Hemorrhagic Fevers - part 2

Today I think I had my second unexpected run in with hemorrhagic fevers. I was hoping the Bundibugyo Ebola virus would be my first and last encounter, but sadly not so. The following is a little clinical in wording, but please bear with me.

Today I saw an otherwise healthy 26 year-old male who was having constant headaches and fevers x 4 days. He was also having photophobia, mild lateral neck tenderness, and some generalized muscle cramps. His exam was pretty normal, except his temp was 102, he had some LUQ tenderness, and some bilateral calf tenderness with deep palpation.

I was worried about meningitis, and I just thought he looked sick. The flu test was negative (I have seen several positive flu cases in the past few days). I checked his CBC and his platelets were 69. His WBC was normal, but I had the lab do a smear, and they found a large left shift with 25 bands and numerous atypical looking cells. He also had an extremely elevated LDH. The lab tentatively called it Hantavirus after looking at the smear! Hantavirus is a form of hemorrhagic fever, but it is not spread through human to human contact. It is only spread through rodents, especially mouse feces or urine that dries out and become dust particles. Even if it truly is Hantavirus, I am at no risk of contracting it from him.

So after talking with numerous infectious disease docs from all over New Mexico, it appears the patient really does have hantavirus!! It is extremely rare, but of the few cases reported in the United States in the past 15 years, the southwest is where most have happened. I won't have all the confirmation results until tomorrow, but I ended up having to care flight him to Albuquerque, New Mexico to be admitted to the intensive care unit. Everyone I work with was alarmed about hemorrhagic fevers after hearing this, but I told them this was my second run in with hemorrhagic fevers, unfortunately...now they want me to do a CME for the entire emergency/urgent care department.

Anyways, if it truly is hantavirus there is about a 40% fatality rate. I would covet your prayers for this young gentleman. He was so scared when I told him what was going on, he just began to weep. His family was equally as scared when they arrived at the hospital, a few moments earlier thinking that their loved one had a bad cold or even flu, but now being told he may have a very deadly disease. My heart breaks for him, and I hope it truly is not hantavirus but something much less harmful instead. I’ll keep you posted.