Hantavirus cardiopulmonary syndrome

Hantavirus cardiopulmonary syndrome (HCPS) is a notifiable condition.

Epidemiologic history of rodent infestation in or around the dwelling and/or cleaning out of rodent-contaminated enclosed areas are risk factors for hantavirus infection.

Human-to-human transmission has been rarely described with the Andes virus (ANDV), which is found in South America, and was the cause of the 2026 M/V Hondius cruise ship outbreak.

Presents as a nonspecific viral illness with fever, headache, myalgias, and often prominent gastrointestinal symptoms. During the pulmonary phase there is increasing dyspnea and hypoxemia, which can progress rapidly to cardiogenic shock and death.

Testing is recommended if a patient has compatible symptoms and recent rodent exposure in an endemic region or contact with a known case of ANDV infection during an outbreak.

Although there is no specific treatment or cure, early intensive medical care is critical to improve the chances of recovery. Supportive care includes careful fluid management, oxygen, vasoactive agents, platelet transfusion, and possibly mechanical ventilation.

In the cardiopulmonary phase of the disease, a falling cardiac index with evidence of cardiovascular collapse is an indication for extracorporeal membrane oxygenation (ECMO).

Mortality rate is approximately 20% to 50%, due to pulmonary edema and cardiogenic shock.

Hantavirus cardiopulmonary syndrome (HCPS), also known as hantavirus pulmonary syndrome (HPS), is a severe, life-threatening complication of hantavirus infection. It is an acute febrile illness marked by a nonspecific viral prodrome followed by rapidly progressive pulmonary insufficiency and shock occurring in an otherwise healthy person. Infection is typically acquired through aerosol contact with rodent excreta.[1]Vial PA, Ferrés M, Vial C, et al. Hantavirus in humans: a review of clinical aspects and management. Lancet Infect Dis. 2023 Sep;23(9):e371-82. http://www.ncbi.nlm.nih.gov/pubmed/37105214?tool=bestpractice.com

Hantavirus infection is associated with two types of severe acute febrile illness: HCPS, which occurs in the western hemisphere, and hemorrhagic fever with renal syndrome (HFRS), which occurs in Asia and Europe and is an Old World disease.[1]Vial PA, Ferrés M, Vial C, et al. Hantavirus in humans: a review of clinical aspects and management. Lancet Infect Dis. 2023 Sep;23(9):e371-82. http://www.ncbi.nlm.nih.gov/pubmed/37105214?tool=bestpractice.com

New World hantaviruses (e.g., Sin Nombre, Bayou, New York, Black Creek Canal, Monongahela, and Andes viruses) are associated with HCPS, while Old World hantaviruses (e.g., Hantaan, Dobrava, Seoul, and Puumala viruses) cause HFRS.[2]Vapalahti O, Mustonen J, Lundkvist A, et al. Hantavirus infections in Europe. Lancet Infect Dis. 2003 Oct;3(10):653-61. http://www.ncbi.nlm.nih.gov/pubmed/14522264?tool=bestpractice.com

This topic focuses on the diagnosis and management of hantavirus infection resulting in HCPS. HFRS is beyond the scope of this topic. While HCPS with renal involvement has been reported, it is not considered to be HFRS.