Hantavirus causes hantavirus cardiopulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS). HPS is caused by the hantavirus Sin Nombre and occurs in the Americas while the hantaviruses in Asia and Europe cause HFRS.

  • Diagnosis
  • Background
  • Lab Tests
  • References
  • Related Topics

Indications for Testing

  • Consider diagnosis in patients with acute respiratory or febrile illness, with thrombocytopenia and applicable rodent exposure

Criteria for Diagnosis

Laboratory Testing

  • Initial testing
    • Early in syndrome, diagnosis is usually clinical, but confirmation requires serum testing
    • CBC – in cardiopulmonary phase
      • Peripheral smear demonstrates thrombocytopenia – associated with prolonged tachypnea
      • Myelocytosis – >10% lymphocytes with immunoblastic morphology
    • Liver function tests – commonly elevated
    • Prothrombin time (PT)/partial thromboplastin time (PTT) – prolonged PTT is most common
  • Serologies using ELISA testing – confirm diagnosis
    • IgM appears relatively early after infection and declines over several weeks
      • Indicates recent exposure
    • IgG generally appears later and may remain elevated for years
  • PCR
    • Not widely available
    • Only useful in early stages when patient is viremic


  • Immunohistochemical staining (if available) is sensitive

Imaging Studies

  • Chest x-ray
    • Interstitial infiltrates most common
    • Pulmonary edema evident in more severe cases

Differential Diagnosis


  • Incidence – <50 cases annually in U.S.
  • Sex – M>F
  • Transmission – inhalation of infected aerosols from rodents


  • Hantavirus is the only member of the Bunyaviridae family that is not transmitted by arthropods
    • At least 11 species associated with human disease
  • Enveloped virus with tri-segmented, negative-stranded RNA
  • At least 25 genotypes identified in Americas
  • Virus is hosted by rodents of family Cricetidae

Clinical Presentation

  • Incubation of 1-2 weeks – fever, myalgia, headache, chills, abdominal pain, nonproductive cough, gastrointestinal symptoms
  • HPS – rapid development of dyspnea and pulmonary edema; diffuse infiltrates on chest x-ray
    • If hospitalization does not occur, hypotension and shock may follow, resulting in death within 3-6 days
  • Prolonged tachypnea; tachycardia common
Tests generally appear in the order most useful for common clinical situations. Click on number for test-specific information in the ARUP Laboratory Test Directory.

Hantavirus Antibodies, IgG and IgM 2001540
Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay


False positives occur in cytomegalovirus, influenza, and Mycoplasma pneumoniae infection


If test results are equivocal, repeat testing in 10-14 days

General References

Hartline J, Mierek C, Knutson T, Kang C. Hantavirus infection in North America: a clinical review. Am J Emerg Med. 2013; 31(6): 978-82. PubMed

Klein SL, Calisher CH. Emergence and persistence of hantaviruses. Curr Top Microbiol Immunol. 2007; 315: 217-52. PubMed

Mattar S, Guzmán C, Figueiredo LT. Diagnosis of hantavirus infection in humans. Expert Rev Anti Infect Ther. 2015; 13(8): 939-46. PubMed

Mertz GJ, Hjelle B, Crowley M, Iwamoto G, Tomicic V, Vial PA. Diagnosis and treatment of new world hantavirus infections. Curr Opin Infect Dis. 2006; 19(5): 437-42. PubMed

Mir MA. Hantaviruses. Clin Lab Med. 2010; 30(1): 67-91. PubMed

Simpson SQ, Spikes L, Patel S, Faruqi I. Hantavirus pulmonary syndrome. Infect Dis Clin North Am. 2010; 24(1): 159-73. PubMed

Medical Reviewers

Last Update: October 2017