Clinical Information

Hantaviruses are a group of rodent-borne viruses, with different strains tied to specific regions and host species, causing either hantavirus pulmonary syndrome (HPS) in the Americas or hemorrhagic fever with renal syndrome (HFRS) in Europe and Asia. Severity varies by strain, from milder infections like Puumala and Seoul viruses to more severe ones like Sin Nombre, Andes, and Hantaan, with Andes virus uniquely capable of limited person-to-person transmission. In the US, the principal syndrome is HPS, most commonly associated with the deer mouse (Peromyscus maniculatus), with cases concentrated in the Southwest but reported nationwide. Risk factors include activities that disturb rodent-infested environments (eg, cleaning cabins, barns, or sheds), occupational exposure (construction, farming), and peridomestic infestations.

After an incubation period of about 1 to 6 weeks, HPS typically begins with a nonspecific prodrome of fever, myalgias (often prominent in the thighs and back), fatigue, and headache, sometimes accompanied by gastrointestinal symptoms. Within several days, patients can progress rapidly to cough and noncardiogenic pulmonary edema leading to hypoxemic respiratory failure and shock. Laboratory findings often include thrombocytopenia, hemoconcentration, leukocytosis with left shift (elevated white blood cell count with increased immature neutrophils), and elevated lactate dehydrogenase. Diagnosis is confirmed by serology (IgM and rising IgG antibodies), polymerase chain reaction analysis for viral RNA, or immunohistochemistry in specialized settings. Early recognition is critical due to the potential for rapid deterioration.

Management is primarily supportive, with early intensive care monitoring, careful fluid management, and prompt initiation of advanced respiratory support, including mechanical ventilation; extracorporeal membrane oxygenation (ECMO) may be lifesaving in severe cases. There is no widely approved specific antiviral therapy for HPS. Mortality for HPS remains high (approximately 30%-40%). Prevention focuses on minimizing rodent exposure through environmental control, safe cleanup practices (wet disinfection, avoiding aerosolization), and public health education.