From the Guidelines
Hantavirus infection is characterized by distinct bloodwork abnormalities, including hemoconcentration, thrombocytopenia, and neutrophilic leukocytosis, which are crucial for early diagnosis and management. These abnormalities are part of the typical clinical laboratory findings in hantavirus pulmonary syndrome (HPS), as described in the case definitions for infectious conditions under public health surveillance by the Centers for Disease Control and Prevention 1. The typical prodrome of hantavirus disease includes fever, chills, myalgia, headache, and gastrointestinal symptoms, which are often accompanied by laboratory findings such as:
- Hemoconcentration
- Left shift in the white blood cell count
- Neutrophilic leukocytosis
- Thrombocytopenia
- Circulating immunoblasts
These laboratory abnormalities reflect the pathophysiology of hantavirus infection, which involves increased vascular permeability, immune-mediated damage, and direct viral effects on endothelial cells. Early recognition of these patterns is crucial for diagnosis, especially when combined with exposure history and clinical symptoms, as specific antiviral treatment options are limited and supportive care remains the mainstay of management. The study by the Centers for Disease Control and Prevention 1 provides the most relevant guidance on the clinical laboratory findings associated with hantavirus infection, and its findings should be considered in the diagnosis and management of patients with suspected hantavirus disease.
From the Research
Bloodwork Abnormalities with Hantavirus
- Leukocytosis, thrombocytopenia, and hemoconcentration are common bloodwork abnormalities associated with hantavirus cardiopulmonary syndrome 2
- Elevated serum creatinine and liver enzymes, high C-reactive protein, and hematuria are also seen in patients with hemorrhagic fever with renal syndrome (HFRS) caused by hantavirus 3
- Low platelet count is a characteristic feature of HFRS, and patients may also present with acute kidney injury (AKI) 3
- Hantavirus infection can cause increased vascular permeability, leading to various clinical syndromes, including HFRS and hantavirus cardiopulmonary syndrome (HCPS) 4
Laboratory Findings
- Presumptive diagnosis of hantavirus infection can be made based on pulmonary interstitial edema on chest radiographs in association with leukocytosis, thrombocytopenia, and hemoconcentration 2
- Serology testing is essential for confirming the diagnosis of hantavirus infection, and suspected cases should be reported to the appropriate public health authorities 2, 3
- Laboratory abnormalities, such as elevated liver enzymes and high C-reactive protein, can be used to monitor the progression of the disease and guide treatment decisions 3
Clinical Implications
- Early clinical suspicion and prompt transfer to a facility with critical care units are crucial for improving clinical outcomes in patients with hantavirus infection 4
- Supportive treatment, including intensive care unit admission, mechanical ventilation, and vasoactive agents, is often necessary to manage severe cases of hantavirus infection 2, 5
- Rodent control and public health education and promotion play a major role in preventing hantavirus infection, and future efforts should be directed toward increasing awareness and understanding of the disease among healthcare professionals and the general public 5, 3