Hantavirus Pulmonary Syndrome (HPS): Chifukwa Chake Simuyenera Kupukuta kapena Kupukuta Zodontha za Makoswe mu Kabin kapena Shedi¶

Mukatsegula kanyumba kotsekedwa, malo osungiramo zinthu, nkhokwe, chapamwamba, garaja, crawlspace, kapena RV / camper yoyimitsidwa ndikuwona zitosi zouma za makoswe kapena zomangira zisa, **kugwira tsache, burashi ya whisk, kapena chotsukira m'nyumba kuti musese chipwirikiticho ndi kulakwitsa koopsa kwa moyo . Kupukuta kapena kupukuta mpweya kumatulutsa tinthu ting'onoting'ono ta mkodzo wouma, malovu, ndi ndowe zomwe zili ndi Hantavirus (such as Sin Nombre virus carried by the North American Deer Mouse, or Puumala and Dobrava viruses in Europe and Asia) molunjika mumlengalenga, momwe mumakokera kachilomboka m'mapapu anu. Ngati wina ayamba malungo, kuzizira, kupweteka kwambiri kwa minofu (especially in the thighs, hips, back, and shoulders), mutu, nseru, kapena kusanza mkati 1 to 8 weeks kulowa mnyumba yokhala ndi makoswe - kutsatiridwa patatha masiku 3 mpaka 5 ndi chifuwa chowuma kapena kupuma modzidzimutsa **, imbani nambala yanu yadzidzidzi yakudera lanu kudzera pa manambala angozi lolemba ndikupita ku chipatala chachikulu cha Emergency department ndi ECMO (Extracorporeal Membrane Oxygenation) luso nthawi yomweyo. Onaninso maupangiri athu pa kuzindikira sepsis ndi septic shock, leptospirosis (matenda a Weil) kuchokera kumadzi osefukira ndi mkodzo wa makoswe, anticoagulant rodenticide (poizoni wa makoswe).,ndi kulumidwa ndi nyama ndi matenda a chiwewe prophylaxis.

Malinga ndi Centers for Disease Control and Prevention (CDC), Pan American Health Organisation (PAHO / WHO), ndi European Center for Disease Prevention and Control (ECDC), Hantavirus Pulmonary Syndrome (HPS, amatchedwanso Hantavirus Cardiopulmonary Syndrome / HCPS) ili ndi chiwopsezo cha kufa kwa milandu 35% to 38% (and up to 50% pakubuka kwambiri kwa ma virus a Andes) - ngakhale achichepere athanzi omwe ali ndi ziro kale. Chomwe chimapangitsa Hantavirus Pulmonary Syndrome kukhala yonyenga komanso yakupha muchipatala chadzidzidzi ndi **msampha wachipatala wa magawo awiri : mkati mwa ** 3 yoyamba mpaka masiku 6 (the Febrile Prodrome), wodwala amawoneka ngati ali ndi fuluwenza kapena viral gastroenteritis (fever, severe thigh/back muscle aches, headache, nausea, abdominal pain, and a completely clear chest X-ray with ZERO runny nose or sore throat), kotero zipatala zosamalira anthu mwachangu zimawatumiza kunyumba pafupipafupi. Kenako, popanda chenjezo, wodwalayo amalowa mu Cardiopulmonary Capillary-Leak Phase, pomwe kachilomboka kamapangitsa kuti minyewa yam'mapapo yam'mapapo ikhale yotayirira, kusefukira m'mapapo onse kuchokera mkati ndi madzi am'magazi okhala ndi mapuloteni m'maola 4 mpaka 8 kwinaku akukhumudwitsa minofu yamtima.cardiogenic + non-cardiogenic shock). Choyipa kwambiri, ngati dokotala wakuchipinda chadzidzidzi alakwitsa wodwala wa Hantavirus chifukwa cha sepsis ya mabakiteriya nthawi zonse ndikumupatsa mabotolo amchere amchere am'mitsempha akulu akulu.30 mL/kg), madzi owonjezera amenewo amathira molunjika kudzera m'mapapo otayira ndipo amamiza wodwala pa machira. Kudziwa CDC Wet-Bleach Rodent Cleanup Protocol ndi Lamulo la 5-Count Blood Smear Triage Rule (Hantavirus Triad) amapulumutsa miyoyo.

