Symptoms & Clinical Syndromes

Hantaviruses cause two distinct clinical syndromes depending on the viral strain and geographic region. Both can progress rapidly — early recognition is critical.

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Medical Emergency

If you experience sudden fever, severe fatigue, and breathing difficulty after potential rodent exposure, seek emergency care immediately. Hantavirus illness can progress from mild symptoms to life-threatening respiratory or kidney failure within hours.

Quick Comparison

FeatureHPSHFRS
Primary organ affectedLungsKidneys
Geographic rangeAmericasEurope, Asia
Example virusesSin Nombre, AndesHantaan, Puumala, Seoul
Case fatality rate35–40%0.1–15%
Incubation period1–8 weeks1–8 weeks
Person-to-person spreadAndes virus onlyNot documented
TreatmentSupportive (ECMO)Supportive + dialysis
HPS

Hantavirus Pulmonary Syndrome

Causative viruses

Sin Nombre, Andes, Choclo, Juquitiba

Regions

North America, South America

Incubation

1–8 weeks (average 2–4 weeks)

Case fatality rate

35–40%

Transmission

Inhalation of aerosolized rodent excreta; Andes virus also spreads person-to-person

Clinical Phases

Phase 1: Prodromal Phase

3–5 days
  • –High fever (38–40°C / 100–104°F)
  • –Severe fatigue and myalgia
  • –Headache
  • –Dizziness
  • –Chills
  • –Nausea, vomiting, diarrhea, or abdominal pain (30–40% of cases)

Phase 2: Cardiopulmonary Phase

Hours to days after prodrome
  • –Rapidly progressing cough
  • –Shortness of breath (dyspnea)
  • –Pulmonary edema (fluid in lungs)
  • –Severe hypoxia
  • –Hypotension and cardiogenic shock
  • –Bradycardia progressing to atrial fibrillation or ventricular tachycardia

Phase 3: Convalescent Phase

Weeks to months
  • –Gradual resolution of pulmonary edema
  • –Diuresis (increased urination)
  • –Persistent fatigue
  • –Shortness of breath during exertion may persist
HFRS

Hemorrhagic Fever with Renal Syndrome

Causative viruses

Hantaan, Puumala, Seoul, Dobrava

Regions

Europe, Asia

Incubation

1–8 weeks (typically 2–4 weeks)

Case fatality rate

0.1% (Puumala) to 15% (Hantaan)

Transmission

Inhalation of aerosolized excreta from infected rodents

Clinical Phases

Phase 1: Febrile Phase

3–7 days
  • –Abrupt-onset high fever
  • –Severe headache
  • –Back and abdominal pain
  • –Flushing of face and neck
  • –Blurred vision
  • –Petechiae (small red spots) on palate and skin

Phase 2: Hypotensive Phase

Hours to 2 days
  • –Sudden drop in blood pressure
  • –Nausea and vomiting
  • –Leakage of plasma from capillaries
  • –Thrombocytopenia (low platelet count)
  • –Hemorrhagic manifestations

Phase 3: Oliguric Phase

3–7 days
  • –Severely reduced urine output
  • –Kidney failure
  • –Fluid overload
  • –Electrolyte imbalances
  • –Risk of pulmonary edema

Phase 4: Diuretic Phase

Days to weeks
  • –Excessive urine output (up to 8L/day)
  • –Risk of dehydration and electrolyte imbalance
  • –Gradual improvement in kidney function

Phase 5: Convalescent Phase

Weeks to months
  • –Gradual recovery
  • –Persistent fatigue
  • –Some patients develop chronic kidney disease

Transmission & Prevention

How Hantavirus Spreads

  • → Inhaling dust contaminated with rodent urine, feces, or saliva
  • → Touching contaminated surfaces then touching eyes, nose, or mouth
  • → Rodent bites (rare)
  • → Andes virus: person-to-person contact (unique among hantaviruses)

Hantavirus is NOT spread by coughing, sneezing, or casual person-to-person contact (except Andes virus).

Prevention Measures

  • ✓ Seal gaps and cracks where rodents can enter structures
  • ✓ Store food and garbage in rodent-proof containers
  • ✓ Remove brush, woodpiles, and debris near the home
  • ✓ Use N95 respirator when cleaning infested areas
  • ✓ Wet-mop or spray disinfectant before sweeping (prevents dust)
  • ✓ Trap rodents using snap traps rather than disturbing nests
  • ✓ Wear rubber gloves when handling traps or cleaning
  • ✓ Camp away from rodent burrows and dense brush

Diagnosis & Treatment

Diagnosis

  • RT-PCR: Detects viral RNA in blood during acute phase
  • ELISA serology: IgM and IgG antibodies (most common test)
  • Immunohistochemistry: Used on tissue in fatal cases
  • Plaque reduction neutralization test (PRNT): Confirmatory gold standard

Treatment

There is no FDA-approved antiviral therapy. Treatment is intensive supportive care:

  • HPS: Mechanical ventilation, ECMO (extracorporeal membrane oxygenation), careful fluid management
  • HFRS: Intravenous fluids, electrolyte management, dialysis for kidney failure
  • Ribavirin: Some evidence for HFRS in early stages; not proven for HPS