Summary
Definition
History and exam
Key diagnostic factors
- exposure to rodent excreta/bite
- dyspnea
- hypotension
Other diagnostic factors
- fever
- myalgias
- gastrointestinal symptoms
- headache
- normal or low oxygen saturation
- lung rales
Risk factors
- exposure to rodent excreta/bite
- close contact with hantavirus-infected humans
Diagnostic tests
1st tests to order
- CBC
- chest x-ray
- IgM and IgG serologies for hantavirus
- reverse transcriptase polymerase chain reaction (RT-PCR)
Tests to consider
- ABG
- serum lactate
- ECG
- echocardiogram
- flow-directed pulmonary artery catheter (Swan-Ganz catheter)
- lung biopsy
Emerging tests
- serum viral-RNA load
- neutralizing antibody
Treatment algorithm
sepsis of unknown cause
confirmed hantavirus infection
Contributors
Authors
Michael Sands, MD, MPH &TM, FIDSA

Professor of Medicine
College of Medicine
University of Florida
Jacksonville
FL
Disclosures
MS declares that he has no competing interests.
Carmen Isache, MD

Assistant Professor of Medicine
College of Medicine
University of Florida
Jacksonville
FL
Disclosures
CI declares that she has no competing interests.
Peer reviewers
Tze Wai Wong, FFPH, FRCP (Glasg)
Professor
School of Public Health and Primary Care
The Chinese University of Hong Kong
Prince of Wales Hospital
Shatin
Hong Kong
Disclosures
TWW declares that he has no competing interests.
Mary Joung Won Choi, MD, MPH
Medical Officer
Viral Special Pathogens Branch
US Centers for Disease Control and Prevention
Atlanta
GA
Disclosures
MC declares that she has no competing interests.
References
Key articles
Jonsson CB, Hooper J, Mertz G. Treatment of hantavirus pulmonary syndrome. Antiviral Res. 2008 Apr;78(1):162-9.Full text Abstract
Mertz GJ, Hjelle B, Crowley M, et al. Diagnosis and treatment of new world hantavirus infections. Curr Opin Infect Dis. 2006 Oct;19(5):437-42. Abstract
Chang B, Crowley M, Campen M, et al. Hantavirus cardiopulmonary syndrome. Semin Respir Crit Care Med. 2007 Apr;28(2):193-200. Abstract
Centers for Disease Control and Prevention. Hantavirus pulmonary syndrome (HPS) 2015 case definition. 2015 [internet publication].Full text
Centers for Disease Control and Prevention. General hantavirus technical/clinical information: clinical manifestation. August 2012 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Viral upper respiratory tract infection
- Influenza
- Mycoplasma pneumoniae pneumonia
More DifferentialsGuidelines
- CDC Yellow Book: health information for international travel - viral hemorrhagic fevers
- Hantavirus reporting and surveillance guidelines
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