Chitani izi tsopano¶

1. IMANI nthawi yomweyo ngati muwona zitosi za makoswe, zisa, kapena mbewa zakufa mkati mwa shedi, kanyumba, m’chipinda chapamwamba, pamalo olowera injini ya galimoto, kapena m’chipinda chapansi: MUSAMASEPO ndi tsache, MUSAgwiritse ntchito chotsukira (ngakhale chotsukira m’sitolo ya HEPA), ndipo MUSAMAUZE fumbi ndi chowuzira masamba kapena mpweya woponderezedwa. Kusesa kowoneka bwino kapena vacuum. 1-to-5-micron fumbi lodzaza ndi ma virus m'dera lanu lopumira komwe limakhazikika mumpweya kwa maola ambiri.
2. Perekani mpweya pamalo otsekedwa poyamba osachepera 30 full minutes potsegula zitseko ndi mazenera akunja ndikuyenda kubwerera KUNJA (staying upwind while fresh outdoor air flushes the room). Hantavirus ndi kachilombo ka RNA (Bunyavirales / Orthohantavirus) omwe envelopu yake ya lipid imachotsedwa mwachangu ndi ** ultraviolet yakunja (UV) kuwala kwa dzuwa** ndi kuchepetsedwa kwa mpweya wabwino.
3. *Valani magolovesi a rabara/nitrile (ndi an N100 / P100 kapena FFP3 particulate respirator for the heavy infestations), kenaka MVANI zitosi zonse, zisa, ndi makoswe akufa mosakaniza mwatsopano. 1:10 Household Bleach Solution (1 part liquid chlorine bleach to 9 parts water, kapena mankhwala ophera tizilombo olembetsedwa ndi EPA ngati Lysol) ndikuwasiya kuti anyowe. 5 to 10 full minutes musanakhudze kalikonse. Kunyowetsa zitosi kumamatira fumbi pansi kotero kuti lisapitirire mpweya pamene sodium hypochlorite imawononga 100% ya ma virus a lipid envelopu.
4. Tengani zitosi zoviikidwa ndi bulichi ndi zomangira zisa zokhala ndi matawulo a mapepala achinyowa (OSATI KUSYA), sindikizani zopukutira zamapepala zonyowa ndi mbewa zakufa m'matumba apulasitiki awiri, ndipo sambani magolovesi anu ndi sopo MUSASANDA kuvula magolovu anu.
5. Ngati mukudwala malungo (>= 38.0 C / 100.4 F), kupweteka kwambiri kwa minofu (thighs, lower back, hips), mutu, nseru, kusanza, kapena kutsekula m'mimba 1 to 8 weeks (7 to 56 days) mutatsuka kanyumba, kumanga msasa, kapena kugwira nkhuni: pitani ku dipatimenti yoona za ngozi zadzidzidzi m’chipatala NTHAWI YOMWEYO (ngakhale mulibe chifuwa).
6. Nenani mawu enieni awa kwa Namwino ndi Sing'anga wa Emergency Room Triage mumasekondi 30 oyamba: "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."

Mtengo wosankha: Kutsuka makoswe otetezedwa ndi Hantavirus Pulmonary Syndrome Clinical triage¶

Tsatirani ndondomeko yoyendetsera ntchitoyi kuti mutetezedwe panthawi yoyeretsedwa komanso mukayezetsa zachipatala mukadzidziwitsidwa.

flowchart TD
    Start["Zitosi za Makoswe, Nests, Madontho a Mkodzo, Kapena Mbewa Zakufa Zapezeka mu Cabin, Shed, Barn, Attic, Garage, kapena RV"] --> Scenario{"Kodi Mukutsuka Tsopano KAPENA Mukukhala ndi Zizindikiro Pambuyo Powonekera Kale?"}

