Hantavirus pulmonary syndrome (HPS) is an infectious disease that is acquired through exposure to rodents carrying the causative virus, the Hantavirus. A few cases have been documented, where the infection was acquired through human to human contact [1] [2].

HPS usually occurs in specific geographical locations, such as north and south America. The disease appears to affect all individuals equally, although men may have a higher incidence rate due to more recurrent exposure to the vector. For the same reason, HPS typically does not present in young children or the elderly.

HPS is one of many syndromes that can arise from Hantavirus infection [3] [4]. The affected organ systems depend on the specific type of Hantavirus an individual has come in contact with. The severity of illness varies greatly between cases, ranging from mild to severe. Furthermore, it demonstrates significantly high case mortality rates, estimated at up to 50%. This syndrome is characterized by severe respiratory compromise. The illness has several stages entailing a prodromal phase, respiratory phase, and convalescent phase. The disease has an incubation period of one week to one month, after which prodromal symptoms manifest.

Prodromal symptoms are often nonspecific and may involve gastrointestinal discomfort, vomiting, headache, and muscle pain [5]. These individuals also experience pyrexia. The typical signs usually last up to 5 days.

Subsequently, the host immune system attacks endothelial cells lining the lungs, displaying viral antigens. This process leads to increased permeability of the endothelium and thus pulmonary edema. The cardiopulmonary phase lasts up to 48 hours and is characterized by the emergence of respiratory findings such as coughing, tachypnea, crepitations, and dyspnea. Patients frequently require mechanical ventilation during this time. Some individuals may develop hypotension and circulatory collapse due to cardiogenic shock, the latter being the main cause of death in HPS [6] [7] [8]. Oliguria is not an uncommon observation during this phase, and in a few cases, may lead to renal failure.

The third stage is preceded by an episode of diuresis and is made evident by the resolution of cardiopulmonary features.

• Fever

  KEYWORDS: dengue; dengue hemorrhagic fever; hantavirus; hantavirus pulmonary syndrome; viral hemorrhagic fevers [ncbi.nlm.nih.gov]

  Virus hemorrhagic fevers: special reference to hemorrhagic fever with renal syndrome (epidemic hemorrhagic fever). J Pediatr 1962 ;60: 841 - 857 22. Lee HW. Hemorrhagic fever with renal syndrome in Korea. [nejm.org]

• Chills

  The typical prodrome consists of fever, chills, myalgia, headaches, and gastrointestinal symptoms, and can become complicated by acute respiratory distress syndrome (ARDS), respiratory failure, and shock. The case fatality rate is 35%. [dph.georgia.gov]

  Medical Definition of hantavirus pulmonary syndrome : an acute respiratory disease caused by various hantaviruses and characterized initially especially by fever, muscle pain, headache, cough, vomiting, and chills which rapidly progress to pulmonary edema [merriam-webster.com]

  The Maine resident went to a community hospital in early April with a 5-day history of fatigue, decreased appetite, weakness, chills, myalgias, and progressive shortness of breath. On examination, he was hypoxic and tachypneic. [ncbi.nlm.nih.gov]

  The infection has_symptom fever, has_symptom muscle pain, has_symptom headache, has_symptom cough, has_symptom vomiting, has_symptom chills which rapidly progress to bilateral interstitial pulmonary infiltrates occurrence, pulmonary edema and hypoxia [amp.pharm.mssm.edu]

  Symptoms are similar to the flu at first (fever, muscle aches, headaches and chills) and are followed by difficulty breathing. Patients with Hantavirus Pulmonary Syndrome need to be hospitalized for respiratory and/or blood pressure support. [nj.gov]

• Malaise

  Other early symptoms may include gastrointestinal disturbances, headache, chills, and malaise, which may last up to 5 days. The secondary phase is called the cardiopulmonary phase and this includes an acute onset of pulmonary edema. [austincc.edu]

  Headache, fever, injected sclerae, malaise, nausea, pain in limbs and back, leukopenia Prolonged mental depression Rare No Sindbis virus infection ( Alphavirus spp.) [nap.edu]

  Other early symptoms include gastrointestinal disturbances, headache, chills, and malaise. 4 Physical findings on initial presentation include fever, tachypnea, and tachycardia, but the remainder of the examination is usually normal. [aafp.org]

• Laboratory Technician

  For example, in a recent community outbreak of brucellosis, one-third of the laboratory technicians developed brucellosis. Employment in the laboratory was the only identified risk factor. [ilocis.org]

