Morphology: Enveloped, single-stranded negative-sense RNA virus. Family Hantaviridae. Rodent reservoirs (deer mouse for Sin Nombre in US; striped field mouse for Hantaan in Asia). Inhalation of aerosolized rodent excreta → no human-to-human transmission (except Andes virus in S. America, rare).
Typical drugs
- #1Ribavirin— **Limited benefit even where used.** Some evidence for HFRS (Asian Hantaan). **NO benefit for HPS (Sin Nombre, Americas)** — supportive ICU only.
Empiric therapy when resistant
HPS (Hantavirus Pulmonary Syndrome — Americas): aggressive ICU support, mechanical ventilation, pressors; ECMO can be lifesaving in severe cardiopulmonary failure (one of few survivable supportive options when caught early). HFRS (Hemorrhagic Fever with Renal Syndrome — Asia, Europe): ribavirin within 7 days may benefit. No effective antiviral for HPS.
Resistance notes
N/A.
Pearls
HPS (Hantavirus Pulmonary Syndrome): rural Western US, recent rodent exposure → prodrome (fever, myalgia 3–5 d) → cardiopulmonary phase (pulmonary edema, shock — mortality 30–40%). Classic boards triad: thrombocytopenia + hemoconcentration + immunoblasts on CBC. HFRS: prodrome → hypotensive phase → oliguric AKI ("5 phases" — febrile, hypotensive, oliguric, diuretic, convalescent). No antiviral works well for HPS — aggressive supportive care + ECMO is the answer. Prevention: avoid sweeping / vacuuming rodent-infested spaces; wet down with bleach solution first + ventilate well. Notifiable disease. No vaccine in US; Korea has Hantavax for HFRS.