    Scenario -->|"KUYERETSA ZOCHITA ZOKHUDZA TSOPANO"| CleanRule["CDC 5-STEP WET-BLEACH CLEANUP PROTOCOL: 1. MUSAMASESE, kusesa, kapena kugwiritsa ntchito mpweya woponderezedwa. bulichi mpaka makapu 9 amadzi) pazitosi/zisa mpaka zitanyowetsedwa bwino -> Dikirani 5 mpaka 10 MPHINDI ZONSE 5. Pukutani ndi zopukutira zamapepala zonyowa -> Chikwama chawiri -> Sekani pansi zolimba ndi bulitchi -> Sambani manja ovala magolovesi musanachotse magolovesi"]

    Scenario -->|"KUDZIWA ZIZINDIKIRO (Masabata 1 mpaka 8 Pambuyo pa Rodent / Cabin / Shed / Wood Exposure)"| ProdromeCheck{"Ndi Gawo Lanji la Zizindikiro Zomwe Zilipo?"}

    ProdromeCheck -->|"STAGE 1 FEBRILE PRODROME (Masiku 1 mpaka 5): Kutentha thupi (>38 C / 100.4 F), Kuzizira, Kupweteka Kwambiri kwa Minofu (ntchafu, M'chiuno, Kumbuyo), Kupweteka kwa Mutu, Mseru / Kusanza / Kupweteka kwa M'mimba, Chizungulire (Zindikirani: Kawirikawiri PALIBE mphuno kapena zilonda zapakhosi)"| ERTriage["URGENT HOSPITAL ER TRIAGE (MUSALOLE CLINIC KUCHOTSA NTCHITO MONGA 'CHIFLU'): 1. Pitani ku Chipatala Emergency Department Mwamsanga 2. Kuwulura za rodent/cabin exposure -> Funsani STAT CBC with Manual Blood Smear + Chest X-Ray 3. Yang'anani CBC ya 5-of-ad-5 Platelet (<150,000/uL - chidziwitso choyambirira) - Kukwera kwa Hematocrit/Hemoglobin (Hemoconcentration kuchokera ku capillary leak) - WBC count yosinthidwa kumanzere ndi>10% Atypical Lymphocytes (Immunoblasts)"]

    ProdromeCheck -->|"STAGE 2 CARDIOPULMONARY CRASH (Masiku 4 mpaka 7 - Zenera la Ola la 4): Chifuwa chowuma, Kupuma pang'ono, Kupuma Mofulumira (>22 / min), SpO2 <94%, Bilateral Lung Crackles, Cold Extremities, kapena Kutaya Magazi"| ECMORush["ECMO & ICU EMERGENCY ZOYAMBIRA MOYO (38% Mortality): 1. Imbani 911 / 112 / 999 -> Pemphani Kusamutsidwa Mwamsanga ku Tertiary ECMO Center 2. MALAMULO WOYENERA KUKHALA WA ICU: - KUKHALA KWAMBIRI KWAMBIRI (OSATI perekani 30 mL / id yoponderezedwa) kapena crystall 30 mL / ID Inotrope (Norepinephrine + Dobutamine) ya Cardiogenic/Capillary Shock - Kuphatikizika koyambirira kwa VA-ECMO ngati Cardiac Index <2.0 L/min/m2 kapena PaO2/FiO2 <60"]

    ERTriage -->|"Ngati Platelets Drop (<150k) kapena Interstitial Kerley B Lines pa Chest X-Ray"| ECMORush

Gawo 1: Momwe Mungadziwire Makoswe Oopsa Kwambiri ndi Malo Obisika Obisika (Why You Never Have to Touch a Mouse to Get Hantavirus)¶

Zatha 70% mwa odwala omwe adapezeka ndi Hantavirus Pulmonary Syndrome akuti **sanakhudzepo mbewa yamoyo kapena yakufa **. M’malomwake, ankakoka tinthu ting’onoting’ono tosaoneka bwino akamagwira ntchito, akugona, kapena kuyeretsa m’malo otsekeredwa kumene makoswe am’tchire anali atakodzerako kapena kuchita chimbudzi milungu ingapo m’mbuyomo.

