition is crucial because the disease can progress from mild symptoms to respiratory failure within 24-48 hours 5.