Hantavirus Pulmonary Syndrome (HPS): Nea Enti a Ɛnsɛ sɛ Woprapra Mpɔtorɔ Nsu a Ɛyow anaa Fa Vacuum Mu Da wɔ Cabin anaa Shed mu¶

Sɛ wubue bere mu dan a wɔato mu, adekoradan, adidibea, abansoro dan, kar dan, baabi a wɔwea, anaa RV/camper a esi hɔ na wuhu mpɔtorɔ nsu a ayow anaasɛ nneɛma a wɔde yɛ berebuw a wɔabubu a, sɛ wobɛfa broom, whisk brush, anaa ofie vacuum cleaner de aprapra basabasayɛ no mu a, ɛyɛ mfomso a ɛde wo nkwa to asiane mu. Dry-sweeping anaa vacuuming aerosolizes microscopic nneɛma nketenkete a ɛwɔ mprako nsu, nnompe, ne nsu a ayow a Hantavirus (such as Sin Nombre virus carried by the North American Deer Mouse, or Puumala and Dobrava viruses in Europe and Asia) tẽẽ kɔ mframa mu, baabi a wohome mmoawa no kɔ w’ahurututu mu tɔnn. Sɛ obi nya atiridiinini, atiridiinini, ntini mu yaw kɛse (especially in the thighs, hips, back, and shoulders), tiyɛ, akisikuru, anaasɛ ɔfe wɔ mu 1 to 8 weeks sɛ wobɛhyɛn ɔdan a mpɔtorɔ ahyɛ mu ma mu - a nnafua 3 kosi 5 akyi no, ɔfe a ɛyɛ kusuu anaasɛ ahome a ɛyɛ tiaa mpofirim, frɛ wo mpɔtam hɔ nɔma a egye ntɛmpɛ denam yɛn nɔma ahorow a egye ntɛmpɛ directory na kɔ ayaresabea a ɛto so abiɛsa Emergency Department a ECMO (Extracorporeal Membrane Oxygenation) tumi ahorow ntɛm ara. Afei nso san hwɛ yɛn akwankyerɛ ahorow a ɛfa sepsis ne septic shock a wohu, . leptospirosis (Weil yare) a efi nsuyiri nsu ne mpɔtorɔ nsu mu ba, . aduru a ekum mogya a ɛko tia mmoawa a wɔde kum mmoawa (rat poison) a wɔnom, na mmoa a wɔka wɔn ne rabies a wɔde siw ano.

Sɛnea Asoɛe a Ɛhwɛ Nyarewa So na Wosiw Ano (CDC), Pan Amerika Akwahosan Ahyehyɛde (PAHO / WHO), ne Europa Asoɛe a Ɛhwɛ Nyarewa a Wosiw Ano ne Nea Wosiw So (ECDC), Hantavirus Ahurututu mu Yare (HPS, a wɔsan frɛ no Hantavirus Koma ne Ahurututu mu Yare / . HCPS) kura asɛm-owu dodow a ɛyɛ 35% to 38% (and up to 50% wɔ Andes mmoawa a ɛpae a emu yɛ den mu) - mpo wɔ mmerante ne mmabaa a wɔadu mpanyin afe so a wɔwɔ apɔwmuden a wonni ayaresa tebea biara a edi kan no mu. Nea ɛma Hantavirus Pulmonary Syndrome yɛ nnaadaa na edi awu kɛse wɔ nnuru a egye ntɛmpɛ mu ne ne ayaresa afiri a ɛwɔ afã abien: wɔ nnafua 3 kosi 6 a edi kan no mu (the Febrile Prodrome), ɔyarefo no te sɛ nea ɔwɔ atiridii anaa ɔyare mmoawa a ɛma obi nya yafunu mu yare ara kwa (fever, severe thigh/back muscle aches, headache, nausea, abdominal pain, and a completely clear chest X-ray with ZERO runny nose or sore throat), enti ayaresabea ahorow a wɔhwɛ wɔn a egye ntɛmpɛ no de wɔn kɔ fie daa. Afei, a ɔmmɔ kɔkɔ no, ɔyarefo no hyɛn Cardiopulmonary Capillary-Leak Phase mu, faako a mmoawa no ma ahurututu mu ntini a ɛwɔ ahurututu no mu no yɛ nea ɛretu kɛse, de mogya mu nsu a protein pii wom ma ahurututu abien no nyinaa fi mu kɔ akyi wɔ nnɔnhwerew 4 kosi 8 pɛ mu bere a bere koro no ara ɛma koma ntini no yɛ basaa (cardiogenic + non-cardiogenic shock). Nea enye koraa no, sɛ oduruyɛfo bi a ɔhwɛ ayaresabea a wɔhwɛ wɔn a wɔwɔ ayaresa a egye ntɛmpɛ mu di mfomso bu Hantavirus ɔyarefo bi sɛ ɔyare mmoawa a wɔsɛe no daa na ɔde nkyene bolus a wɔde fa ntini mu a ɛdɔɔso a wɔahyɛ da ayɛ ( ) ma no a.30 mL/kg), saa nsu a ɛboro so no hwie fa ahurututu mu ntini a ɛretu no mu tẽẽ na ɛmene ɔyarefo no wɔ stretcher no so. Mastering CDC Wet-Bleach Rodent Cleanup Protocol ne Mogya a Wɔde Siesie Nnipa 5 Ho Nhwehwɛmu Mmara (Hantavirus Triad) gye nkwa.