1. Mitundu Yoyambira ya Vector (New World HPS vs. Old World HFRS)¶

Ma Hantaviruses amagawidwa m'mabanja awiri a malo ndi azachipatala, aliyense amanyamulidwa ndi malo osungiramo makoswe (note: common domestic pet hamsters/gerbils and urban house mice *Mus musculus* do NOT carry Sin Nombre HPS virus):

2. Malo Asanu ndi Awiri Obisika Anthu Amakoka mpweya wa Hantavirus Osazindikira¶

1. Kutsegula Kabindi Kanyengo, Kanyumba Kolenjelako, Nyumba Yomanga Panja, Kapena Khola M’nyengo Yachilimwe/Chilimwe: Kuyatsa chounikira padenga, kukutumula mabulangete/ matiresi afumbi kumene mbewa zinkayenda m’nyengo yozizira, kapena kusesa pansi pa khitchini.
2. Galimoto & RV Air Conditioning Vents ndi Cabin Air Zosefera (A Major Overlooked Source): Makoswe a mbawala nthawi zambiri amakwawira m'nyumba zotentha za HVAC, mpweya wa ng'ombe, ndi chipinda cha injini chokhala ndi magalimoto oyimitsidwa, magalimoto, mathirakitala afamu, ndi ma RV, kumanga zisa zotsekera pamwamba pa ** fyuluta ya mpweya**. Mukayatsa chotenthetsera kapena fani ya A/C, chowuziriracho chimaphulitsa mkodzo wa mbewa ndi zitosi kumaso kwanu. Osaphulitsanso fyuluta ya mpweya ya m'galimoto yokhala ndi mbewa yokhala ndi mpweya woponderezedwa: zilowerereni chisacho pansi pa hood ndi Lysol/mankhwala opha tizilombo mutavala chigoba cha N100/P100 ndi magolovesi.
3. Kunyamula Nkhuni Zozinga Pachifuwa Chanu: Mbewa zimasalira mkati mwa milu ya nkhuni; kukweza zipika zowuma ndikutsuka fumbi la khungwa ndi mkodzo wouma pansi pa mphuno yanu.
4. Kutsuka Mabokosi a Makatoni mu Attics, Basement, Crawlspaces, kapena Malo Odzisungira Okha.
5. Kugona Mwachindunji Pansi Kapena Pansi Pamalo Osatsekedwa, Khola, Kapena Kanyumba.

Gawo 2: The Official CDC Step-by-step Wet-Bleach Rodent Cleanup Protocol¶

Kodi Hantavirus amakhala nthawi yayitali bwanji kunja kwa mbewa? Panja panja, kuwala kwa UV kumapha kachilomboka 2 to 3 hours. Komabe, m'kati mwa kanyumba kamdima, kozizira, kowuma, kosungira, chipinda, kapena bokosi lamoto, Hantavirus yopatsirana mumkodzo wouma kapena zitosi imakhalabe yamoyo komanso yopatsirana. 2 to 3 full days pa firiji (ndi mpaka 2 weeks m'malo ozizira).

Osakhudza tsache kapena chotsukira. Tsatirani izi Masitepe 6 Onyowa Kuwotcha:

+-------------------------------------------------------------------------+
|  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.   |
+-------------------------------------------------------------------------+

Gawo 3: Kuzindikira Magawo Awiri Achipatala a Hantavirus (Why Urgent Care Doctors Mistake Phase 1 for the Flu)¶

Chifukwa nthawi yamakulitsidwe a Hantavirus ndi 1 to 8 weeks (median 14 to 21 days) akakoka fumbi, odwala kaŵirikaŵiri amaiwala kuti anatsuka shedi milungu itatu m’mbuyomo pamene malungo awo ayamba. Lowezani magawo awiri azachipatala komanso momwe mungadziwire Hantavirus popanda chimfine kapena COVID-19:

