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Hantavirus: Clinical Reference

A concise reference for clinicians evaluating suspected hantavirus pulmonary syndrome (HPS) or hemorrhagic fever with renal syndrome (HFRS).

Last reviewed: May 2026 · Reviewed by HantaFAQs medical review panel

This page is intended for healthcare professionals. It is a summary, not a substitute for national clinical guidelines. Always defer to CDC, WHO, PAHO, or your local public health authority for jurisdiction-specific guidance.

Case definition (suggested)

  • Clinical: Febrile illness (≥38.3°C) with bilateral diffuse interstitial edema or ARDS within 72 h of hospitalization, or unexplained respiratory failure.
  • Epidemiologic: Possible rodent exposure or travel to endemic area within 6 weeks; close contact with confirmed Andes virus case for person-to-person spread.
  • Laboratory: Detection of hantavirus-specific IgM, ≥4-fold rise in IgG, or RT-PCR-confirmed viral RNA, or immunohistochemistry on tissue.

Differential diagnosis

  • Influenza, COVID-19, and other viral pneumonias
  • Leptospirosis
  • Plague (pneumonic)
  • Rickettsial disease (e.g. RMSF)
  • Sepsis with ARDS
  • Acute interstitial pneumonia

Diagnostic workup

  • CBC: thrombocytopenia, hemoconcentration, left-shifted leukocytosis, immunoblasts >10%
  • BMP: AKI in HFRS; elevated lactate in HPS shock
  • LDH, AST/ALT typically elevated
  • Chest imaging: bilateral interstitial edema progressing to alveolar filling
  • Hantavirus serology (IgM/IgG ELISA), RT-PCR — coordinate with state public health lab

Management — HPS

  • Early ICU admission — clinical decompensation can occur within hours.
  • Conservative fluid management — capillary leak; avoid aggressive crystalloid.
  • Vasopressors — norepinephrine first-line for cardiogenic shock.
  • Mechanical ventilation — low tidal volume (6 mL/kg IBW), permissive hypercapnia.
  • VA-ECMO — consider for refractory cardiogenic shock; survival benefit reported in case series.
  • Ribavirin — efficacy unclear for HPS; established for HFRS if started within 7 days of symptom onset.

Infection control

  • Sin Nombre and other non-Andes strains: standard precautions.
  • Andes virus: contact + droplet + airborne precautions; negative-pressure room when available; N95/PAPR for aerosol-generating procedures.

Reporting

Hantavirus is a nationally notifiable disease in the United States and many other jurisdictions. Report suspected cases promptly to local public health authorities.