Yɛ eyi mprempren¶

1. SƐ wohu mpɔtorɔ nsuo, wɔn berebuw, anaa mprako a wɔawuwu wɔ ɔdan, ɔdan ketewa, ɔdan atifi, kar engine dan, anaa dan ase a, GYINA ntɛm ara: MFA broom nprapra dry-sweep DA, MFA vacuum cleaner (HEPA shop-vac mpo) nni dwuma DA, na MMFA ahaban a wɔde bɔ anaa mframa a wɔahyɛ no den mmɔ mfutuma DA. Sweeping anaa vacuuming launches millions of a wontumi nhu 1-to-5-micron mfutuma a mmoawa ahyɛ mu ma no kɔ wo home beae a ɛsensɛn mframa a ɛnyɛ den mu nnɔnhwerew pii.
2. Fa mframa di kan hyɛ baabi a wɔato mu no mu anyɛ yiye koraa no 30 full minutes denam abɔnten apon ne mfɛnsere a wubebue na woasan anantew AKYI (staying upwind while fresh outdoor air flushes the room). Hantavirus yɛ RNA mmoawa a wɔakata so ( RNA virus a wɔakata so ( )Bunyavirales / Orthohantavirus) a ne lipid envelope no yɛ adwuma ntɛmntɛm denam abɔnten ultraviolet ( .UV) owia hann ne mframa pa a wɔde hyɛ mu.
3. Fa rɔba/nitrile nsateaa (ne an N100 / P100 anaasɛ FFP3 particulate respirator for heavy infestations), afei FA nsuo, wɔn berebuw, ne mpɔtorɔ a wɔawuwu nyinaa fa aduru a wɔadi afra foforo no mu yiye 1:10 Household Bleach Solution (1 part liquid chlorine bleach to 9 parts water, anaa nnuru a wɔde kum mmoawa a wɔtɔn a wɔakyerɛw din wɔ EPA mu te sɛ Lysol) na ma ɛntra hɔ nsu ma 5 to 10 full minutes ansa na wode wo nsa aka biribiara. Sɛ wode nsuo no gu nsuo mu a, ɛma mfuturo no kɔ fam sɛdeɛ ɛbɛyɛ a ɛntumi nkɔ mframa mu berɛ a sodium hypochlorite no sɛe mmoawa no sradeɛ nkatasoɔ no 100%.
4. Fa krataa mpopaho a ɛyɛ nwini fa nsu a wɔde bleach ahyɛ mu ma ne nneɛma a wɔde yɛ berebuw no (MFA mpopaho DA), fa krataa mpopaho a ɛyɛ nsu ne mprako a wɔawuwu no to plastic nwura kotoku abien mu, na fa samina ne nsu hohoro wo nsa a wɔde nsateaa ahyɛ mu no ANSA na woayi wo nsateaa afi hɔ.
5. Sɛ wo nya atiridiinini (>= 38.0 C / 100.4 F), ntini mu yaw a emu dɔ ( .thighs, lower back, hips), tiyɛ, akisikuru, ɔfe, anaa akisikuru a ɛba obi mu 1 to 8 weeks (7 to 56 days) bere a woasiesie dan ketewa/adan mu, akɔtena nsraban mu, anaasɛ woadi nnua ho dwuma awie no: kɔ ayaresabea Dwumadibea a Ɛho Hia Ntɛmntɛm (sɛ mpo wo nnyaa ɔfe mpo a).
6. Ka nsɛm yi pɛpɛɛpɛ kyerɛ Emergency Room Triage Nurse and Physician wɔ sikani 30 a edi kan no mu: "I was exposed to rodent droppings / mice ___ weeks ago and now have fever and muscle aches. Please evaluate immediately for Hantavirus Pulmonary Syndrome (HPS), order a STAT Complete Blood Count (CBC) with manual peripheral blood smear (checking for the Hantavirus Triad: thrombocytopenia, hemoconcentration, and immunoblasts), and AVOID aggressive IV fluid boluses that can trigger fatal pulmonary edema." **

Gyinaesi dua: Mpɔtorɔ a wɔtew ho a ahobammɔ wom ne Hantavirus Pulmonary Syndrome ayaresabea mu nhwehwɛmu¶

Di saa adwumayɛ ne ayaresabea nhyehyɛe yi akyi ma siw ano bere a wɔresiesie ne aduruyɛ mu nhwehwɛmu a egye ntɛmpɛ bere a wɔde wɔn ho ahyɛ mu akyi.

flowchart TD
    Start["Mpɔtorɔ Nsu, Berebuw, Nsu mu Nkekae, anaa Mpɔtorɔ a Awuwu a Wohu wɔ Cabin, Shed, Barn, Attic, Garage, anaa RV mu"] --> Scenario{"So Worehohoro Wo Ho Mprempren ANAA Worehu Nsɛnkyerɛnne Bere a Woakɔ Ase Bere Bi Awie no?"}

    Scenario -->|"RODENT DROPPINGS A WƆREHOROW MPREMPREN"| CleanRule["CDC 5-STEP WET-BLEACH CLEANUP PROTOCOL: 1. MFA dry-sweep, vacuum, anaa mfa mframa a wɔahyɛ no den nni dwuma DA 2. Bue apon & mfɛnsere nyinaa na fi ɔdan no mu SIMA 30 ma mframa nkɔ mu 3. Fa Nitrile Gloves + N100/P100 Respirator (ma berebuw a emu yɛ duru/a wɔato mu) 4. Spray 1:10 Bleach Solution (bleach kuruwa 1 kɔ nsuo nkuruwa 9) so gu nsuo/nsuo mu kɔsi sɛ ɛbɛtɔ yie -> Twɛn 5 kɔsi 10 FULL MINUTES 5. Fa krataa mpopaho a ɛyɛ nsuo popa -> Double-bag -> Fa bleach popa fam a ɛyɛ den -> Hohoro nsa a wode nsateaa ahyɛ mu ansa na woayi nsateaa"]

