Case 1
On May 16, a boy aged 6 years who lived in Colorado went to a Texas hospital with a 2-day history of diarrhea and shortness of breath. On initial examination, the child had cyanotic lips and nail beds, with cold extremities. His pulse was 163, and his temperature was 101°F (38.3°C). Soon after arrival at the hospital, the child became apneic and had no palpable pulse. Chest compressions were initiated, and the child was intubated and ventilated. A chest radiograph revealed bilateral infiltrates, and blood analysis demonstrated elevated hematocrit, elevated WBC count, and thrombocytopenia (Table). Within 2 hours of admission to the hospital, the boy died from apparent cardiac failure secondary to shock. The child had been treated with intravenous fluids, ceftriaxone, epinephrine, atropine, and albuterol. The working diagnosis at the time of the child's death was shock and sepsis caused by pneumonia.
An enzyme-linked immunosorbant assay (ELISA) performed by the Colorado Department of Public Health and Environment revealed Sin Nombre hantavirus--specific serum immunoglobulin M (IgM). An environmental assessment conducted at the boy's home in Colorado found rodent droppings and nesting materials under his bed and in bushes in front of the home where the boy had played.
Case 2
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. Upon admission, the child had a fever of 103°F (39.4°C), pulse of 100, and a respiratory rate varying between 40 and 60. He was thrombocytopenic and had elevated WBC with atypical lymphocytosis (Table). A chest radiograph revealed bilateral interstitial infiltrates. No details were provided regarding treatment or any suspicion of HPS.
Because of worsening respiratory distress and hypoxia, the patient was intubated and mechanically ventilated for approximately 24 hours. He improved and was discharged home on June 13. An ELISA of serum detected Sin Nombre hantavirus--specific IgM at the Washington State Public Health Laboratories. A follow-up environmental assessment found rodent fecal contamination in a container of corn that the youth reported hand-grinding 8 days before illness onset.
Case 3
On July 12, a boy aged 6 years went to a Colorado emergency department with a 5-day history of fever (maximum 103°F [39.4°C]), erythematous facial rash, and myalgia. Upon admission the boy's pulse was 120, respiratory rate 48, and oxygen saturation 72% on room air. Dyspnea was apparent with coarse breath sounds, wheezes, and crackles on auscultation. His WBC count was elevated, and thrombocytopenia was noted (Table). A chest radiograph revealed bilateral diffuse pulmonary infiltrates with pleural effusions. HPS was suspected, and the boy was treated with intravenous fluids, ceftriaxone, and azithromycin.
The boy was intubated and mechanically ventilated from July 12 to July 20; he was discharged on July 22. Serum ELISA performed by the Colorado Department of Public Health and Environment revealed positive Sin Nombre hantavirus IgM. Family members reported that approximately 10 days before hospitalization the child was bitten on the finger by a mouse. During environmental assessment, evidence of rodent infestation was observed in outbuildings and abandoned vehicles but not within the house.
Case 4
On July 12, a girl aged 9 years living in Arizona went to a New Mexico hospital with chest pain and shortness of breath. Symptoms began with abdominal discomfort on July 6, which was followed by headache, vomiting, and myalgia. Upon examination, the girl's temperature was 99.9°F (37.7°C), and her pulse was 162. Laboratory findings included thrombocytopenia, elevated hematocrit, and elevated WBC count (Table). A chest radiograph revealed diffuse interstitial infiltrates. During transport to a tertiary care facility for further treatment, the child's temperature reached 103.8°F (39.9°C). HPS was suspected, and the girl was treated with intravenous fluids, ceftriaxone, and vancomycin.
Because of worsening signs of pulmonary distress, the girl was intubated and received extracorporeal membrane oxygenation therapy for 4 days. She remained on a ventilator until July 22 and was hospitalized until August 5. Serum tested with a commercial immunoblot assay revealed Sin Nombre hantavirus immunoglobulin G (IgG). Evidence of rodents was found at three residences frequented by the girl in Arizona: the family home, grandparents' home, and a summer home where she played in an underground dugout that had rodent burrows.
Case 5
On November 25, an adolescent boy aged 13 years went to a California emergency department with a 5-day history of fever (maximum 102.6°F [39.2°C]), cough, posttussive vomiting, diarrhea, and abdominal pain. Physical examination revealed a tender chest, with crackles and diminished breath sounds in the lower lobes of the lungs, and a respiratory rate of 30. Laboratory findings included elevated WBC, elevated hematocrit, and thrombocytopenia (Table). Chest radiographs revealed diffuse interstitial opacities with pleural effusion. Treatment included intravenous fluids, ceftriaxone, clindamycin, and azithromycin. The patient received supplemental oxygen by nasal cannula and was discharged home on December 3.
Testing for hantavirus was requested on day 4 of hospitalization. Serum was submitted to a commercial diagnostic laboratory, and Sin Nombre hantavirus IgM and IgG antibodies were detected by immunoblot assay. Extensive remodeling was under way in the youth's home at the time of illness, including removal and replacement of floors and walls. Three mice were trapped in the youth's kitchen and garage approximately 3 months before disease onset, but the patient had no known direct or indirect contact with the rodents.
RAT DROPPINGS
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Originally Posted by Leon Blum - For All Mankind
- Proud Horseman of the Presence 
. If it was a houserat that left the droppings, your chances of an infection are even lower, because infections normally spread in sizeable rat populations. 
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