Hantavirus pulmonary syndrome — DTM&H MCQ

Correct answer: A — Hantavirus pulmonary syndrome

The correct answer is A, Hantavirus pulmonary syndrome. The vignette describes exposure to a rodent infested dwelling in the Americas followed by a prodrome of fever and myalgia that rapidly progresses to non-cardiogenic pulmonary oedema and shock, which is the classic cardiopulmonary phase of New World hantavirus infection caused by inhalation of aerosolised rodent excreta. This capillary leak syndrome, driven by immune mediated endothelial dysfunction, typically evolves over hours to days after a nonspecific febrile prodrome, exactly as described. Rodent contact in an enclosed, poorly ventilated hut in Central or South America is the textbook exposure risk highlighted in UK travel health guidance. There is no antiviral treatment; management is supportive, with early recognition and intensive care access being the key determinant of survival. Why the other options are wrong: B Influenza: causes fever and myalgia but does not typically progress within days to profound capillary leak pulmonary oedema and shock, and has no specific link to rodent exposure. C Melioidosis: linked to soil and water exposure in Southeast Asia and northern Australia, not rodent contact in Central America, and usually causes pneumonia or abscesses over a more indolent course. D Leptospirosis: also follows rodent urine exposure but classically causes Weil disease with jaundice, renal failure and conjunctival suffusion rather than a predominantly cardiopulmonary shock picture. E Lassa fever: transmitted by rodents but confined to West Africa, and presents with haemorrhagic fever features rather than the abrupt pulmonary oedema and shock syndrome described here. Key point: rodent exposure in the Americas followed by a febrile prodrome that rapidly progresses to capillary leak pulmonary oedema and shock points to hantavirus pulmonary syndrome, not leptospirosis or influenza.

Reference: NaTHNaC TravelHealthPro, Hantavirus factsheet, 2024, https://travelhealthpro.org.uk/disease/66/hantavirus