Patient Presentation
A 17-year-old male came to clinic with general tiredness and sore throat for about 2 weeks after returning to the United States from a trip to the Middle East. He had previously been well and he described the sore throat as more irritation than actual pain. He said that he had not been sleeping well because he still felt he had not time shifted since the trip. Additionally, he had restarted classes and begun a new sport team. There were no known strep throat or Epstein-Barr virus exposures. He was worried that he had Hantavirus because during his trip in his hotel room he had seen a rat. Internet information had told him that rats caused Hantavirus.
The review of systems was otherwise negative.
The pertinent physical exam showed a healthy appearing male. Throat examination showed a mildly injected posterior throat without exudates. The rest of his examination was negative including lungs and abdomen. The diagnosis of viral pharyngitis and tiredness secondary to inadequate sleep hygiene was made. Sleep hygiene was discussed with the patient as well as symptomatic treatment for the pharyngitis. The physician also explained that Hantavirus was unlikely as he had not traveled in the southwest and other areas of North American nor South America. He also had not experienced, at least yet, the symptoms associated with it. He was to return to clinic if symptoms worsened or persisted.
Discussion
Hantavirus pulmonary syndrome is a rare but potentially deadly disease transmitted by rodents. It was first discovered in 1993 in the southwest United States. It is usually contracted through aerosolization of the urine and feces with respiratory inhalation. Incubation can be up to 1-6 weeks. The prodrome occurs at 3-7 days with fever, chills, myalgia, headache, emesis, diarrhea, dizziness and sometimes cough. Extensive bilateral interstitial pneumonia with pulmonary edema and pleural effusions occur along with severe myocardial depression and hypotension. Treatment includes critical care support with possible extracorporeal membrane oxygenation. Ribavirin and steroids have been used in experimental trials. Mortality unfortunately is about 30-40%
Learning Point
Rodent spread diseases include:
- Hantavirus
- Virus – Bunyaviridae family
- Vector – Cotton rat, Rice rat, Deer mouse, White-footed mouse
- Location – North and South America
- Spread – Direct or respiratory contact of urine and droppings, bites occur infrequently
- Hemorrhagic Fever with Renal Syndrome
- Virus – Bunyaviridae family
- Vector – Brown or Norway rat, Striped field mouse, Yellow-necked field mouse, Bank vole
- Location – Eastern Asia, Balkans, Western Europe, Korea, Russia, Scandinavia
- Spread – Direct or respiratory contact of urine and droppings, bites occur infrequently, direct person-to-person contact is rare
- Lassa Fever
- Virus – Arenaviridae family
- Vector – Multi-mammate rat
- Location – West Africa
- Spread – Direct or respiratory contact or eating food with urine and droppings, bites occur infrequently, may spread by direct person-to-person contact
- Leptospirosis
- Bacteria – Leptospira genus
- Vector – rodents and other animals
- Location – Worldwide
- Spread – Eating food or water contaminated with infected animal urine, or direct contact with skin or mucous membranes with infected water or soil
- Lymphocytic Chorio-meningitis
- Virus – Lymphocytic choriomeningitis virus
- Vector – House mouse
- Location – Worldwide
- Spread – direct or respiratory contact of urine and droppings, bites occur infrequently
- Omsk Hemorrhagic Fever
- Virus – Flaviviridae family
- Vector – Muskrats, Narrow-skulled voles possibly
- Location – Western Siberia
- Spread – Direct contact with infected animal, or tick bite from infected tick
- Plague
- Bacteria – Yersinia pestis
- Vector – Wild rodents including wood rats, prairie dogs, rock squirrels, fox squirrels, other species of ground squirrels and chipmunks
- Location – Africa, Asia, South American, Western US
- Spread – Direct contact with infected animal, or flea bite from infected flea
- Rat-Bite Fever
- Bacteria – Streptobacillus moniliformis and Spirillum minue
- Vector – Rats, mice possibly
- Location – Worldwide
- Spread – Bite or scratch from infected rodent, direct contact with dead rodent, eating food or water contaminated with infected animal feces
- Salmonellosis
- Bacteria – Salmonella species
- Vector – Rats and mice
- Location – Worldwide
- Spread – Eating food or water contaminated with infected animal feces
- South American Arenavirus
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(including Argentine hemorrhagic fever, Bolivian hemorrhagic fever, Sabia-associated hemorrhagic fever, Venezuelan hemorrhagic fever)
- Virus – Arenaviridae family
- Vector – Cane rat, Drylands Vesper mouse, Vesper mouse
- Location – South American specifically Argentina, Bolivia, Venezuela and Brazil
- Spread – Direct or respiratory contact of urine and droppings, bites occur infrequently, also spread through direct person-to-person contact
- Tularemia
- Bacteria – Francisella tularensis
- Vector – Wild rodents including muskrats, ground squirrels and beavers
- Location – Worldwide
- Spread – Direct contacted with infected animal carcasses, respiratory contact, insect bite from infected insects including ticks and deerflies, eating contaminated food or water
Questions for Further Discussion
1. What diseases are spread by common pets?
2. What diseases are spread by domesticated animals?
3. How can you prevent spread of rodent-borne diseases?
Related Cases
- Symptom/Presentation: Fatigue | Sore Throat
- Age: Teenager
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for these topics: Animal Diseases and Hantavirus.
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
American Academy of Pediatrics. Hantavirus, In Pickering LD, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th edit. Elk Grove Village, IL: American Academy of Pediatrics; 2009;321-323.
Centers for Disease Control. All About Hantaviruses.
Available from the Internet at http://www.cdc.gov/ncidod/diseases/hanta/hps/index.htm (rev. 1/14/2010, cited 1/24/11).
Centers for Disease Control. Diseases directly transmitted by rodents.
Available from the Internet at http://www.cdc.gov/rodents/diseases/direct.html (rev. 7/29/2010, cited 1/24/11).
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients’ is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
4. Patient management plans are developed and carried out.
5. Patients and their families are counseled and educated.
8. Health care services aimed at preventing health problems or maintaining health are provided.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
17. A therapeutic and ethically sound relationship with patients is created and sustained.
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital
Pediatric Education 