Abstract
During the spring of 1993, a mysterious respiratory disease struck the Four Corners region of the southwestern United States. Persons who became ill were generally young and previously healthy before succumbing to an acute febrile illness that began with simple influenza-like symptoms and often culminated in death by pulmonary edema and cardiovascular collapse. With astonishing speed and efficiency, a collaborative team of federal, state, and local healthcare workers, including clinicians, epidemiologists, and laboratory scientists, identified a newly discovered species of hantavirus as the causative agent of the outbreak. In the ensuing 25 years, the epidemiology, virology, pathophysiology, clinical course, and treatment of hantavirus pulmonary syndrome have been the focus of ongoing research. Because of its rarity, and because of the need for early acute intervention in the face of precipitous decline, recognition of the unique laboratory profile of hantavirus pulmonary syndrome in the setting of a predisposing exposure history is of paramount importance.
Highlights
During the spring of 1993, a mysterious respiratory disease struck the Four Corners region of the southwestern United States
On the morning of May 14, 1993, a 19-year-old Native American man was traveling by car through the Four Corners region of New Mexico, USA—the area where New Mexico, Arizona, Colorado, and Utah meet—when he became so severely short of breath that his alarmed accompanying family members pulled into a nearby service station to call for help
By the time the responding ambulance crew arrived, he had collapsed because of respiratory failure. He was taken to the emergency department at the Gallup Indian Medical Center, where he was found to have florid pulmonary edema, and where, despite maximal resuscitative efforts, he died in the emergency department
Summary
During the spring of 1993, a mysterious respiratory disease struck the Four Corners region of the southwestern United States. He had been called after a young woman, a Navajo tribal member, had died from acute pulmonary edema without any clinical clues pointing to a distinct etiology. Malone had referred that case for a postmortem examination to Patricia McFeeley, a University of New Mexico pathologist who worked in conjunction with the office of the medical examiner.
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