On October 22, 1993, a previously healthy 33-year-old resident
of Dade County, Florida, was hospitalized for an illness associated
with hypotension, bilateral pulmonary infiltrates, rhabdomyolysis,
thrombocytopenia, and an elevated serum creatinine level; onset of
severe manifestations followed a 4-day febrile prodrome. His
azotemia rapidly resolved, but he required prolonged ventilatory
and circulatory support before discharge.
Routine bacterial cultures were negative. A serum sample
collected 11 days after onset of illness contained immunoglobulin
G (IgG) antibody when tested with Muerto Canyon virus (MCV)
antigen, but no antibody could be detected by immunoglobulin M
(IgM) capture enzyme-linked immunosorbent assay (ELISA); moreover,
the IgG titer was unchanged when a serum sample obtained 6 weeks
later was tested at CDC. The patient had not traveled outside of
Dade County within 6 months of onset of illness, but previously had
lived in a state where cases of hantavirus pulmonary syndrome (HPS)
and MCV-infected Peromyscus maniculatus have been confirmed (1).
The state, district, and county health departments and CDC
initiated an investigation to fully characterize the illness and
the prevalence of hantavirus seropositivity in the local rodent
population. Preliminary serologic findings indicated the presence
of hantavirus antibody in 12 (13%) of 90 Sigmodon hispidus (cotton
rat) trapped in Dade County as part of the investigation.
Hantavirus sequences were amplified by polymerase chain reaction
(PCR) from lung tissues of three cotton rats. Nucleotide sequence
analysis of amplified viral genetic material indicates that this is
a previously unrecognized hantavirus most closely related to but
distinct from both MCV (2,3) and the hantavirus identified in
Louisiana (4).
Reported by: H Anapol, MD, R Greenman, MD, M Kolber, MD, Jackson
Memorial Hospital, Univ of Miami School of Medicine; ED Sfakianaki,
MD, M Fernandez, MD, M Ares, MD, W Livingstone, MPH, L Rivera, Dade
County Public Health Unit, Miami; AM Bock, AR Neasman, MS, District
XI, WG Hlady, MD, RS Hopkins, MD, State Epidemiologist, Florida
Dept of Health and Rehabilitative Svcs. GE Glass, PhD, Johns
Hopkins Univ, Baltimore. Hantavirus Task Force, Special Pathogens
Br, Div of Viral and Rickettsial Diseases, National Center for
Infectious Diseases, CDC.
Editorial Note
Editorial Note: The findings in this report indicate that evidence
of infection with a newly recognized strain of hantavirus is
present in rodents in Dade County. Although the prodrome and
clinical illness in the patient in Dade County resembled HPS, the
laboratory findings were not diagnostic of an acute hantavirus
infection. Molecular studies are ongoing to determine whether the
lack of IgM ELISA reactivity at CDC potentially resulted from use
of available heterologous hantavirus antigens.
Since the identification of the first pathogenic U.S.
hantavirus in June 1993, HPS has been well characterized, its
etiologic agent (MCV) isolated, its primary rodent reservoir (P.
maniculatus) identified, and specific diagnostic assays developed
(1,5). In addition, in August 1993, the sequence of a second unique
hantavirus was identified in tissues of a Louisiana resident who
died of HPS-like illness (4); however, the reservoir associated
with this hantavirus has not been determined. The results of the
PCR analysis described in this report are consistent with a third
new U.S. hantavirus from a distinct rodent reservoir, S. hispidus,
with an ecologic range extending throughout the southeastern and
the southcentral United States (6).
The pathogenicity of the new hantavirus to humans is unknown.
Therefore, residents of the southeast as well as persons residing
within range of P. maniculatus (7) should minimize exposure to
rodents and their excreta (8). Suspected cases of HPS should be
reported to CDC through state health departments (1).
References
CDC. Hantavirus pulmonary syndrome -- United States, 1993. MMWR
1994;43:45-8.
Hjelle B, Jenison S, Torrez-Martinez N, et al. A novel
hantavirus associated with an outbreak of fatal respiratory disease
in the southwestern United States: evolutionary relationships to
known hantaviruses. J Virol 1994;68:592-6.
Nichol ST, Spiropoulou CF, Morzunov S, et al. Genetic
identification of a hantavirus associated with an outbreak of acute
respiratory illness. Science 1993;262:914-7.
CDC. Update: hantavirus disease -- United States, 1993. MMWR
1993;42:612-4.
Feldmann H, Sanchez A, Morzunov S, et al. Utilization of autopsy
RNA for the synthesis of the nucleocapsid antigen of a newly
recognized virus associated with hantavirus pulmonary syndrome.
Virus Res 1993;30:351-67.
Cameron GN, Spencer SR. Sigmodon hispidus. Mammalian Species
1981;158:1-9.
Hall RE. Peromyscus maniculatus. In: Mammals of North America.
2nd ed. New York: Wiley, 1981;670-83.
CDC. Hantavirus infection -- southwestern United States: interim
recommendations for risk reduction. MMWR 1993;42(no. RR-11).
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