Hantavirus Pulmonary Syndrome is a severe systemic disorder with a prodrome of fever and myalgia followed by noncardiogenic pulmonary edema and respiratory failure. By looking at certain key findings, it is often possible to distinguish patients with Hantavirus Pulmonary Syndrome (HPS) from patients with pneumococcal pneumonia, influenza and unexplained adult respiratory syndrome.
|
Sign or Symptoms |
Finding |
Points |
|
dizziness |
present |
1 |
|
|
absent |
0 |
|
nausea or vomiting |
present |
1 |
|
|
absent |
0 |
|
cough |
present |
-1 |
|
|
absent |
0 |
|
Laboratory Result |
Finding |
Points |
|
platelet count |
< 100,000 per µL |
3 |
|
|
100,000 - 149,000 per µL |
2 |
|
|
150,000 - 199,999 per µL |
1 |
|
|
>= 200,000 per µL |
0 |
|
hematocrit |
>= 50% |
1 |
|
|
< 50% |
0 |
|
serum bicarbonate |
<= 20 mEq/L |
1 |
|
|
> 20 mEq/L |
0 |
total score =
= SUM(points for signs and symptoms) + SUM(points for laboratory findings)
Interpretation:
• minimum score: -1
• maximum score: 7
• Patients with Hantavirus Pulmonary Syndrome have scores >=3, whereas most patients with unexplained ARDS have scores < 3.
A flow chart can be followed which also helps categorize patients:
|
Findings |
Yes |
No |
|
2 or more of the following present?: • respiratory rate >=20 • fever • myalgia |
proceed to next row |
hantavirus pulmonary syndrome excluded |
|
2 or more of the following present?: • no cough • no sore throat • shortness of breath • nausea • diarrhea |
proceed to next row |
consider influenza |
|
lobar infiltrates on chest roentgenogram? |
consider bacterial pneumonia |
proceed to next level |
|
3 or more points from the following: • dizziness (1 point), • nausea (1), • no cough (1), • hematocrit >= 50% (1), • serum bicarbonate <=20 mEq/L (1), • platelet count (3 if < 100,000/µL; 2 if 100,000-149,999/µL; 1 if 150,000-199,999/µL) |
possible hantavirus pulmonary syndrome |
consider unexplained ARDS |
from Figure 1, page 647
Specialty: Infectious Diseases, Pulmonology
ICD-10: ,