1. Gawo 1: The Febrile Prodrome (Days 1 to 5 - Diagnostic Golden Window)¶

Kwa masiku oyambilira 3 mpaka 5 (mtundu 1 to 7 days), wodwala alibechifuwa ndi kupuma movutikira, ndipo X-ray pachifuwa nthawi zambiri imawoneka ngati yabwinobwino: - ** Zizindikiro zonse (Present in >90% of Patients):** - Kutentha kwadzidzidzi kutentha thupi (38.3 to 40.0 C / 101 to 104 F) ndi kunjenjemera koopsa. - Kupweteka kwakukulu kwa minofu (myalgias) kukhudza magulu akuluakulu a minofu ** (thighs, hips, lower back, and shoulders). - Kupweteka kwa mutu wakutsogolo, kutopa kwambiri, ndi chizungulire / kupepuka (orthostasis). - Chidziwitso cha GI (Present in 50% of Patients): - Mseru, kusanza mobwerezabwereza, kutsekula m'mimba, ndi kufalikira kuwawa kwamimba (nthawi zina kumakhala kowawa kwambiri kutengera appendicitis kapena gastroenteritis). - ZOTHANDIZA #1 ZA CHIKWANGWANI KUTI SIKUZIFALA KAPENA CHIFULU (Absence of Upper Respiratory Symptoms): - Mosiyana ndi fuluwenza, COVID-19, RSV, kapena chimfine, Odwala a Hantavirus prrome pafupifupi PALIBE mphuno yothamanga (rhinorrhea), kutsekeka kwa m'mphuno, kuyetsemula, zilonda zapakhosi (pharyngitis), kapena kupweteka kwa sinus . - Lamulo la Zachipatala: **Fever + Severe Thigh/Back Muscle Aches + Nausea/Vomiting + ZERO Runny Nose or Sore Throat (1 to 8 weeks after rural/rodent exposure) = Wokayikira Hantavis Mpaka Kutsimikiziridwa Apo ayi.

2. Gawo 2: Kuwonongeka kwa Cardiopulmonary Capillary-Leak (Starts Abruptly on Day 4 to 6)¶

Popanda chenjezo - nthawi zambiri wodwala malungo amayamba kusweka - wodwalayo amalowa Cardiopulmonary Phase: - Ola 0 mpaka Ola 2:Kuwuma mwadzidzidzi, chifuwa chosabereka kumayamba, kutsagana ndi chifuwa cholimba komanso kupuma kwamphamvu.> 20 to 24 breaths per minute). - Ola 2 mpaka Ola 6: Ma cell a capillary endothelial m'mapapo onse amataya kukhulupirika kwa zotchinga: madzi a m'magazi okhala ndi mapuloteni ambiri (with an edema-fluid-to-serum protein ratio > 0.8) amatsanulira kuchokera m'mitsempha kupita ku lung interstitium ndi alveoli. Kuchuluka kwa oxygen (SpO2) kutsika kuchokera 97% pansi ku 80s ndi 70s, wodwalayo amayamba kutsokomola madzimadzi ofiira apinki kapena amtundu wa udzu, ndipo ma X-ray a pachifuwa amayenda mofulumira kuchokera ku peribronchial cuffing ndi Kerley B lines kufika kusefukira kwathunthu kwa alveolar ("white-out") mkati mwa maola 4 mpaka 8. - Ola 6 mpaka Ola 24 (Msampha wa Myocardial Depression): Mosiyana ndi bacterial septic shock (which causes "warm shock" with high cardiac output and low vascular resistance), Hantavirus imatulutsa vuto la myocardial depressant lomwe limayambitsa zambiri Cardiogenic Shock (low Cardiac Index < 2.0 L/min/m2, high Systemic Vascular Resistance SVR, malekezero ozizira a clammy mottled, lactic acidosis, ndi bradycardia mwadzidzidzi / pulseless magetsi PEA kumangidwa, makamaka pa endotracheal intubation).

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

Confirmatory Hantavirus IgM/IgG ELISA serology ndi RT-PCR yotumizidwa ku dipatimenti ya zaumoyo ya boma kapena labu yowunikira imatenga 24 to 72 hours - ndipo wodwala mu Cardiopulmonary Phase akhoza kufa mu **6 maola . Mwamwayi, ofufuza ku University of New Mexico (UNM, malo otsogola padziko lonse a Sin Nombre Hantavirus ECMO) adatsimikizira kuti chizolowezi Kuwerengera Magazi Okwanira (CBC) ndi Manual Peripheral Blood Smear yochitidwa mu labu yachipatala iliyonse pakadutsa mphindi 45 imazindikira Hantavirus ndi > 95% kukhudzika ndi kutsimikizika ** pamene **osachera 4 mwa izi 5 mfundo za hematologic (including the "Hantavirus Triad") alipo:

Nambala zangozi zachigawo ndi ndondomeko za bungwe¶

Hantavirus ndivuto lodziwika bwino la zoonotic lomwe lili ndi maukonde odzipereka odzipatulira komanso ma labotale:

• United States:
• ** Kutumiza Mwadzidzidzi: ** Imbani ** 911 ** ndikupempha zoyendera kupita ku chipatala chapamwamba chokhala ndi ** wamkulu/madokotala Veno-Arterial ECMO (VA-ECMO)** luso (in the American Southwest, the University of New Mexico Health Sciences Center in Albuquerque is the regional HPS ECMO referral hub).
• Kufunsira kwa CDC: Madokotala azachipatala atha kulumikizana ndi CDC Viral Special Pathogens Branch (VSPBkudzera ku 24/7 CDC Emergency Operations Center (770-488-7100) kapena CDC Hantavirus Hotline (877-232-3322) ya diagnostic serology/PCR ndi malangizo achipatala.
• Canada:
• Imbani 911. Public Health Agency ku Canada (PHACNational Microbiology Laboratory (Winnipeg) amachita zodziwira zadzidzidzi za kachilombo ka Sin Nombre; mayendedwe am'chigawo cha ICU ECMO amalumikiza kubweza mwachangu ku Western ndi Central Canada.
• United Kingdom & European Union:
• Imbani 999 (UK) kapena 112 (EU). Kumpoto ndi ku Central Europe (Finland, Sweden, Germany, France, Belgium), Puumala virus (Bank Vole* zimayambitsa Nephropathia Epidemica (acute kidney injury, thrombocytopenia, fever, back pain, and transient blurred vision), pamene ku Balkans ndi Southeastern Europe (Slovenia, Croatia, Serbia, Greece), Dobrava-Belgrade virus imayambitsa kwambiri Hemorrhagic Fever yokhala ndi Renal Syndrome (HFRS) yofuna chithandizo cham'mbuyo cha hemodialysis ndi ICU (UKHSA Rare and Imported Pathogens Laboratory / ECDC).
• South ndi Central America (Andes Virus Zone):
• Ku Chile, Argentina, Brazil, Paraguay, Uruguay, ndi Panama, Andes Virus (ANDV) ndi ma orthohantavirus ogwirizana nawo amayambitsa HPS yoopsa (Emergency: 131 ku Chile, 107 / 911 ku Argentina, 192 ku Brazil). ** Protocol Yofunika: ** Chifukwa ** Andes Virus imatha kufalitsa munthu ndi munthu ** panthawi ya prodrome komanso chipatala choyambirira, ogwira ntchito yazaumoyo komanso olumikizana ndi mabanja ku South America amagwiritsa ntchito ** Njira Zopewera Zoyendetsa Ndege + Droplet + Contact (N95/FFP2 respirator, eye protection, gown, gloves)** ndi kuika kwaokha/kuwunika pambuyo powonekera.
• China, South Korea, Japan, ndi Asia-Pacific:
• Kachilombo ka Hantaan ndi kachilombo ka Seoul zimayambitsa matenda aHemorrhagic Fever ndi Renal Syndrome (HFRS)* kudutsa kumidzi ndi kumatauni East Asia (120 ku China, 119 ku South Korea ndi Japan). Australia ndi New Zealand alibiretu matenda amtundu wa New World HPS deer-mouse hantaviruses (000 / 111), ngakhale apaulendo obwerera kuchokera ku America kapena Eurasia amafunikira kuyesedwa mwachangu. Mwaona manambala angozi.

Mafunso omwe amafunsidwa pafupipafupi¶

Chifukwa chiyani sindingagwiritse ntchito chotsukira chokhala ndi fyuluta ya HEPA kuyeretsa zitosi zouma za mbewa?¶

Ngakhale m'nyumba kapena m'sitolo muli zosefera za HEPA, burashi yopota ndi mpweya wothamanga kwambiri pansi pamphuno imagwedezeka mwamphamvu ndi **kupukuta tinthu tating'ono tating'ono ta mkodzo wouma wa makoswe ndi malovu pansi pomwe** asanalowe mu payipi - ndikutulutsa pang'ono mozungulira chimbudzi chotuluka muchipinda chotsekera. Kuphatikiza apo, kutsegula thumba la vacuum kapena canister pambuyo pake kumakuwonetsaninso kachiwiri. **Osakolopa kapena kusesa zitosi za makoswe**: nthawi zonse muzipuma mpweya kwa mphindi 30, pukutani ndi **1:10 bulitchi yapakhomo** mpaka inyowe, dikirani **5 mpaka 10 mphindi**, ndipo pukutani ndi matawulo a mapepala anyowa.