    Scenario -->|"NKYERƐKYERƐMU A WƆHWEHWƐ (Adapɛn 1 kosi 8 Bere a Mpɔtorɔ / Cabin / Shed / Firewood Exposure akyi) ."| ProdromeCheck{"Nsɛnkyerɛnne no Fa Bɛn na Ɛwɔ Hɔ?"}

    ProdromeCheck -->|"STAGE 1 FEBRILE PRODROME (Nna 1 kosi 5): Atiridiinini (>38 C / 100.4 F), Atiridiinini, Ntini mu yaw a emu yɛ den (Asen, Asen, Akyi), Tiyɛ, Akisikuru/Afe/Yafunu mu yaw, Adwene a ɛyɛ yaw (Hyɛ no nsow: Mpɛn pii no, hwene mu nsu anaa menewa a ɛyɛ yaw NNI hɔ)"| ERTriage["HOSPITAL ER TRIAGE A ƐYƐ NTƐM (MMMA AYARESABEA MMƆ NSƐM SƐ ‘AFRI’): 1. Kɔ Ayaresabea Emergency Department Ntɛm ara 2. Da rodent/cabin exposure adi -> Bisa STAT CBC a Manual Blood Smear + Chest X-Ray 3. Hwɛ CBC sɛ Hantavirus Triad 5-of-5: - Falling Platelets (<150,000/uL - nsɛnkyerɛnne a edi kan) - Hematocrit/Hemoglobin a ɛkɔ soro (Hemoconcentration fi capillary leak mu) - WBC dodow a ɛsakra benkum so a >10% Atypical Lymphocytes (Immunoblasts)"]

    ProdromeCheck -->|"STAGE 2 CARDIOPULMONARY CRASH (Nna 4 kosi 7 - Nnɔnhwerew 4 Mfɛnsere): Ɔfe a Ɛyɛ Dry, Ɔhome a Ɛyɛ Tiaa, Ɔhome a Wɔhome Ntɛmntɛm (>22/simma), SpO2 <94%, Ahurututu a Ɛwɔ Akyi Abien, Awɔw a Ɛwɔ Akyi, anaa Mogya Nhyɛso a Ɛkɔ fam"| ECMORush["ECMO & ICU NSƐM A ƐTO SO AHYƐDE (38% Owuo): 1. Frɛ 911 / 112 / 999 -> Bisa Ntɛm ara sɛ wɔmfa obi nkɔ Tertiary ECMO Center 2. ICU MMRA A ƐHO HIA: - NSƐM A ƐHO HIA (MMFA 30 mL/kg sepsis crystalloid boluses mma) - Early Vasopressor + Inotrope (Norepinephrine + Dobutamine) ma Koma/Capillary Shock - VA-ECMO Cannulation a wɔde ma ntɛm sɛ Koma no Index <2.0 L/min/m2 anaa PaO2/FiO2 <60 a"]

    ERTriage -->|"Sɛ Mprɛte a Ɛretɔ (<150k) anaasɛ Interstitial Kerley B Lines wɔ Chest X-Ray so a"| ECMORush

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Ɔfã 1: Sɛnea Wobehu Mpɔtorɔ a Asiane Kɛse ne Mmeae a Wɔde Wɔn Ho Hyehyɛ Mu a Ahintaw (Why You Never Have to Touch a Mouse to Get Hantavirus) .¶

Awiei 70% ayarefo a wɔahu sɛ wɔwɔ Hantavirus Pulmonary Syndrome no bɔ amanneɛ sɛ wɔanka mmoawa a wɔte ase anaa wɔawuwu da. Mmom no, wɔhome mfutuma nketenkete a ɛte sɛ nea ɛwɔ hɔ bere a wɔreyɛ adwuma, ada, anaa wɔresiesie baabi a wɔato mu a wuram mpɔtorɔ atow wɔn ho anaasɛ wɔatow wɔn ho agu adapɛn bi a atwam no mu no.

1. Nneɛma a Wɔde Yɛ Nnuruyɛfo Titiriw ( .New World HPS vs. Old World HFRS) .¶

Wɔakyekyɛ hantavirus mu ayɛ no asasesin ne ayaresabea mmusua abien, na wuram mpɔtorɔ akorae pɔtee bi na ɛde emu biara kɔ (note: common domestic pet hamsters/gerbils and urban house mice *Mus musculus* do NOT carry Sin Nombre HPS virus): .

