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CDC: Consider Hantavirus pulmonary syndrome in children with unexplained respiratory distress
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CDC officials are urging physicians to consider Hantavirus pulmonary syndrome children who present with unexplained respiratory problems.
The warning comes after five children, aged 6 years to 14 years, became sick following exposure to rodent droppings last year.
CDC researchers said the first child, a 6-year-old boy who lived in Colorado, developed symptoms in May after contact with rodent droppings and nesting materials in his bedroom and play areas of his home. He was hospitalized with chest pain, elevated temperature and pulse, thrombocytopenia, elevated WBC, elevated hematocrit and bilateral infiltrates. An enzyme-linked immunosorbant assay (ELISA) revealed Sin Nombre Hantavirus immunoglobulin M after his death from apparent cardiac failure secondary to shock.
An ELISA also confirmed evidence of Sin Nombre Hantavirus in the second child, a 14-year-old boy from Washington, who was admitted to the hospital in June with symptoms similar to the first patient along with shortness of breath and a cough. He was exposed to a container that had been contaminated by rodent fecal matter before hospital admission.
The third child, a 6-year-old boy from Colorado, was bitten by a mouse in July, 10 days prior to the appearance of symptoms similar to the other patients as well as dyspnea with coarse breath sounds, wheezes and crackles on auscultation. An ELISA revealed positive Sin Nombre Hantavirus IgM in this case as well.
The fourth patient, a 9-year-old girl from Arizona, presented to a New Mexico hospital with the same symptoms as the first three patients, and after hospitalization, serum tested with a commercial immunoblot assay revealed Sin Nombre Hantavirus IgG. In this case, evidence of rodents was found in several residences that the girl frequently visited.
The fifth patient, a 13-year-old boy, presented to a California emergency department with symptoms similar to the first four patients along with abdominal pain and tender chest. Testing detected hantavirus IgM and IgG. The CDC researchers noted that the boy may have been exposed to rodents during extensive renovations to his home.
The CDC researchers advised people to reduce the risk of infection by monitoring potential rodent infestation and properly disinfecting areas. – by Melissa Foster
Levy C. MMWR. 2009; 58: 1409-1412
This report serves as a reminder that, rare though it is, hantavirus infection should be included in the differential diagnosis of children who present with severe respiratory illness of uncertain etiology, especially if accompanied by leukocytosis and neutropenia. The association of hantavirus infection and exposure to rodent droppings is well established, and is another reason to try to assure that children live and play in rodent-free environments.
– Eugene Shapiro, MD
Infectious Diseases in Children Editorial
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