Symptoms & clinical phases
Hantaviruses cause two distinct severe syndromes depending on the strain and region.
Seek emergency care immediately if you develop sudden shortness of breath, chest tightness or severe muscle pain after possible rodent exposure (rural cabins, barns, rodent-infested buildings).
Hantavirus Pulmonary Syndrome (HPS)
Americas — Sin Nombre, Andes, etc. CFR ≈ 30–40%
1
Incubation
1–8 weeks (typically 2–4) after exposure to infected rodent excreta.
2
Prodromal phase (3–7 days)
Fever ≥38°C, severe myalgia (thighs, hips, back), chills, headache, nausea, abdominal pain. Often misdiagnosed as flu.
3
Cardiopulmonary phase
Sudden cough, dyspnea, non-cardiogenic pulmonary edema, hypotension and shock. Rapid deterioration over hours — ICU support is required.
4
Diuretic & convalescent phase
If patient survives: fluid resorption, then weeks-to-months of fatigue and reduced exercise tolerance.
Hemorrhagic Fever with Renal Syndrome (HFRS)
Eurasia — Hantaan, Puumala, Dobrava, Seoul. CFR 0.1–10%
1
Febrile (3–7 days)
Fever, headache, back/abdominal pain, facial flushing, conjunctival injection, petechiae.
2
Hypotensive (hours–2 days)
Tachycardia, hypoxemia, capillary leak, possible shock. About 1/3 of deaths occur here.
3
Oliguric (3–7 days)
Acute kidney injury, oliguria/anuria, hypertension, hemorrhagic manifestations. Half of deaths occur in this phase.
4
Diuretic + convalescent
Polyuria up to 3–6 L/day, gradual recovery over weeks. Most survivors recover fully.
Diagnosis
- Serology (ELISA / IFA) — IgM antibodies are the standard rapid test.
- RT-PCR — detects viral RNA in blood early in infection; useful for strain typing.
- Imaging & labs — CXR (interstitial edema), thrombocytopenia, elevated hematocrit, elevated LDH, immunoblasts on smear.
Educational summary based on CDC and ECDC clinical guidance. Always consult a clinician for diagnosis and treatment.