2. Mmeae Ason a Ahintaw a Nkurɔfo Hom Hantavirus a Wonhu¶

1. Sesonal Cabin, Hunting Shack, Outbuilding, anaa Barn a wobɛbue wɔ Ahohuru Bere/Awɔw Bere mu: Sɛ wobɛdan ɔdan atifi fan, wobɛwosow ntama/mattress a mfutuma ayɛ mu ma wɔ baabi a mprako nantew wɔ awɔw bere mu, anaasɛ wobɛprapra adididan mu fam.
2. Kar & RV Mframa a Wɔde Yɛ Adwuma Vents ne Cabin Mframa Filters (A Major Overlooked Source): Akraman mprako taa wea kɔ soro kɔ HVAC blower dan a ɛyɛ hyew, cowl mframa a wɔde fa mu, ne engine dan a ɛwɔ kar, lɔre, afuw mu trakta, ne RV a esi hɔ mu, na wɔyɛ berebuw a wɔabubu a wɔde siw mframa ano wɔ cabin air filter no atifi pɛɛ. Sɛ wufi kar no ase na wodan heater anaa A/C fan no a, blower no pae mouse nsu ne nsu a wɔde aerosol ayɛ mu kɔ w’anim tẽẽ. Mfa mframa a wɔahyɛ no den bɔ kar dan mu mframa a wɔde mouse ayɛ mu da: fa Lysol/aduru a wɔde kum mmoawa gu berebuw no ase wɔ hood no ase bere a wohyɛ N100/P100 akataso ne nsateaa.
3. Nnua a Wɔaboaboa Ano a Wɔde Abasa a Wɔde Soa Wo Koma: Mpɔtorɔ yɛ wɔn berebuw wɔ abɔnten nnua a wɔaboaboa ano mu; nnua a ayow a wobɛma so na wode akuturuku no ho mfutuma abɔ wo kotoku mu aerosols a ɛyɛ nsu a ayow wɔ wo hwene ase pɛɛ.
4. Nnaka a Wɔde Siesie Nnaka a Wɔyɛ wɔ Attics, Basements, Crawlspaces, anaa Self-Storage Units mu.
5. Wɔda Tẽẽ wɔ Fam anaa Fam wɔ Akwantuo Dabere, Adidibea, anaa Ɔdan a Wɔantoto mu.

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Ɔfa 2: CDC Ɔmanfoɔ Anamɔn-Anamɔn Wet-Bleach Rodent Cleanup Protocol¶

Hantavirus tra ase bere tenten ahe wɔ mmoawa no akyi? Wɔ owia hann a ɛwɔ abɔnten tẽẽ mu no, UV mframa kum mmoawa no wɔ 2 to 3 hours. Nanso, wɔ dan ketewa a ɛyɛ sum, ɛyɛ nwini, ɛyɛ kusuu, ɔdan a wɔde nneɛma gu mu, ɔdan a wɔde nneɛma gu mu, anaa kar nsateaa adaka mu no, Hantavirus a ɛde ɔyare ba a ɛwɔ nsu a ayow anaa nsu a ɛyɛ fĩ mu no da so ara te ase na ɛyɛ ɔyare mmoawa ma 2 to 3 full days wɔ dan mu hyew mu (na ɛkɔ soro kodu 2 weeks wɔ mmeae a awɔw wom).

Mfa wo nsa nka broom anaa vacuum cleaner da. Di Anamɔn 6 Wet Decontamination Sequence yi pɛpɛɛpɛ akyi:

+-------------------------------------------------------------------------+
|  CDC STEP-BY-STEP WET-BLEACH RODENT DROPPINGS CLEANUP PROTOCOL          |
|                                                                         |
|  STEP 1: CROSS-VENTILATE FOR 30 MINUTES BEFORE ENTERING                 |
|  - Open all exterior doors, garage doors, and windows wide.             |
|  - Walk OUTSIDE and stay out for at least 30 FULL MINUTES so fresh air  |
|    exchanges the stagnant indoor air (never turn on indoor fans while   |
|    you are inside the room).                                            |
|                                                                         |
|  STEP 2: PUT ON PERSONAL PROTECTIVE EQUIPMENT (PPE)                     |
|  - Wear non-absorbent Nitrile, Latex, or Rubber Household Gloves.       |
|  - For light mouse droppings in a ventilated kitchen: gloves + eye      |
|    protection are sufficient if you strictly wet-spray without sweeping.|
|  - For HEAVY rodent infestations (piles of nests, dead mice, crawlspaces|
|    or unventilated attics): wear a tight-fitting NIOSH N100 or P100     |
|    Particulate Respirator (or European FFP3 mask) and unvented goggles. |
|                                                                         |
|  STEP 3: MIX FRESH 1:10 BLEACH SOLUTION & SOAK FOR 5 TO 10 MINUTES      |
|  - Mix 1 part household liquid chlorine bleach (5% to 8.25% sodium      |
|    hypochlorite) with 9 parts water (e.g., 1.5 cups / 360 mL of bleach  |
|    in 1 gallon / 3.8 Liters of water) in a pump/trigger spray bottle    |
|    (OR use a commercial phenol/quaternary disinfectant like Lysol if    |
|    bleach will ruin fabric/upholstery).                                 |
|  - Gently mist and SOAK all droppings, urine stains, nests, and dead    |
|    rodents until thoroughly wet (do not blast them with a hard jet).    |
|  - WAIT 5 TO 10 FULL MINUTES for the bleach to inactivate the virus.    |
|                                                                         |
|  STEP 4: WIPE UP WITH PAPER TOWELS & DOUBLE-BAG                         |
|  - Use disposable paper towels to pick up the wet droppings, nest, and  |
|    dead mouse. Place everything inside a plastic bag, seal it shut,     |
|    place that bag inside a SECOND plastic trash bag, seal it, and       |
|    place in an outdoor covered trash bin.                               |
|                                                                         |
|  STEP 5: WET-MOP FLOORS & STEAM/LAUNDER FABRICS                         |
|  - Mop hard floors and wipe countertops with the 1:10 bleach solution.  |
|  - Wash bedding/clothing in HOT water (`>= 60 C / 140 F`) with laundry  |
|    detergent and dry on HIGH heat (or leave heavy rugs/mattresses out   |
|    in direct bright noon sunlight for several hours after disinfecting).|
|                                                                         |
|  STEP 6: SAFE GLOVE REMOVAL                                             |
|  - Wash your GLOVED hands thoroughly with soap and water (or bleach     |
|    solution) FIRST, peel off the gloves turning them inside out, and    |
|    then wash your bare hands with soap and warm water for 30 seconds.   |
+-------------------------------------------------------------------------+