• Cough

  The confirmed case involved a previously healthy young woman who died with signs and symptoms of acute respiratory insufficiency 5 days after presenting fever, myalgia and a dry cough. [ncbi.nlm.nih.gov]

  Prodromal symptoms are flu-like ones, such as fever, cough, myalgia, headache, lethargy, and shortness of breath, which rapidly deteriorates into acute respiratory failure. [en.wikipedia.org]

  The second phase lasts 2 to 8 days and includes rapid development of fever, dry cough, body aches, headaches, diarrhea, and abdominal pain. Heart and lung failure can develop during this phase. [lung.org]

• Dyspnea

  Temporary exertional dyspnea and reduced expiratory flow are common in early convalescence after HPS but resolves in almost all patients. [ncbi.nlm.nih.gov]

• Tachypnea

  The most common physical findings were tachypnea (100 percent), tachycardia (94 percent), and hypotension (50 percent). [ncbi.nlm.nih.gov]

  The cardiopulmonary phase lasts up to 48 hours and is characterized by the emergence of respiratory findings such as coughing, tachypnea, crepitations, and dyspnea. Patients frequently require mechanical ventilation during this time. [symptoma.com]

  A cough and tachypnea develop before pulmonary edema and signs of hypoxia. Cardiac abnormalities might present such as myocardial depression, and after that the illness usually gets worse. Hospitalization may be required along with ventilation. [microbewiki.kenyon.edu]

• Pharyngitis

  Fever, often with shaking chills; severe polyarticular arthralgia; rash with headache, photophobia, retro-orbital pain, sore throat, pharyngitis, nausea, vomiting Arthralgia and myalgia Frequent No Potentially More Prevalent Among Troops in Southwest [nap.edu]

  Rash, rhinorrhea, pharyngitis, and conjunctivitis are rare in HPS and thus, argue against SNV infection. 13 It is important to note that rash and conjunctivitis are often seen in patients with HPS in South America. [aafp.org]

  […] deformans) pancreas cancer pancreatitis panic disorder paralysis parkinson's disease paronychia pelvic inflammatory disease (pid) penis cancer pericarditis, acute periodontitis (gum inflammation) peripheral neuropathy (peripheral neuritis) peritonitis pharyngitis [healthse.com]

  A systematic review of Andes virus infection in Argentina documented marked conjunctival injection, facial flushing ( rubicundez, in Spanish; this symptom is also found in HFRS), pharyngeal congestion, and petechiae. [academic.oup.com]

  He had been diagnosed with streptococcal pharyngitis 2 weeks prior to admission. Given the presence of hemoptysis, bronchoscopy was performed and was consistent with DAH. [science.gov]

• Sore Throat

  Sore throat, runny nose, watery eyes, sneezing and rashes are rarely seen. These symptoms would suggest the illness is due to some other cause. [nasdonline.org]

  pressure (bed sores; decubitus ulcers) spinal-cord tumor sporotrichosis sprains & strains (pulled muscle) stomach cancer (gastric carcinoma) strabismus strep throat (streptococcal sore throat) stroke (cerebrovascular accident) stye (hordeolum) subarachnoid [healthse.com]

  Fever, often with shaking chills; severe polyarticular arthralgia; rash with headache, photophobia, retro-orbital pain, sore throat, pharyngitis, nausea, vomiting Arthralgia and myalgia Frequent No Potentially More Prevalent Among Troops in Southwest [nap.edu]

• Vomiting

  In the prodromal stage, HPS presents with flu-like symptoms, nausea, vomiting, and gastrointestinal pain and is often mistaken on the first visit for other infectious diseases or gastroenteritis. [ncbi.nlm.nih.gov]

  Medical Definition of hantavirus pulmonary syndrome : an acute respiratory disease caused by various hantaviruses and characterized initially especially by fever, muscle pain, headache, cough, vomiting, and chills which rapidly progress to pulmonary edema [merriam-webster.com]

  Nausea, vomiting, acute shock, and hypotension may occur in this stage. The following stage is the oliguric, and kidney function improves in the stage that follows, the diuretic stage. [microbewiki.kenyon.edu]

  Prodromal symptoms are often nonspecific and may involve gastrointestinal discomfort, vomiting, headache, and muscle pain. These individuals also experience pyrexia. The typical signs usually last up to 5 days. [symptoma.com]

