Hantavirus infection is a viral disease that is spread from rodents to people. The virus can cause severe infections of the lungs (with cough and shortness of breath) or kidneys (with abdominal pain, and sometimes kidney failure).
Hantaviruses are spread through contact with infected rodents or their droppings.
The infection starts with sudden fever, headache, muscle aches, and sometimes abdominal symptoms, which may be followed by a cough and shortness of breath or by kidney problems.
Blood tests to identify the virus can confirm the diagnosis.
Oxygen and medications to stabilize blood pressure are used if the lungs are affected, and dialysis may be needed if the kidneys are affected.
(See also Overview of Arbovirus, Arenavirus, and Filovirus Infections.)
Hantaviruses infect various species of rodents throughout the world. The virus is present in the urine and feces of the rodents. The infection is spread when people have contact with rodents or their droppings or urine or possibly when they inhale virus particles in places with large amounts of rodent droppings. Most hantaviruses do not spread from person to person; rarely, Andes hantavirus in southern South America spreads directly between people in close physical contact. Hantavirus infections are becoming more common.
There are several species of hantavirus. Depending on the species the virus affects different organs:
The lungs, causing hantavirus cardiopulmonary syndrome (HCPS)
The kidneys, causing hemorrhagic fever with renal syndrome (HFRS)
However, many symptoms of the two infections overlap.
The cardiopulmonary syndrome was first recognized in the southwestern United States in 1993. As of 2017, about 697 cases have occurred in the United States, most in the western states. Cases have also occurred in Canada and several Central and South American countries.
The renal syndrome occurs primarily in parts of Europe, Korea, China, and Russia. Seoul hantavirus causes the renal syndrome. This virus is spread by brown Norway rats and has been spread throughout the world by rats on ships. A few cases of hantavirus infection, spread by pet or laboratory rats, have occurred in the United States, Canada, and Europe.
Symptoms of Hantavirus Infection
Symptoms of hantavirus infection begin with sudden fever, headache, and muscle aches, typically about 2 weeks after exposure to the rodent droppings or urine. People may also have abdominal pain, diarrhea, or vomiting.
These symptoms continue for several days (usually for about 4 but sometimes up to 15 days).
Hantavirus cardiopulmonary syndrome
People with cardiopulmonary syndrome then develop a cough and shortness of breath, which may become severe within hours. Fluid collects around the lung, and blood pressure becomes low.
The cardiopulmonary syndrome causes death in up to about 50% of people. Those who survive the first few days improve rapidly and recover completely in about 2 to 3 weeks.
Hemorrhagic fever with renal syndrome
Hemorrhagic fever with renal syndrome is a group of similar illnesses caused by hantaviruses.
In some people with hemorrhagic fever with renal syndrome, the infection is mild and does not cause symptoms.
In others, vague symptoms (such as a high fever, muscle aches, headache, and nausea) begin suddenly. People with mild symptoms recover completely.
In others, symptoms become severe. Very low blood pressure (shock) develops in a few people. Kidney failure develops, and urine production may stop (called anuria). People may have blood in their urine and/or stool and bruises on their skin. Death occurs in 6 to 15%. Of those who survive, most recover in 3 to 6 weeks, but recovery may take up to 6 months.
Diagnosis of Hantavirus Infection
Blood tests to identify the virus
Hantavirus infection is suspected when people who may have been exposed to the virus have characteristic symptoms.
Blood tests to identify the virus can confirm the diagnosis.
Doctors do other blood tests to evaluate the function of the kidneys and other organs. If the cardiopulmonary syndrome is suspected, a chest x-ray may be done. Echocardiography (ultrasonography of the heart) is usually done to exclude other causes of fluid around the lungs.
Treatment of Hantavirus Infection
Supportive care
For the cardiopulmonary syndrome, oxygen and medications to stabilize blood pressure
For the renal syndrome, dialysis and ribavirinFor the renal syndrome, dialysis and ribavirin
Treatment of hantavirus infection is mostly supportive.
For the cardiopulmonary syndrome, oxygen and medications to stabilize blood pressure appear to be most crucial to recovery. Sometimes a ventilator is needed to help with breathing or in very severe cases blood oxygenation machine treatment (extracorporeal membrane oxygenation [ECMO]) may be necessary.
For the renal syndrome,dialysis may be needed and can be lifesaving, and the antiviral medication ribavirin, given intravenously, may help reduce the severity of symptoms and the risk of death.may be needed and can be lifesaving, and the antiviral medication ribavirin, given intravenously, may help reduce the severity of symptoms and the risk of death.