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Ɔfã 3: Hantavirus no Ayaresa mu Nneɛma Abien a Wohu (Why Urgent Care Doctors Mistake Phase 1 for the Flu) .¶

Efisɛ bere a Hantavirus no hyɛ mu no yɛ ** .1 to 8 weeks (median 14 to 21 days)** bere a ayarefo no home mfutuma no akyi no, wɔn werɛ taa fi sɛ wɔsiesiee ɔdan bi a wɔde nneɛma gu mu adapɛn abiɛsa a atwam no bere a wɔn atiridii fi ase no. Fa ayaresabea akwan abien a ɛsono emu biara ne sɛnea wobɛkyerɛ Hantavirus a ɛda nsow wɔ influensa a ɛyɛ daa anaa COVID-19 ho no gu wo tirim:

1. Ɔfã 1: Atiridiinini Prodrome (Days 1 to 5 - a wodi Diagnostic Sika Mfɛnsere no) .¶

Wɔ nnafua 3 kosi 5 a edi kan no mu (range 1 to 7 days), ɔyarefo no ɔfefe biara na ɔhome tiaa, na ne koko X-ray taa yɛ te sɛ nea ɛteɛ koraa: - Amansan Nsɛnkyerɛnne (Present in >90% of Patients): - atiridiinini a ɛkɔ soro mpofirim ( .38.3 to 40.0 C / 101 to 104 F) ne awɔw a ɛwosow. - Ntini mu yaw a emu yɛ den, a emu dɔ (myalgias) a ɛka ntini akuw KƐSE no (thighs, hips, lower back, and shoulders). - Ti a ɛyɛ yaw a ɛyɛ yaw wɔ anim, ɔbrɛ a emu dɔ, ne adwene a ɛyɛ no yaw / ti a ɛyɛ hare (orthostasis) na ɛyɛ. - GI Nkyerɛkyerɛmu (Present in 50% of Patients): - Akisikuru, ɔfe mpɛn pii, atiridiinini a nsu wom, ne yafunu mu yaw a ɛtrɛw (ɛtɔ mmere bi a emu yɛ den araa ma ɛsuasua appendicitis a emu yɛ den anaa yafunu mu yare). - #1 CLINICAL CLUE SƐ ƐNYƐ ƐNYƐ Atiridii ANAA Atiridiinini (Absence of Upper Respiratory Symptoms): - Nea ɛnte sɛ atiridiinini, COVID-19, RSV, anaa atiridiinini a ɛtaa ba no, ɛkame ayɛ sɛ Hantavirus prodrome ayarefo no nnya hwene mu nsu da (rhinorrhea), hwene a ɛyɛ den, ahurututu, menewa a ɛyɛ yaw ( .pharyngitis), anaasɛ sinus mu yaw. - Ayaresa Mmara: Fever + Severe Thigh/Back Muscle Aches + Nausea/Vomiting + ZERO Runny Nose or Sore Throat (1 to 8 weeks after rural/rodent exposure) = Wosusuw sɛ Hantavirus Kosi sɛ Wɔakyerɛ sɛ Ɛnyɛ saa.

2. Ɔfã 2: Koma ne Ahurututu mu Ntini a Ɛtwetwe (Starts Abruptly on Day 4 to 6) .¶

Sɛ wɔmmɔ kɔkɔ - mpɛn pii no bere a ɔyarefo no atiridiinini no fi ase bubu no ara pɛ - ɔyarefo no hyɛn Koma ne ahurututu Fa no mu: - Dɔnhwerew 0 kosi Dɔnhwerew 2: ɔfe a ɛyɛ kusuu mpofirim a ɛnyɛ nea ɛsow aba fi ase, a ne koko a ɛyɛ den kakra ne ɔhome a ɛkɔ soro ka ho (> 20 to 24 breaths per minute). - Dɔnhwerew 2 kosi Dɔnhwerew 6: Capillary endothelial nkwammoaa a ɛwɔ ahurututu abien no nyinaa mu no hwere akwanside no mudi mu kura: mogya mu mogya a protein pii wom (with an edema-fluid-to-serum protein ratio > 0.8) hwie fi mogya ntini no mu kɔ ahurututu no ntam ne ahurututu mu. Oxygen a ɛdɔɔso ( .SpO2) hwe ase fi 97% sian kɔ 80s na 70s. - Dɔnhwerew 6 kosi Dɔnhwerew 24 (The Myocardial Depression Trap): Nea ɛnte sɛ bacterial septic shock (which causes "warm shock" with high cardiac output and low vascular resistance), Hantavirus yi koma ntini mu adwenemhaw bi a ɛde Profound Cardiogenic Shock (low Cardiac Index < 2.0 L/min/m2, Systemic Vascular Resistance a ɛkorɔn SVR, awɔw a ɛyɛ nwininwini a ɛyɛ nsensanee, lactic acidosis, ne bradycardia/apɔw-mu-teɛteɛ a enni ahoɔden a ɛba mpofirim PEA kyere, titiriw bere a wɔde endotracheal intubation).

