INFECTIONS - Medicine for Mountaineering and Other Wilderness Activities - page 315

The hantavirus pulmonary syndrome (HPS) was first recognized in the Four Corners
area of New Mexico, Arizona, Utah, and Colorado in May 1993. Through March 2007,
465 infections had been reported in the United States, 35 percent of which had resulted in
death. Infections have been reported in thirty states, including most of the western half of
the country and some eastern states. Infections have also been reported from Canada, Ar-
gentina, Brazil, Chile, Paraguay, and Uruguay.
The agent responsible has been named Sin Nombre virus. (Other hantaviruses—the
Hantaan, Dobrava-Belgrade, Seoul, and Puumala varieties—cause infections that produce
renal failure and hemorrhagic fever. These infections have been recognized in Europe and
Asiasince1913andmayhavebeenobservedinChinaasearlyas AD 960).Thenamehant-
avirus comes from the Hantan River in Korea, although Lee Ho-wang, who first isolated
the virus, in his original publications transliterated the river's name idiosyncratically as
“Hantaan.”
AtonsetHPSisflulike:fever,muscleaches,headache,andcough.Progressiontorespir-
atory failure and death frequently is quite rapid. Urgent hospitalization and intensive care
are usually required. No specific treatment is available. Therapy is supportive and includes
control of hypoxia, avoidance of excessive fluids, and support of blood pressure.
In the Four Corners area hantavirus infection was found in 30 percent of the deer mice,
whichdonotbecomeillbutshedtheorganismsinsaliva,urine,andfeces.Humaninfection
occurs when infected saliva or excreta that has dried are inhaled as aerosols. Dried rodent
excreta that are introduced directly into broken skin or the eyes may also infect humans.
The disease is best controlled by environmental hygiene that excludes rodents. For
campers, the CDC recommends the following commonsense precautions:
◆ Tents or sleeping bags should not be placed near areas attractive to rodents such as
garbage dumps or woodpiles.
◆ Rodent infested cabins should be avoided.
◆ Tents with floors or cots should be used for sleeping—bare ground should be avoided.
◆ Food should be kept in rodent-proof containers.
◆ Garbage should be disposed of properly.
◆ Water should be disinfected.
◆ Dead mice should be handled with gloves.
More information is available at www.cdc.gov/ncidod/diseases/hanta/hps .
Hemorrhagic Fever Syndromes
The hemorrhagic fever syndromes (HFS) are a group of infections caused by four en-
tirely different families of viruses, although all are RNA viruses and have a fatty envelope
( Table 22-1 ) . Most of the infections have a high mortality rate. Ebola Zaire has a mortal-
ity rate of 80 percent, although this infection occurs mostly in areas where sophisticated
medical care is rarely available. Some are quite common. Yellow fever is estimated to kill