HANTAVIRUS PULMONARY SYNDROME - A CLINICAL DESCRIPTION OF 17 PATIENTS WITH A NEWLY RECOGNIZED DISEASE
HANTAVIRUS PULMONARY SYNDROME - A CLINICAL DESCRIPTION OF 17 PATIENTS WITH A NEWLY RECOGNIZED DISEASE
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DOI：
10.1056/nejm199404073301401
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发表时间：
1994-04-07
影响因子：
158.5
通讯作者：
MCDADE, J
中科院分区：
文献类型：
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作者：
DUCHIN, JS;KOSTER, FT;MCDADE, J
背景1993年5月，美国西南部爆发了严重的呼吸道疾病。一种以前未知的汉坦病毒被确定为原因。在亚洲，汉坦病毒与出血热和肾病有关。在北美，它们尚未被认为是人类疾病的原因。方法。我们分析了临床、实验室和尸检资料的第一个17人证实感染这种新发现的汉坦病毒株。患者的平均年龄为32.2岁（范围，13至64岁）; 61%为女性，72%为美洲原住民，22%为白色，6%为西班牙裔。最常见的前驱症状是发热和肌痛（100%），咳嗽或呼吸困难（76%），胃肠道症状（76%）和头痛（71%）。最常见的体格检查结果是呼吸急促（100%）、心动过速（94%）和低血压（50%）。实验室检查结果包括白细胞增多（峰值细胞计数中位数，每立方毫米26，000个），通常伴有髓样前体细胞，红细胞压积升高，血小板减少（最低血小板计数中位数，每立方毫米64，000个），凝血酶原和部分凝血活酶时间延长，血清乳酸脱氢酶浓度升高，血清蛋白浓度降低和蛋白尿。17名患者中有15名（88%）发生了快速进展性急性肺水肿，13名患者（均患有严重低血压）死亡（病死率为76%）。红细胞压积和部分凝血活酶时间的增加是死亡的预测因素。一种新的汉他病毒感染引起汉他病毒肺综合征，其特征是短暂的前驱疾病，随后迅速进行性，非心源性肺水肿。
Background. In May 1993 an outbreak of severe respiratory illness occurred in the southwestern United States. A previously unknown hantavirus was identified as the cause. In Asia hantaviruses are associated with hemorrhagic fever and renal disease. They have not been known as a cause of human disease in North America.Methods. We analyzed clinical, laboratory, and autopsy data on the first 17 persons with confirmed infection from this newly recognized strain of hantavirus.Results. The mean age of the patients was 32.2 years (range, 13 to 64); 61 percent were women, 72 percent were Native American, 22 percent white, and 6 percent Hispanic. The most common prodromal symptoms were fever and myalgia (100 percent), cough or dyspnea (76 percent), gastrointestinal symptoms (76 percent), and headache (71 percent). The most common physical findings were tachypnea (100 percent), tachycardia (94 percent), and hypotension (50 percent). The laboratory findings included leukocytosis (median peak cell count, 26,000 per cubic millimeter), often with myeloid precursors, an increased hematocrit, thrombocytopenia (median lowest platelet count, 64,000 per cubic millimeter), prolonged prothrombin and partial-thromboplastin times, an elevated serum lactate dehydrogenase concentration, decreased serum protein concentrations, and proteinuria. Rapidly progressive acute pulmonary edema developed in 15 of the 17 patients (88 percent), and 13 patients, all of whom had profound hypotension, died (case fatality rate, 76 percent). Increases in the hematocrit and partial-thromboplastin time were predictive of death.Conclusions. Infection with a newly described hantavirus causes the hantavirus pulmonary syndrome, which is characterized by a brief prodromal illness followed by rapidly progressive, noncardiogenic pulmonary edema.