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Ɔfã 4: "Hantavirus Peripheral Blood Smear Triad" (How Any Hospital Lab Can Spot Hantavirus in 45 Minutes) .¶

Confirmatory Hantavirus IgM/IgG ELISA serology ne RT-PCR a wɔde kɔ ɔman akwahosan dwumadibea anaasɛ reference lab gye 24 to 72 hours - na ɔyarefo bi a ɔwɔ Cardiopulmonary Phase betumi awu wɔ ** nnɔnhwerew 6** mu. Nea eye ne sɛ, nhwehwɛmufo a wɔwɔ New Mexico Sukuupɔn (UNM, wiase no mu Sin Nombre Hantavirus ECMO adwumayɛbea a edi kan) daa no adi sɛ adeyɛ bi a wɔyɛ no daa Mogya Kan a Edi Mu (CBC) a wɔde Manual Peripheral Blood Smear a wɔyɛ wɔ ayaresabea lab biara mu wɔ simma 45 mu no hu Hantavirus a ** .> 95% nkate ne pɔteeyɛ** bere a anyɛ yiye koraa no, mogya ho gyinapɛn 5 yi mu 4 (including the "Hantavirus Triad") wɔ hɔ:

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Mpɔtam hɔ ntɛmpɛ nɔma ne adwumakuw no nhyehyɛe ahorow¶

Hantavirus yɛ mmoa a wɔhwɛ wɔn a wɔyare ntɛm ne reference-lab nkitahodi ahorow a wɔatu wɔn ho ama wɔ ɔman no mu:

• Amerika:
• Emergency Dispatch: Frɛ 911 na bisa sɛ wode wo bɛkɔ aduruyɛbea a ɛto so abiɛsa a mpanyimfo/mmofra Veno-Arterial ECMO (VA-ECMO) tumi (in the American Southwest, the University of New Mexico Health Sciences Center in Albuquerque is the regional HPS ECMO referral hub).
• CDC Nkɔmmɔbɔ: Ayaresabea nnuruyɛfo betumi ne CDC Viral Special Pathogens Branch (VSPB) nam CDC Adwumayɛbea a Ɛhwɛ Ntɛmntɛm So 24/7 (770-488-7100) anaa CDC Hantavirus Ntrɛwmu (877-232-3322) ma diagnostic serology/PCR ne ayaresabea dwumadie akwankyerɛ.
• Canada:
• Frɛ 911. Canada Ɔmanfo Akwahosan Dwumadibea (PHAC) Ɔman Nkwammoaa Ho Nhwehwɛmubea ( .Winnipeg) yɛ Sin Nombre mmoawa no ho nhwehwɛmu a egye ntɛmpɛ; ɔmantam ICU ECMO akwantu nhyehyɛe ahorow no yɛ nhyehyɛe ma wɔde gye nneɛma ntɛmntɛm wɔ Canada Atɔe ne Mfinimfini fam nyinaa.
• Aman Nkabom & Europa Aman Nkabom:
• Frɛ 999 (UK) anaa 112 (EU). Wɔ Europa Atifi fam ne Mfinimfini (Finland, Sweden, Germany, France, Belgium), Puumala mmoawa (Bank Vole) na ɛde Nephropathia Epidemica (acute kidney injury, thrombocytopenia, fever, back pain, and transient blurred vision), bere a ɔwɔ Balkan ne Europa Kesee Fam Apuei (Slovenia, Croatia, Serbia, Greece), Dobrava-Belgrade virus de Mogya a ɛtɔ atiridii a emu yɛ den a ɛwɔ Renal Syndrome (HFRS) a ɛhia sɛ wɔyɛ mogya mu nhwehwɛmu ntɛm ne ICU mmoa (UKHSA Rare and Imported Pathogens Laboratory / ECDC).
• Amerika Kesee Fam ne Mfinimfini fam (Andes Virus Zone):
• Wɔ Chile, Argentina, Brazil, Paraguay, Uruguay, ne Panama mu no, Andes Virus (ANDV) ne orthohantavirus a ɛfa ho no de HPS a emu yɛ den ba (Ntɛm ara: 131 wɔ Chile no, . 107 / 911 wɔ Argentina no, . 192 wɔ Brazil). Critical Protocol: Esiane sɛ Andes Virus tumi trɛw onipa biara mu wɔ prodrome ne ayaresabea fã a edi kan mu nti, akwahosan ho adwumayɛfo ne abusua a wɔbɛn wɔn ho wɔn ho wɔ South America de Airborne + Droplet + Contact Precautions (N95/FFP2 respirator, eye protection, gown, gloves) ne quarantine/monitoring akyi a wɔde wɔn ho ahyɛ mu.
• China, South Korea, Japan, ne Asia-Pacific:
• Hantaan virus ne Seoul virus de Mogya Atiridii a emu yɛ den a ɛwɔ Renal Syndrome (HFRS) wɔ Asia Apuei fam nkuraase ne nkurow akɛse mu (120 wɔ China, 119 wɔ South Korea ne Japan). Australia ne New Zealand nni New World HPS deer-mouse hantavirus a ɛwɔ hɔ ankasa (000 / . 111), ɛwom sɛ akwantufo a wofi Amerika anaa Eurasia resan aba no hwehwɛ sɛ wɔpaw wɔn ntɛm ara de. Hwɛ nɔma ahorow a egye ntɛmpɛ.

