NOTES

NOTES
BUNYAVIRUSES

MICROBE OVERVIEW
▪ Bunyaviruses: RNA virus order Morphology
▪ AKA Bunyavirales ▪ Enveloped (outer lipid membrane)
▪ Spherical
Genetic material
▪ Size: 90–100nm
▪ Negative-sense, single-stranded RNA
▪ Tripartite genome Replication
▫ Large (L) segment (encodes RNA- ▪ Host cytoplasm replication
polymerase); medium (M) segment
(encodes surface glycoproteins); small Transmission
(S) segment (encodes nucleocapsid ▪ Vector-borne, person-to-person, contact
proteins) with reservoir (species-dependent)
▪ Reservoirs: arthropods, mammals
(especially rodents

Figure 58.1 Families of the Bunyavirus order and associated clinical syndromes.

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 HANTAVIRUS
osms.it/hantavirus
▪ ↑ vascular permeability → ↓ blood pressure
PATHOLOGY & CAUSES → kidney endothelial dysfunction
▪ Hantavirus cardiopulmonary/pulmonary
▪ Single-stranded RNA virus genus → syndrome (“New World” AKA North, South
causes severe renal/pulmonary disease America)
▪ AKA Orthohantavirus ▪ ↑ vascular permeability → non-cardiogenic
▪ Hantaviridae family pulmonary edema
▪ Reservoir
▫ Rodents (mice, voles, shrews, rats) CAUSES
▪ Incubation period ▪ Rodents (urine/feces/saliva particle
▫ 9–33 days inhalation); person-to-person (rare)
▪ Tissue tropism
▫ Lymphoid organ, heart, lung, kidney RISK FACTORS
vascular endothelium
▪ Rural indoor spaces (e.g. barns)
▪ Hantavirus inhalation → lung phagocytosis
▪ Wild rodent exposure
→ transport to lymph nodes → hantavirus
enters epithelial cells using beta-3 integrins ▪ Smoking → Puumala virus infection risk
→ ↑ vascular permeability → dissemination ▪ ↑ risk among biological males
▪ Immune response
▫ CD4+/CD8+ cytotoxic T cells, dendritic COMPLICATIONS
cells ▪ Cardiogenic shock, pulmonary edema,
▪ High-prevalence regions arrhythmia, renal insufficiency, acute kidney
▫ China, Russia, Europe injury (AKI), coagulopathy, disseminated
intravascular dissemination (DIC),
Associated clinical syndromes hemorrhage; high mortality rate
▪ Hemorrhagic fever + renal syndrome (“Old
World” AKA Asia, Europe)

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 Chapter 58 Bunyaviruses

Urinalysis
SIGNS & SYMPTOMS ▪ Renal syndrome: proteinuria, hematuria
Pulmonary syndrome Tissue biopsy
▪ Systemic ▪ Kidneys: edema, perirenal hemorrhage,
▫ Fever, chills, myalgia, headaches, tubular destruction
weakness ▪ Lungs: edema, mononuclear cell infiltrates,
▪ Nausea, vomiting, diarrhea, abdominal pain, tracheal/pleural fluid, hyaline deposits
cough, oliguria ▪ Lymphoid organs: mononuclear cell
▪ Sometimes conjunctivitis, flushing, infiltrates
petechiae

Hemorrhagic fever + renal syndrome TREATMENT

▪ Fever, hypotension, malaise, headache,
diffuse hemorrhage (e.g. petechiae, melena, MEDICATIONS
ecchymoses), abdominal/loin pain, nausea/ ▪ Renal syndrome antivirals
vomiting, oliguria
▫ Nucleoside analogue

DIAGNOSIS OTHER INTERVENTIONS

▪ ICU monitoring, mechanical ventilation
DIAGNOSTIC IMAGING ▪ Severe cases
Chest X-ray ▫ Extracorporeal membrane oxygenation
(ECMO), dialysis, platelet transfusion
▪ Lungs: bilateral pulmonary infiltrates,
pleural effusion Prevention
Abdominal ultrasound ▪ Potential rodent nesting site removal (e.g.
debris, garbage)
▪ Kidneys: ↑ size, perirenal fluid
▪ Closed spaces ventilation
▪ Avoid rodent contact
LAB RESULTS
▪ Reverse-transcriptase polymerase chain
reaction (RT-PCR)

Tests
▪ Diagnostic triad: thrombocytopenia,
↑ immunoblasts (> 10%), left-shifted
granulocytic series
▪ ↑ lactate dehydrogenase (LDH), serum
lactate
▪ ↑ liver enzymes
▪ ↑ C-reactive protein
▪ Severe
▫ ↑ hemoglobin, hematocrit; ↓ albumin;
altered coagulation tests
▪ Renal syndrome
▫ ↑ serum creatinine, ↓ glomerular filtration
rate (GFR)

Serologic tests
▪ IgM/IgG detection through ELISA,
strip immunoblot, Western blot,
immunofluorescence

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