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 rash, abdominal pain, and sometimes kidney failure).

• The virus is 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 a rash and kidney problems.
• Blood tests to identify the virus can confirm the diagnosis.
• Oxygen and drugs to stabilize blood pressure are used if the lungs are affected, and dialysis may be needed if the kidneys are affected.

Hantaviruses infect various species of rodents throughout the world. The virus is present in the urine, feces, and saliva of the rodents. The infection is spread when people have contact with rodents or their droppings or possibly when they inhale virus particles in places with large amounts of rodent droppings. Some evidence suggests that rarely, the virus spreads from person to person. Hantavirus infections are becoming more common.

There are several strains of hantavirus. Some strains affect the lungs, causing hantavirus pulmonary syndrome. Other strains affect the kidneys, causing hemorrhagic fever with renal syndrome. However, many symptoms of the two infections are the same. The pulmonary syndrome was first recognized in the southwestern United States in 1993. Since then, about 450 cases have occurred in the United States, most in the western states. Cases have also occurred in several Central and South American countries. The renal syndrome occurs primarily in parts of Europe and Korea.

Symptoms

Symptoms begin with sudden fever, headache, and muscle aches, typically about 1 to 5 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). People with the pulmonary syndrome then develop a cough and shortness of breath, which may become severe within hours. This syndrome causes death in about 50 to 75% of people.

In some people with the renal syndrome, the infection is mild and does not cause symptoms. In others, vague symptoms last for 3 or 4 days. Then in most people, the face becomes red, resembling a sunburn, and is covered with hives. A rash may develop on the trunk. Very low blood pressure (shock) develops in a few people. Kidney failure develops, and urine production may stop (called anuria). In some people, symptoms are mild, and they recover completely. In others, symptoms become severe, with death occurring in 6 to 15%.

Diagnosis and Treatment

Diagnosis 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.

Treatment is mostly supportive. For the pulmonary syndrome, oxygen and drugs to stabilize blood pressure appear to be most crucial to recovery. For the renal syndrome, dialysis may be needed and can be lifesaving, and ribavirinSome Trade Names
VIRAZOLE
, given intravenously, may help reduce the severity of symptoms and the risk of death. Most people recover in 3 to 6 weeks but recovery may take up to 6 months.

Last full review/revision November 2009 by Marguerite A. Urban, MD