Chapman L E, Khabbaz R F
Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333.
Infect Agents Dis. 1994 Oct;3(5):234-44.
In May and June 1993, a handful of previously healthy residents of rural areas in the Four Corners region of the southwestern United States died of acute unexplained respiratory distress, later diagnosed as hantavirus pulmonary syndrome. Their illnesses were characterized most prominently by a prodrome of fever and myalgias, followed by thrombocytopenia, the presence of immature white blood cells on the peripheral smear, and catastrophic respiratory decline associated with the sudden onset of noncardiogenic pulmonary edema and hypotensive shock. Although the primary care doctors who treated these patients were spread over a relatively wide rural geographic area, this cluster was recognized in large part because these patients belonged to a defined cohort receiving medical care from a unified system of interconsulting physicians, the Indian Health Service. By just over 2 weeks after receiving laboratory diagnostic specimens, Public Health Service scientists had identified a newly recognized hantavirus as the cause of this disease cluster and Peromyscus maniculatus (the deer mouse) as the rodent reservoir for this zoonotic virus. The oral history of local American Indian healers describes clusters of similar deaths occurring over three cycles during the twentieth century in association with identifiable ecological markers. The abrupt introduction to Western medical practitioners of a disease long recognized by indigenous healers through illness occurring among a cohort of patients seeking care from medical officers of the U.S. Uniformed Services parallels the initial Western medical recognition of previous human illnesses associated with hantaviral infections through disease outbreaks among military troops. The remarkable speed with which the etiology of this disease was elucidated is attributable to both the power of modern genetic investigational techniques and the scientific groundwork laid by nearly half a century of systematic research on hantaviruses.
1993年5月和6月，美国西南部四角地区农村的一些此前健康的居民死于急性不明原因呼吸窘迫，后来被诊断为汉坦病毒肺综合征。他们的病症最显著的特征是前驱症状为发热和肌痛，随后出现血小板减少、外周血涂片上有未成熟白细胞，以及与非心源性肺水肿和低血压休克突然发作相关的灾难性呼吸功能衰退。尽管治疗这些患者的初级保健医生分布在相对广阔的农村地理区域，但这一病例群很大程度上得以被识别，是因为这些患者属于一个由相互咨询的医生组成的统一系统——印第安卫生服务机构提供医疗服务的特定队列。在收到实验室诊断标本后仅两周多一点的时间，公共卫生服务机构的科学家就确定了一种新发现的汉坦病毒是这一疾病群的病因，并确定白足鼠（鹿鼠）是这种人畜共患病毒的啮齿动物宿主。当地美国印第安治疗师的口述历史描述了在20世纪，类似的死亡病例群在三个周期中出现，并伴有可识别的生态标志。这种长期以来被本土治疗师所认识的疾病，突然出现在一群向美国军队医务人员寻求治疗的患者中，这让西方医生有所了解，这与西方医学最初通过军队中的疾病爆发认识到先前与汉坦病毒感染相关的人类疾病的情况类似。这种疾病的病因能如此迅速地被阐明，既归功于现代基因研究技术的强大力量，也归功于近半个世纪对汉坦病毒进行系统研究所奠定的科学基础。