  The infection has_symptom fever, has_symptom muscle pain, has_symptom headache, has_symptom cough, has_symptom vomiting, has_symptom chills which rapidly progress to bilateral interstitial pulmonary infiltrates occurrence, pulmonary edema and hypoxia [amp.pharm.mssm.edu]

• Nausea

  In the prodromal stage, HPS presents with flu-like symptoms, nausea, vomiting, and gastrointestinal pain and is often mistaken on the first visit for other infectious diseases or gastroenteritis. [ncbi.nlm.nih.gov]

  Symptoms include abrupt onset of fever, chills, weakness, nausea, vomiting, and abdominal pain followed by difficulty breathing. HPS can be rapidly fatal if not identified and treated promptly. [foundation.chestnet.org]

  Signs of hantavirus infection usually occur within one to five weeks after exposure, and include fever, muscle aches, dizziness, nausea, difficulty breathing, and coughing. [directorsblog.health.azdhs.gov]

  In the first stage, which can last for several days, the most common signs and symptoms are: Fever and chills Muscle aches or pain Headache Some people also experience: Nausea Stomach pain Vomiting Diarrhea As the disease progresses, it can lead to damaged [mayoclinic.org]

  Nausea, vomiting, acute shock, and hypotension may occur in this stage. The following stage is the oliguric, and kidney function improves in the stage that follows, the diuretic stage. [microbewiki.kenyon.edu]

• Diarrhea

  The second phase lasts 2 to 8 days and includes rapid development of fever, dry cough, body aches, headaches, diarrhea, and abdominal pain. Heart and lung failure can develop during this phase. [lung.org]

  Diarrhea (may last 1-4 weeks), nausea, fever, myalgia Chronic diarrhea (in people immunocompromised at time of infection, diarrhea may be persistent despite treatment) Rare No Postinfection enteropathy c Rare No Cryptosporidial cholangitis and acalculous [nap.edu]

  In the first stage, which can last for several days, the most common signs and symptoms are: Fever and chills Muscle aches or pain Headache Some people also experience: Nausea Stomach pain Vomiting Diarrhea As the disease progresses, it can lead to damaged [mayoclinic.org]

  Some people also get headaches, dizziness, vomiting, or diarrhea. After about four to ten days, people who are sick with hantavirus infection begin to cough and have shortness of breath. [wcsv.org]

  Symptoms that almost always occur in the early stages of HPS are: fever, muscle pain, fatigue, headache, chills, nausea, vomiting, diarrhea, abdominal pain, dizziness, and feeling generally ill. [breathebayarea.org]

• Abdominal Pain

  The second phase lasts 2 to 8 days and includes rapid development of fever, dry cough, body aches, headaches, diarrhea, and abdominal pain. Heart and lung failure can develop during this phase. [lung.org]

  Symptoms include abrupt onset of fever, chills, weakness, nausea, vomiting, and abdominal pain followed by difficulty breathing. HPS can be rapidly fatal if not identified and treated promptly. [foundation.chestnet.org]

  Symptoms that almost always occur in the early stages of HPS are: fever, muscle pain, fatigue, headache, chills, nausea, vomiting, diarrhea, abdominal pain, dizziness, and feeling generally ill. [breathebayarea.org]

  Early symptoms include: Fatigue Fever Muscle aches in large muscle groups Headache Dizziness Chills Nausea and vomiting Diarrhea Abdominal pain 4-10 days after initial symptoms begin, more severe symptoms occur: Coughing Shortness of breath Lungs filling [gethealthycarsoncity.org]

  Some individuals may experience more serious symptoms such as vomiting, dizziness, abdominal pain followed by coughing, shortness of breath and difficulty breathing. [simcoemuskokahealth.org]

• Hypotension

  The most common physical findings were tachypnea (100 percent), tachycardia (94 percent), and hypotension (50 percent). [ncbi.nlm.nih.gov]

  The illness takes a severe turn when hypotension and respiratory distress appear suddenly. A cough and tachypnea develop before pulmonary edema and signs of hypoxia. [microbewiki.kenyon.edu]

  Some individuals may develop hypotension and circulatory collapse due to cardiogenic shock, the latter being the main cause of death in HPS. Oliguria is not an uncommon observation during this phase, and in a few cases, may lead to renal failure. [symptoma.com]

