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Probable Hantavirus Pulmonary Syndrome That Occurred in New Mexico in 1975
- Charlton Wilson, MD;
- Brian Hjelle, MD; and
- Steven Jenison, MD
- United States Public Health Service Indian Hospital; Mescalero, NM 88340 University of New Mexico School of Medicine; Albuquerque, NM 87131 Disclaimer: The opinion expressed is that of the authors and does not necessarily reflect the opinion of the U.S. Public Health Service.
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TO THE EDITOR:
We describe a case of acute pulmonary disease consistent with the hantavirus pulmonary syndrome [1-3].
In March 1975, fever and severe myalgias developed in a 37-year-old Native American ranch hand from New Mexico. He was hospitalized 3 days later with dyspnea and hypoxemia. Laboratory findings were as follows: arterial blood pH, 7.48; PCO2, 22 mm Hg; PO2, 41 mm Hg; hematocrit, 0.59; leukocyte count, 31 900 × 106/L; and platelet count, 44 000 × 106/L. Peripheral blood contained immature neutrophils, including promyelocytes. Serum protein was 49 g/L, albumin was 28 g/L, lactate dehydrogenase level was 8.10 µkat/L, and aspartate aminotransferase was 1.33 µkat/L. A chest radiograph showed bilateral lower-lobe infiltrates. Bacterial cultures of sputum, blood, bone marrow, and cerebrospinal fluid were negative. Acid-fast bacilli cultures of sputum and bone marrow were negative. Cold agglutinins were not found.
On the fifth day of illness, a chest radiograph showed pulmonary infiltrates suggestive of the adult respiratory distress syndrome. Respiratory insufficiency necessitated mechanical ventilation. The patient's arterial blood pH was 7.23, his PO2 was 72 mm Hg, and his PCO2 was 54 mm Hg with a delivered oxygen concentration of 1.0. His platelet count was 20 000 × 106/L. His respiratory status improved, and he was extubated after 5 days. His platelet count was normal. The discharge diagnosis was viral pneumonia.
Since then, he has been generally healthy. During a November 1993 clinic visit, it was noted that the 1975 illness resembled the hantavirus pulmonary syndrome. No samples from 1975 were available. A serum sample obtained on 16 November 1993 was tested for antibodies to Four Corners hantavirus nucleocapsid and glycoprotein-1 recombinant proteins by Western immunoblot assay [3-5]. The serum contained IgG antibodies to both Four Corners hantavirus nucleocapsid and glycoprotein-1 proteins; no IgM reactivities were detected. Nucleocapsid and glycoprotein-1 IgG reactivities were mapped to the same antigen locations as antibodies from patients with acute hantavirus pulmonary syndrome [5]. Because the clinical features of the 1975 illness are highly suggestive of the syndrome, we believe it represents remote Four Corners hantavirus infection as confirmed by serologic test results.
Charlton Wilson, MD
United States Public Health Service Indian Hospital; Mescalero, NM 88340
Brian Hjelle, MD
Steven Jenison, MD
University of New Mexico School of Medicine; Albuquerque, NM 87131
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