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Nsɛm a wɔtaa bisa¶

Dɛn nti na mintumi mfa vacuum cleaner a wɔde HEPA filter ahyɛ mu mfa nsiesie mmoadabi a ayow?¶

Sɛ mpo ofie anaa sotɔɔ mu vacuum wɔ HEPA exhaust filter a, spinning brush roll ne high-velocity suction airflow a ɛwɔ fam nozzle no kanyan no denneennen na **aerosolize microscopic dust particles of dried rodent urine and saliva right at the floor level** ansa na wɔahyɛn hose no mu da - na nsuo nketenkete a ɛtwa vacuum canister no ho hyia no seals blast viral aerosols fi adi kɔ dan no mu. Nea ɛka ho no, sɛ wubue vacuum bag anaa canister no mu a, akyiri yi ɛda wo adi ne mprenu so. **Mfa vacuum anaa dry-sweep rodent droppings da**: bere nyinaa ma mframa nkɔ mu simma 30, fa **1:10 ofie bleach** petepete so kosi sɛ ɛbɛtɔ nsu, twɛn **simma 5 kosi 10**, na fa krataa mpopaho a ɛyɛ nsu popa.

Ɔkwan bɛn so na oduruyɛfo betumi ahu nsonsonoe a ɛda Hantavirus a ɛba ntɛm ne atiridii a ɛba daa anaa yafunu mu mmoawa ntam wɔ nnafua 3 a edi kan no mu?¶

Wɔ ayaresabea no, Hantavirus a edi kan (`Days 1 to 4`) de atiridiinini a ano yɛ den, ntini mu yaw kɛse ba **ntini akuw akɛse no mu ( .`thighs, hips, and lower back`)**, tiyɛ, na ɛtaa yɛ akisikuru, ɔfe, anaa yafunu mu yaw, **a ɔhome a ɛwɔ soro no ho sɛnkyerɛnne a ɛyɛ nwonwa a enni hɔ (`no runny nose, no stuffy nose, no sneezing, and no sore throat`)** na ɛyɛ. Wɔ **simma 45 mogya mu nhwehwɛmu a ɛnyɛ den so (`Complete Blood Count / CBC`)**, ɛkame ayɛ sɛ bere nyinaa ɔyarefo bi a ɔwɔ Hantavirus da mogya mu nkwammoaa a ɛma mogya tu no dodow so tew **`thrombocytopenia < 150,000/uL`)** wɔ atiridii nna a edi kan koraa mu, na ɛno akyi no, hematocrit a ɛkɔ soro, mogya mu nkwammoaa fitaa dodow a ɛkɔ soro a band nkwammoaa a ennyinii wom, ne atypical lymphocytes (`immunoblasts`).

Dɛn nti na ɛyɛ hu saa sɛ dan a wɔhwɛ wɔn a wɔwɔ yare a egye ntɛmpɛ mu ma Hantavirus ɔyarefo bi nkotoku akɛse a wɔde IV nkyene nsu gu mu te sɛ nea wɔyɛ ma sepsis daa a?¶

Wɔ ɔyare mmoawa a wɔde sepsis a ɛyɛ mpapahwekwa mu no, ayarefo mogya ntini mu atrɛw na wonya so mfaso `2 to 3 liters` a wɔde nkyene fa ntini mu. Nanso, wɔ **Hantavirus Pulmonary Syndrome** mu no, mmoawa no ma **capillary leak kɛse bi ba ahurututu no mogya ntini a ɛyɛ mmerɛw no nkutoo so** bere a bere koro no ara mu no, ɛma koma ntini no ahoɔden a ɛbɔ no yɛ mmerɛw. Sɛ oduruyɛfo bi hwie gu a `2 to 3 liters` a wɔde IV saline gu Hantavirus ɔyarefo bi ntini mu no, saa nsu no fi ahurututu mu ntini nketenkete no mu tẽẽ kɔ mframa kotoku no mu (`alveoli`), a ɛde **fulminant pulmonary edema a ɛma ɔyarefo no nsu wɔ nnɔnhwerew kakraa bi mu** ba. Mmom no, ICU nnuruyɛfo de **nsu anohyeto a emu yɛ den**, ntɛm **vasopressor ne inotropic nnuru di dwuma (`Norepinephrine + Dobutamine`)**, ne ntɛm **VA-ECMO koma-ahurututu mu bypass**.

So Hantavirus betumi atrɛw afi onipa biako so akɔ foforo so, anaasɛ afi me kraman anaa me kraman mu?¶

**Amerika Atifi fam Hantavirus (`such as Sin Nombre virus carried by deer mice in the US and Canada`) ne Europa/Asia Hantavirus ( .`Puumala, Hantaan, Seoul`) MMA ntrɛw mfi onipa so nkɔ onipa so** - wuntumi nnya North American HPS mfi atuu, nsa a wode bɛka, anaa ɔyarefo a ɔwɔ ɔyare no a wobɛhwɛ no mu. *(Wiase nyinaa a ɛyɛ soronko nkutoo ne **South American Andes Virus** a ɛwɔ Chile ne Argentina, a ebetumi atrɛw wɔ afie a ɛbɛn wɔn ho wɔn ho ntam na ɛhwehwɛ sɛ wɔtew wɔn ho fi mframa/nsuo mu.)* Akraman ne mpataa **nnyare mfi Hantavirus mu na wɔmfa mmoawa no ngu wɔn nsu mu**, ɛwom sɛ ɛtɔ mmere bi a abɔnten so ɔkraman anaa ɔkraman betumi de wuram akraman mmoawa a wɔawuwu a wɔanya ɔyare no akɔ wo fie anaa wo abrannaa so de.