• Tachycardia

  The most common physical findings were tachypnea (100 percent), tachycardia (94 percent), and hypotension (50 percent). [ncbi.nlm.nih.gov]

  paroxysmal tachycardia) heatstroke or heat exhaustion (sunstroke; heat prostration) heel spur (calcaneal spur) hemophilia hemorrhoids (piles) hepatitis, viral hepatoma (malignant liver tumor; hepatocellular carcinoma) hernia herpangina herpes, genital [healthse.com]

• Chest Pain

  A previously healthy 29-year-old male presented to the emergency department with pleuritic chest pain, nonproductive cough, and dyspnea. He was treated empirically for community acquired pneumonia and discharged to home. [ncbi.nlm.nih.gov]

  On June 7, an adolescent boy aged 14 years went to a Washington emergency department with a 5-day history of shortness of breath, chest pain, cough, and fever. [jamanetwork.com]

  Late symptoms of HPS symptoms occur about four to 10 days after the early symptoms and include coughing, chest pain, and shortness of breath that can become severe. [medicinenet.com]

  Patients may be asymptomatic and have their disease diagnosed incidentally on chest radiographs, or they may have dyspnoea and chest pain. Mesotheliomas tend to be invasive. The median survival is 4 to 18 months in various series. [iloencyclopaedia.org]

• Anisocoria

  Right upper lid ptosis, right miosis and anisocoria were recognized on the first postoperative day. Findings of Horner's syndrome were ameliorated completely at the 6th month. [science.gov]

• Petechiae

  The hemorrhagic part of the disease name comes from petechiae, hematuria, and melena that may develop in more severe cases. [microbewiki.kenyon.edu]

  This is followed by flushing, then petechiae. The disease progresses to hemorrhage (gastrointestinal, subconjunctival) and hemodynamic instability, occasionally progressing to shock. [web.archive.org]

  The high fever is typically present for 3 to 7 days and ends with conjunctival hemorrhages and palatal petechiae. [ncbi.nlm.nih.gov]

  A systematic review of Andes virus infection in Argentina documented marked conjunctival injection, facial flushing ( rubicundez, in Spanish; this symptom is also found in HFRS), pharyngeal congestion, and petechiae. [academic.oup.com]

  However, in this group of patients we also observed conjuntival injection in 10/25 (42%), facial flushing in 8/25 (33%), pharyngeal congestion in 7/25 (29%) and petechiae in 3/25 (12%). [science.gov]

• Myalgia

  The confirmed case involved a previously healthy young woman who died with signs and symptoms of acute respiratory insufficiency 5 days after presenting fever, myalgia and a dry cough. [ncbi.nlm.nih.gov]

  The typical prodrome consists of fever, chills, myalgia, headaches, and gastrointestinal symptoms, and can become complicated by acute respiratory distress syndrome (ARDS), respiratory failure, and shock. The case fatality rate is 35%. [dph.georgia.gov]

  First identified in the southwestern United States, this syndrome is characterized most commonly by fever, myalgias, headache, cough, and rapid respiratory failure. [profiles.umassmed.edu]

• Back Pain

  Early symptoms are much like the flu and include fever, chills, headache, and severe muscle pain, especially in the lower back and legs. There is severe abdominal, joint and back pain, and possibly, nausea and vomiting. [nasdonline.org]

  The incubation period is approximately 2 to 4 weeks and starts abruptly with a high fever, headache, vomiting, abdominal pain, and back pain often associated with blurred vision and somnolence. [ncbi.nlm.nih.gov]

  […] arthritis) arthritis, juvenile rheumatoid arthritis, rheumatoid asbestosis asthma atelectasis atherosclerosis (hardening of the arteries) athlete's foot (tinea pedis; ringworm of the feet) atrial fibrillation attention-deficit hyperactivity disorder (adhd) back [healthse.com]

  Case report: A 45-year-old Danish woman living in an area endemic for Hanta virus, without prior medical history, was admitted because of lower back pain radiating to the left hip, fever, headache, nausea, and malaise. [science.gov]

  Leptospirosis-Associated Severe Pulmonary Hemorrhagic Syndrome with Lower Back Pain as an Initial Symptom DEFF Research Database (Denmark) Søndergaard, Mads Madsen; tursunovic, Amela; Thye-Roenn, Peter 2016-01-01 BACKGROUND Leptospirosis is a zoonosis [worldwidescience.org]

• Arthralgia

  Clinical Presentation: Hantavirus pulmonary syndrome infection often presents as a "flu-like" illness, with fever, intense headache, myalgia, nausea and other gastrointestinal symptoms; this is followed by cough, shortness of breath, dizziness, sweats and arthralgia [tbdhu.com]

