Analysis of fatal pulmonary hantaviral infection in New York by reverse transcriptase in situ polymerase chain reaction.

The purpose of this study was to analyze the histological distribution of polymerase chain reaction (PCR)-amplified hantaviral cDNA in three cases of fatal hantaviral infection that occurred 2 years ago in Long Island, NY. The three otherwise healthy patients had a rapid death characterized by fever and pulmonary failure and were identified from the autopsy files at University Hospital, Stony Brook. Six autopsy controls with either no pulmonary disease (three) or fatal pneumonitis of known etiology (three) were also studied. PCR-amplified hantaviral cDNA was detected in the lung tissue of the three cases and none of the six controls using the reverse transcriptase in situ PCR technique. In the positive cases, viral RNA was detected in approximately 20% of pneumocytes and alveolar endothelial cells as determined with a consensus and Four Corners-specific primer pair. Infected endothelial cells were identified in a wide variety of other sites, but at rates much lower than in the lungs. The selective localization of the viral RNA in many pneumocytes and pulmonary endothelial cells using a highly sensitive PCR-based test demonstrates a correlation between direct viral infection in the lung and the disease process.