Kodi adotolo angadziwe bwanji kusiyana pakati pa Hantavirus yoyambilira ndi fuluwenza kapena vuto la m'mimba m'masiku atatu oyamba?¶

Zachipatala, Hantavirus yoyambirira (`Days 1 to 4`) zimayambitsa kutentha thupi, kupweteka kwambiri kwa minofu mu **magulu akuluakulu a minofu (`thighs, hips, and lower back`)**, kupweteka mutu, ndipo nthawi zambiri nseru, kusanza, kapena kupweteka kwa m'mimba, **popanda kukhala ndi zizindikiro zapamwamba za kupuma (`no runny nose, no stuffy nose, no sneezing, and no sore throat`)**. Pakuyezetsa magazi kosavuta ** mphindi 45 (`Complete Blood Count / CBC`)**, wodwala Hantavirus pafupifupi nthawi zonse amawonetsa **kutsika kwa mapulateleti (`thrombocytopenia < 150,000/uL`)** m’masiku oyambirira a malungo, kenaka kukwera kwa magazi m’thupi, kuchuluka kwa maselo oyera a m’magazi okhala ndi ma band band cell, ndi atypical lymphocyte (`immunoblasts`).

Chifukwa chiyani ndizowopsa ngati chipinda chadzidzidzi chipatsa wodwala Hantavirus matumba akulu amadzi amchere a IV monga amachitira pa sepsis wamba?¶

Mu wamba bakiteriya sepsis, odwala dilated mitsempha ndi kupindula `2 to 3 liters` mtsempha wa saline. Mu **Hantavirus Pulmonary Syndrome**, komabe, kachilomboka kamayambitsa kutulutsa kwakukulu kwa **capillary kudzera m'mitsempha yosalimba ya m'mapapo** kwinaku akufooketsa mphamvu yakupopa kwa minofu yamtima. Ngati dokotala akutsanulira `2 to 3 liters` IV saline kulowa m'mitsempha ya wodwala Hantavirus, madzimadzi amatuluka molunjika kuchokera m'mapapo kupita m'matumba a mpweya (`alveoli`), kuchititsa **fulminant pulmonary edema yomwe imamiza wodwalayo mkati mwa maola **. M'malo mwake, madokotala a ICU amagwiritsa ntchito ** kuletsa madzimadzi **, oyambirira ** vasopressor ndi inotropic mankhwala (`Norepinephrine + Dobutamine`)**, ndi koyambirira **VA-ECMO heart-lung bypass**.

Kodi Hantavirus ingafalikire kuchokera kwa munthu kupita kwa wina, kapena kuchokera kwa galu wanga kapena mphaka?¶

**Matenda a Hantavirus aku North America (`such as Sin Nombre virus carried by deer mice in the US and Canada`) ndi European/Asian Hantaviruses (`Puumala, Hantaan, Seoul`) MUSAMASULIKANE kuchokera kwa munthu kupita kwa munthu** - simungagwire HPS yaku North America pompsompsona, kugwirana, kapena kusamalira wodwala yemwe ali ndi kachilomboka. *(Zosiyana zapadziko lonse lapansi ndi **South America Andes Virus** ku Chile ndi Argentina, zomwe zimatha kufalikira pakati pa anthu apabanja ndipo zimafuna kudzipatula ndi ndege/madontho.)* Agalu ndi amphaka **sadwala matenda a Hantavirus ndipo samakhetsa kachilomboka mumkodzo**, ngakhale mphaka kapena galu wakunja nthawi zina amatha kunyamula mbewa yakufa yomwe ili m'khonde kulowa m'nyumba mwanu.