  Fever, often with shaking chills; severe polyarticular arthralgia; rash with headache, photophobia, retro-orbital pain, sore throat, pharyngitis, nausea, vomiting Arthralgia and myalgia Frequent No Potentially More Prevalent Among Troops in Southwest [nap.edu]

  Persons with acute brucellosis develop high daily fevers, arthralgia and hepatosplenomegaly. [iloencyclopaedia.org]

  Ron M; Wells, Athol U 2006-03-01 Hypocomplementaemic urticarial vasculitis syndrome (HUVS) is a rare disorder characterised by complement activation and the presence of C1q precipitins together with a syndrome of urticarial vasculitis, angioedema, arthralgia [science.gov]

• Headache

  Infected patients suffer from fatigue, fever, and muscle aches often accompanied by headaches, dizziness and gastrointestinal problems in the weeks following exposure. [en.wikipedia.org]

  The second phase lasts 2 to 8 days and includes rapid development of fever, dry cough, body aches, headaches, diarrhea, and abdominal pain. Heart and lung failure can develop during this phase. [lung.org]

  The typical prodrome consists of fever, chills, myalgia, headaches, and gastrointestinal symptoms, and can become complicated by acute respiratory distress syndrome (ARDS), respiratory failure, and shock. The case fatality rate is 35%. [dph.georgia.gov]

  The most common prodromal symptoms were fever and myalgia (100 percent), cough or dyspnea (76 percent), gastrointestinal symptoms (76 percent), and headache (71 percent). [ncbi.nlm.nih.gov]

  Medical Definition of hantavirus pulmonary syndrome : an acute respiratory disease caused by various hantaviruses and characterized initially especially by fever, muscle pain, headache, cough, vomiting, and chills which rapidly progress to pulmonary edema [merriam-webster.com]

• Dizziness

  Infected patients suffer from fatigue, fever, and muscle aches often accompanied by headaches, dizziness and gastrointestinal problems in the weeks following exposure. [en.wikipedia.org]

  Signs of hantavirus infection usually occur within one to five weeks after exposure, and include fever, muscle aches, dizziness, nausea, difficulty breathing, and coughing. [directorsblog.health.azdhs.gov]

  Some people also get headaches, dizziness, vomiting, or diarrhea. After about four to ten days, people who are sick with hantavirus infection begin to cough and have shortness of breath. [wcsv.org]

  Symptoms that almost always occur in the early stages of HPS are: fever, muscle pain, fatigue, headache, chills, nausea, vomiting, diarrhea, abdominal pain, dizziness, and feeling generally ill. [breathebayarea.org]

Upon presentation, baseline blood tests, as well as more specific laboratory testing should be carried out. Often requested laboratory studies include:

• Complete blood count (CBC), urea and electrolytes, peripheral smear, and arterial blood gas analysis (ABGA).
• Immunochemistry.
• Serology.
• PCR (polymerase chain reaction).

CBC may reveal low platelets and elevated white blood cells, with an unusually high proportion of immature cells [9]. Serum lactate dehydrogenase (LDH) is also high. Other parameters may reflect the distributive shock experienced in Hantavirus pulmonary syndrome [6] [7]. One such finding is hemoconcentration. A peripheral blood smear, in addition to the above, may reveal the presence of atypical immune cells, as well as immunoblasts [9]. Once these findings are observed, HPS can be diagnosed.

Imaging studies are usually carried out in the form of a chest radiograph. Signs of pulmonary edema that may be visualized include increased hilar markings, diffuse bilateral infiltrates, Kerley B lines, and peribronchial thickening. The cardiac silhouette is of normal size, and pleural effusions might also be present.

• Pericardial Effusion

  A 9-year-old girl was referred to our institution with pericardial effusion. [science.gov]

  […] shadows, 2 cases had cystic lesions, cavity, pleural thickening, focal bronchiectasis, pericardial effusion and focal pneumothorax was presented in 1 case respectively. [worldwidescience.org]

The high rate of mortality could be reduced if effective therapeutics could be discovered for treatment of this illness. [ncbi.nlm.nih.gov]

However, if recognized early, patients may fair better than those who do not seek medical treatment. [austincc.edu]

The prognosis for HPS is ominous and misdiagnoses may increase mortality. Better chances of survival depend on prompt intensive care support. [ncbi.nlm.nih.gov]

