HPS was defined as fever [greater than or equal to] 38.3 [degrees]C with bilateral diffuse interstitial edema and respiratory compromise within 72 hours of hospitalization, occurring in a previously healthy person, or an unexplained respiratory illness resulting in death, for which an autopsy demonstrated noncardiogenic pulmonary edema
without an identifiable cause (15).
Other causes of noncardiogenic pulmonary edema
should be excluded before the diagnosis is made.
Transfusion-related acute lung injury (TRALI) produces a clinical picture similar to that of adult respiratory distress syndrome, consisting of hypotension, fever, dyspnea, and tachycardia.[1,2] Noncardiogenic pulmonary edema
with diffuse bilateral pulmonary infiltrates on chest radiography is characteristic.
The most common clinical presentations include a noncardiogenic pulmonary edema
, disturbances of the central nervous system (CNS) of variable severity, and coagulative alterations.
The clinical case definition, as approved by the Council of State and Territorial Epidemiologists, includes fever and pulmonary symptoms (bilateral diffuse interstitial edema, clinical diagnosis of acute respiratory distress syndrome, or radiographic evidence of noncardiogenic pulmonary edema
) or unexplained respiratory illness resulting in death and an autopsy examination demonstrating noncardiogenic pulmonary edema
without identifiable cause (14).
An increase in BNP within the normal range at 24 hours post-race (p = 0.006) deserves study as a possible mechanism for hyponatremia and noncardiogenic pulmonary edema
as may occur in endurance athletes after competition (20).
The basic clinical features in humans include fever, headache, myalgia, and gastrointestinal symptoms, followed by noncardiogenic pulmonary edema
, cardiovascular collapse, and a 40%-60% case-fatality proportion.
Arieff, "Hyponatremia, cerebral edema, and noncardiogenic pulmonary edema
in marathon runners," Annals of Internal Medicine, vol.
Several pulmonary complications are associated with the inhalation of crack cocaine (e.g., intensive cough, hemoptysis, shortness of breath, chest pain, acute bilateral pulmonary infiltrates, thermal airway injury, pneumothorax and noncardiogenic pulmonary edema
, production of carbonaceous sputum, and exacerbation of asthma) (9).
To identify cases, public health officials established a provisional surveillance case definition of 1) radiographic evidence of unexplained bilateral pulmonary interstitial infiltrates with hypoxemia (arterial oxygen saturation of <90% while breathing room air) or 2) an autopsy finding of unexplained noncardiogenic pulmonary edema
occurring during 1993.
A suspected case was also defined as an unexplained respiratory illness resulting in death, with a postmortem examination indicating noncardiogenic pulmonary edema
without identifiable cause (34).
The surprising rapidity with which noncardiogenic pulmonary edema
affects often previously healthy victims separates HPS from many other common febrile diseases seen in North America.