Ndikapeza chisa cha mbewa pamwamba pa fyuluta ya mpweya ya kanyumba ka galimoto yanga kapena pansi pa chivundikiro, ndingachiyeretse bwanji bwinobwino?¶

Osayambanso chotenthetsera mkati mwagalimoto kapena chowombera cha A/C ngati mukuganiza kuti mbewa zakhala mkati mwa bokosi la mpweya la HVAC, ndipo **musamawuzitsenso chipinda cha injini kapena fyuluta ya mpweya ndi mpweya**. Kankhani kapena ikani galimoto **panja panja ndi kuwala kwadzuwa **, tsegulani chitseko ndi zitseko zonse zinayi zamagalimoto kwa **mphindi 30**, valani **magalavu a nitrile ndi mpweya wopumira wa N100/P100**, tsitsani chisa ndi nyumba zosefera zanyumba bwino ndi mankhwala ophera tizilombo toyambitsa matenda (`like Lysol`) kapena `1:10` bleach solution (`avoiding bare electrical connectors`), dikirani **mphindi 10**, tulutsani chisa chonyowa ndi fyuluta yakale muthumba lapulasitiki losindikizidwa, ndikuyika fyuluta yatsopano ya mpweya wa kanyumba musanayatse mpweya wamkati.

*Bukhuli limapereka chidziwitso chadzidzidzi chachipatala ndi chitetezo cha chilengedwe ndipo sichilowa m'malo mwachipatala chadzidzidzi chachipatala kapena kufunsira kwa anthu odwala kwambiri. Chifukwa Hantavirus Pulmonary Syndrome ikhoza kupita patsogolo kuchokera ku chifuwa chochepa mpaka kupuma komanso kumangidwa kwa mtima mkati mwa maola 4, timalimbikitsa kwambiri kutenga chithandizo choyamba chovomerezeka cha manja ndi CPR kuchokera ku Red Cross, St John Ambulance, kapena wothandizira ovomerezeka wamba.

Maupangiri ogwirizana¶

• Leptospirosis (matenda a Weil) atatha kulowa m'madzi osefukira kapena madzi abwino: maso ofiira ndi ululu wa mwana wa ng'ombe.
• Sepsis ndi kuzindikira kugwedezeka kwa septic ndikuyesa mwadzidzidzi
• Anticoagulant rodenticide (poizoni wa makoswe), superwarfarin, ndi zinc phosphide kumeza.
• Kulumidwa ndi nyama, kuthirira mabala, ndi matenda a chiwewe post-exposure prophylaxis
• Nambala zangozi

Magwero ndi malangizo ovomerezeka¶

• Malo owongolera ndi kupewa matenda (CDC Viral Special Pathogens Branch, United States): Kuyeretsa Pambuyo pa Makoswe: Official 1:10 Bleach Disinfection Protocol ndi Hantavirus Pulmonary Syndrome (HPS) Kuzindikira Kwachipatala, Peripheral Blood Smear Triad, ndi ICU Fluid Management (cdc.gov/hantavirus).
• ** Yunivesite ya New Mexico (UNM) Health Sciences Center & Hantavirus Clinical Research Program (Koster, Hjelle, Crowley, & Wernly):** Rapid Peripheral Blood Smear Triage Criteria (5-of-5 Rule) ndi Early Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Rescue for Refractory Hantavirus Cardiopulmonary Syndrome.
• Pan American Health Organisation (PAHO) & World Health Organization (WHO): Hantavirus in the Americas: Guidelines for Diagnosis, Treatment, Prevention, and Control (Kuphatikiza Kusamala kwa Munthu ndi Munthu ku South America Andes Virus).
• European Center for Disease Prevention and Control (ECDCndi Robert Koch Institute (RKI, Germany): Factsheet and Clinical Guidance on Old World Orthohantaviruses (Puumala Nephropathia Epidemica ndi Dobrava Hemorrhagic Fever yokhala ndi Renal Syndrome).
• National Institute for Occupational Safety and Health (NIOSH, United States): Kupewa Hantavirus Pulmonary Syndrome (HPS) Pakati pa Ogwira Ntchito ndi Makoswe kapena Kutsuka Mapangidwe ndi Magalimoto Okhala ndi Makoswe (N100/P100 Kusankha kwa mpweya).