Intersecting Paths of Emerging and Reemerging Infectious Diseases

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shares common clinicopathologic features with other severe pulmonary illnesses. Hantavirus pulmonary syndrome was diagnosed in 2 patients in Arizona, USA, suspected of dying from infection with SARS-CoV-2. Differential diagnoses and possible co-infections should be considered for cases of respiratory distress during the SARS-CoV-2 pandemic.

Keywords: COVID-19; HPS; Peromyscus maniculatus; SARS-CoV-2; Sin Nombre virus; co-infection; coronavirus disease; differential diagnoses; hantavirus; hantavirus pulmonary syndrome; histopathology; immunohistochemical analysis; pathology; respiratory infections; severe acute respiratory syndrome coronavirus 2; vector-borne infections.

Figure

Histopathologic and immunohistochemical characteristics of fatal hantavirus pulmonary syndrome in 2 patients, Arizona, USA, 2020. A) Patient 1 lung tissue, showing intravascular leukocytosis with left shift (left, original magnification ×50) and hantavirus antigen immunostaining (red) in pulmonary microvasculature (right, original magnification ×158). B) Patient 1 spleen tissue, showing immunoblast proliferation in the red pulp and periarteriolar sheaths (left, original magnification ×50) and immunoblasts with high nuclear to cytoplasmic ratio, vesicular and prominent nucleoli (arrows) and mitosis (arrowhead) (right, original magnification ×158). C) Patient 2 lung tissue, showing severe intraalveolar edema (original magnification ×12.5). D) Patient 2 lung tissue, showing interstitial pneumonitis with hyaline membranes (arrows) (original magnification ×50). E) Patient 2 lung tissue, showing hantavirus antigen immunostaining (red) in pulmonary microvasculature (left, original magnification ×50; right, original magnification ×158). F) Patient 2 kidney tissue, showing hantavirus antigen immunostaining (red) in glomerular capillaries (arrowhead) and interstitial vessel (arrow) (original magnification ×100).