Early recognition of HPS and admission to an intensive care setting offers the best prognosis. Hantavirus pulmonary syndrome was first recognized during the 1993 outbreak in the Four Corners region of the southwestern United States. [en.wikipedia.org]

What is the prognosis of hantavirus pulmonary syndrome? The prognosis of HPS is fair to poor because currently, about 62% of patients recover, while about 38% will die. [medicinenet.com]

What Is the Prognosis? About 45% of patients with HPS die from the infection. However, early identification and supportive care in the hospital will help the majority of infected people recover from this dangerous syndrome. [healthychildren.org]

The white-footed mouse ( Peromyscus leucopus ) serves that role for SNV and the New York virus in the northeastern United States. [8] Prognosis The prognosis of HPS varies, although it appears to correlate with the severity of disease. [emedicine.medscape.com]

These findings underscore the need for systematic archiving and analysis of clinical information and specimens from patients with diseases of unknown etiology to facilitate the study of new clinical entities and their associated etiologic agents. [ncbi.nlm.nih.gov]

Our findings help elucidate the epidemiology of HPS in Brazil, where mast seeding of bamboo can trigger rodent population eruptions and subsequent human HPS outbreaks. [ncbi.nlm.nih.gov]

Epidemiology of hantavirus infections in Europe. Nephrology Dialysis Transplantation 1998 ; 13 : 2729 – 2731. 31. Kilpatrick, ED, et al. [cambridge.org]

The hantavirus pulmonary syndrome (HPS) is an acute, rapidly progressive disease transmitted by rodent excreta, with endothelial damage playing a central role in the pathophysiology. It usually affects rural workers. [ncbi.nlm.nih.gov]

Pathophysiology The basic pathophysiological lesion of HPS, and indeed of all Hantavirus infections, is a generalized increase in capillary permeability that results from endothelial damage. [emedicine.medscape.com]

Loin pain haematuria syndrome Chapter 48 Nutcracker syndrome and phenomenon Chapter 49 Exercise-related pseudonephritis Chapter 50 Proteinuria Chapter 51 Postural proteinuria (benign orthostatic proteinuria) Chapter 52 Nephrotic syndrome Chapter 53 Pathophysiology [oxfordmedicine.com]

There is acute renal failure, but the precise pathophysiologic lesion producing renal failure is uncertain. Mortality is usually from shock or hemorrhage. Pulmonary edema is a frequent finding (Powell, 1954). [web.archive.org]

Because no specific therapies are available for the disease, prevention and early recognition play an important role in reducing mortality from the disease. [ncbi.nlm.nih.gov]

1. Martinez VP, Bellomo CM, Cacace ML, Suarez P, Bogni L, Padula PJ. Hantavirus pulmonary syndrome in Argentina, 1995-2008. Emerg Infect Dis. 2010;16(12):1853-1860.
2. Padula PJ, Edelstein A, Miguel SD, López NM, Rossi CM, Rabinovich RD. Hantavirus pulmonary syndrome outbreak in Argentina: molecular evidence for person-to-person transmission of Andes virus. Virology. 1998;241(2):323-330.
3. Khan A, Khan AS. Hantaviruses: a tale of two hemispheres. Panminerva Med. 2003;45(1):43-51.
4. Peters CJ, Khan AS. Hantavirus pulmonary syndrome: the new American hemorrhagic fever. Clin Infect Dis. 2002;34(9):1224-1231.
5. Vinh DC, Embil JM. Hantavirus pulmonary syndrome: a concise clinical review. South Med J. 2009;102(6):620–625.
6. Jonsson CB, Figueiredo LT, Vapalahti O. A global perspective on hantavirus ecology, epidemiology, and disease. Clin Microbiol Rev. 2010;23(2):412–441.
7. Watson DC, Sargianou M, Papa A, Chra P, Starakis I, Panos G. Epidemiology of Hantavirus infections in humans: a comprehensive, global overview. Crit Rev Microbiol. 2014;40(3):261–272.
8. Verity R, Prasad E, Grimsrud K, et al. Hantavirus pulmonary syndrome in Northern Alberta, Canada: clinical and laboratory findings for 19 cases. Clin Infect Dis. 2000;31(4):942–946.
9. Dvorscak L, Czuchlewski DR. Successful triage of suspected hantavirus cardiopulmonary syndrome by peripheral blood smear review—a decade of experience in an endemic region. Am J Clin Pathol. 2014;142(2):196–201.