Hantavirus Infections in Children

Hantaviruses are rare but deadly pathogens. New World hantaviruses, primarily present in North and South America, cause hantavirus cardiopulmonary syndrome, which leads to death in up to one-third of affected patients. Old World hantaviruses, primarily endemic to Europe and Asia, cause hemorrhagic fever with renal syndrome and, dependent on the specific hantavirus, may cause death in up to 15% of patients. A heightened clinical suspicion is important for diagnosis of these conditions because important epidemiologic clues may exist at the time of presentation. A variety of testing modalities exist, from evaluation of blood smears (for hantavirus cardiopulmonary syndrome and may be available at many rural clinics) to serological evaluation and polymerase chain reaction testing (available at tertiary care centers or as a send-out to a reference laboratory). Despite the absence of proven antiviral therapies for many of these viruses, supportive care present at tertiary-level medical centers including invasive cardiovascular monitoring, mechanical ventilation, and access to dialysis (for hemorrhagic fever with renal syndrome) and extracorporeal membrane oxygenation (for hantavirus cardiopulmonary syndrome) may improve outcomes. Given the high risk of death as well as the potential for these patients to decompensate rapidly over 24 hours, early recognition of hantavirus infections and transfer to a tertiary medical center is imperative. The nonspecific prodrome, which mimics more common viral illnesses ubiquitous in children, as well as a more rapid progression to death in children than adults with hantavirus cardiopulmonary syndrome, highlights the need for pediatricians to remain vigilant for this rare and dangerous disease.