Hantavirus pulmonary syndrome

HPS je rijetka, ali po život opasna bolest koju karakteriziraju plućni edem, hipoksija i hipotenzija (1). Uzročnici HPS-a su hantavirusi, skupina jednostrukih RNK virusa iz porodice Bunyaviridae (2). Hantavirusi za svoj prijenos trebaju vektore, i to glodavce, u kojima uzrokuju kroničnu asimptomatsku infekciju. Čovjek se zarazi inhalacijom aerosola koji sadrži ekskrete glodavaca inficiranih hantavirusima (7). Period inkubacije može trajati različito dugo, obično od 14 do 17 dana. HPS obično počinje s prodromalnim simptomima: vrućica (>38,3C), mialgije, glavobolja ili mučnine kroz nekoliko dana. Na to se nadovezuje dramatično pogoršanje praćeno tahipnejom, dispnejom, hipotenzijom i tahikardijom. U toj fazi bolesti velik broj pacijenata umire zbog nezaustavljivog napredovanja bolesti prema kardiogenom šoku. Bolesnici koji prežive, u trećoj fazi bolesti obično se naglo oporavljaju, iako posljedice bolesti mogu zaostati mjesecima pa i godinama (10). Danas se HPS sve češće označava kao HCPS da bi se naglasila važnost kardiogenog šoka u patogenezi bolesti (4). HPS se dijagnosticira na temelju kliničke slike, laboratorijskih nalaza i nekim od metoda dokazivanja prisutnosti hantavirusa (10). Liječenje HPS-a je potporno, i uključuje nadoknadu tekućine, korekciju hipotenzije vazopresorima i korekciju hipoksije i dispneje ventilatornom potporom. Završni korak u terapiji može biti primjena ECMO uređaja koji drastično poboljšava izglede za preživljenje (1,10).HPS is a rare but life-threatening disease characterized by pulmonary edema, hypoxia and hypotension. The causative agents of HPS are hantaviruses, a single stranded RNA viruses from the Bunyaviridae family. Hantaviruses need vectors for transmission, and their vectors are rodents, in which they cause chronic asymptomatic infection. Man becomes infected by inhalation of an aerosol containing excreta of the origin of urine or feces of rodents infected with hantavirus. The incubation period can last differently, usually from 14 to 17 days. HPS starts with prodromal symptoms like high fever (>38,3C), myalgia, headache or nausea. This is followed by a dramatic deterioration accompanied by tachypnea, dyspnea, hypotension and tachycardia. At this stage, a large number of patients die due to the unstoppable progression of the disease towards cardiogenic shock. Patients who survive, in the third stage usually recover sharply, although the consequences of the disease can last for months and years. Today, HPS is increasingly designated as HCPS to highlight the importance of cardiogenic shock in disease pathogenesis. HPS is diagnosed by clinical imaging, laboratory findings and some of the methods of proving the presence of hantavirus. HPS treatment is supportive, and includes fluid reimbursement, vasopressor hypotension correction and correction of hypoxia and dyspnea with ventilatory support. The most difficult patients need to be intubated, and the final step in therapy may be the use of an ECMO device that drastically improves the chances of survival