Sɛ mihu sɛ mpɔtorɔ berebuw bi wɔ me kar no mu mframa a wɔde yiyi mu no atifi anaasɛ hood no ase a, mɛyɛ dɛn asiesie mu dwoodwoo?¶

Mfa kar no mu heater anaa A/C blower fan mfi ase da sɛ wususuw sɛ mprako ayɛ wɔn buw wɔ HVAC mframa adaka no mu a, na **mfa mframa a wɔde hyɛ mu no mmɔ engine bay anaa cabin air filter no da**. Pia anaa fa kar no si hɔ **wɔ abɔnten wɔ abɔnten ne owia hann a ɛhyerɛn**, bue hood ne kar apon anan no nyinaa **simma 30**, hyɛ **nitrile nsateaa ne N100/P100 respirator**, fa aduru a wɔde petepete berebuw ne cabin filter dan no mu yiye (`like Lysol`) anaasɛ `1:10` bleach aduru ( .`avoiding bare electrical connectors`), twɛn **simma 10**, ma berebuw a ɛyɛ nsu ne afiri dedaw no so kɔ plastic bag a wɔatoto mu mu, na fa mframa a wɔde yi mframa foforo a ɛwɔ dan no mu hyehyɛ mu ansa na woadan mframa a ɛwɔ mu no.

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Saa akwankyerɛ yi de aduruyɛ ne nneɛma a atwa yɛn ho ahyia ahobammɔ ho nsɛm a egye ntɛmpɛ ma na ɛnsi ayaresabea a wɔhwɛ ntɛm anaa ayaresa a emu yɛ den ho animdefo ananmu. Esiane sɛ Hantavirus Pulmonary Syndrome betumi anya nkɔso afi ɔfe a emu nyɛ den so akɔ ɔhome ne koma a ɛyɛ den so wɔ nea ennu nnɔnhwerew 4 mu nti, yɛhyɛ nyansa denneennen sɛ fa nsaanodwuma a edi kan ne CPR adesua a wɔagye atom a efi Red Cross, St John Ambulance, anaa mpɔtam hɔ nteteefo a wɔagye no atom hɔ.

Akwankyerɛ ahorow a ɛfa ho¶

• Leptospirosis (Weil yare) bere a woakɔ nsuyiri anaa nsu pa mu akyi: aniwa kɔkɔɔ ne nantwi ba yaw
• Sepsis ne septic shock a wohu ne ntɛmpɛ triage
• Nnuru a ekum mprako (awuduru a wɔde kum mmoawa), superwarfarin, ne zinc phosphide a wɔnom
• Mmoa a wɔka wɔn, kuru a wɔde gugu nnɔbae so, ne rabies akyi a wɔde siw ano
• Nnɔmba ahorow a egye ntɛmpɛ

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Fibea ne aban akwankyerɛ¶

• Asoɛe a Ɛhwɛ Nyarewa So na Wosiw Ano (CDC Viral Special Pathogens Branch, United States): Ahotew wɔ Mpɔtorɔ Akyi: Official 1:10 Bleach Disinfection Protocol ne Hantavirus Pulmonary Syndrome (HPS) Ayaresa mu Nhwehwɛmu, Mogya a Wɔde Hyɛ Nneɛma a Ɛwɔ Akyi, ne ICU Nsu a Wɔde Di Dwuma (cdc.gov/hantavirus).
• New Mexico Sukuupɔn (UNM) Akwahosan Ho Nyansahu Asoɛe & Hantavirus Ayaresa Nhwehwɛmu Dwumadi (Koster, Hjelle, Crowley, & Wernly): Mogya a Wɔde Hyɛ Ntɛmntɛm a Wɔde Swere Mogya a Wɔde Siesie Ntɛmntɛm Triage Criteria (5-of-5 Rule) ne Oxygen a Ɛma Ntini a Ɛma Ntini a Ɛma Ntini Mu Mfiase ( .VA-ECMO) Nkwagye a Wɔde Ma Hantavirus a Entumi Nnye Koma ne Ahurututu mu Yare.
• Pan Amerika Akwahosan Ahyehyɛde (PAHO) & Wiase Nyinaa Akwahosan Ahyehyɛde (WHO): Hantavirus wɔ Amerika: Akwankyerɛ a ɛfa Nhwehwɛmu, Ayaresa, Siw Ano, ne Nea Wɔde Siw So (A Ahwɛyiye a Wɔde Ma Onipa ne Onipa Ka ho wɔ Amerika Kesee Fam Andes Virus ho).
• Europa Asoɛe a Ɛhwɛ Nyarewa a Wosiw Ano ne Nea Wosiw So (ECDC) & Robert Koch Asoɛe (RKI, Germany): Nokwasɛm Krataa ne Ayaresa Akwankyerɛ a Ɛfa Wiase Dedaw Orthohantavirus Ho (Puumala Nephropathia Ɔyaredɔm ne Dobrava Mogya a Ɛtɔ Atiridii a Ɛwɔ Renal Syndrome).
• Ɔman Asoɛe a Ɛhwɛ Adwumayɛ mu Ahobammɔ ne Akwahosan So (NIOSH, United States): Hantavirus Ahurututu mu Yare a Wɔde Siw Ano (HPS) Wɔ Adwumayɛfo a Wɔhwɛ Mpɔtorɔ anaa Wɔrehohoro Nneɛma ne Kar a Mpɔtorɔ Ayɛ Mu (N100/P100 Ɔhome afiri a Wɔpaw).