Acute Hantavirus Infection Presenting With Fever and Altered Mentation in the Absence of Pulmonary or Renal Manifestations

Abstract

Illness caused by hantaviruses is often severe and is typically characterized by diffuse pulmonary disease or renal insufficiency depending on the type of hantavirus. Here we report 2 cases of hantavirus infection that resulted in severe cognitive impairment but did not have any pulmonary or renal manifestations. These 2 cases may be indicative of previously underreported symptoms of hantavirus infection and might represent examples of hantavirus-related encephalopathy.

Keywords: hantavirus pulmonary syndrome; orthohantavirus.

Figure 1.

Timeline of patient care. Abbreviations: +, abnormal; -, normal; Ab, antibody; AFB, acid-fast bacilli; Ag, antigen; ANA, anti-nuclear antibodies; bld, blood; cfDNA, cell-free DNA; con, contrast; COVID-19, coronavirus disease 2019; CSF, cerebrospinal fluid; CT, computed tomography; GI, gastrointestinal; HIV, human immunodeficiency virus; IV, intravenous; MSSA, methicillin-susceptible Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; PCR, polymerase chain reaction; RF, Rheumatoid Factor; T_max, Maximum body temperature in a 24 hour period; VDRL, Venereal Disease Research Laboratory.

Figure 2.

Hantavirus enzyme-linked immunosorbent assay (ELISA) testing results. Hantavirus serology was a semi-quantitative ELISA test. A value of ≥1.75 indicates a positive result for immunoglobulin M (IgM) antibodies and ≥1.1 indicates a positive result for immunoglobulin G (IgG) antibodies. Values of <0.9 and <0.8 indicate a negative result for IgM and IgG antibodies, respectively. All ELISA values are calculated by dividing the sample optical density by the cutoff value derived from positive and negative controls. *Hantavirus serology tested for 2 classes of hantavirus: Eurasian (Old World) and American (New World). Eurasian tests detected the antigen for the nucleocapsid protein of Hantaan virus, Puumala virus, and Dobrava virus; American tests detected the antigen for the nucleocapsid protein of Sin Nombre virus and Andes virus.