Hantavirus

Hantaviruses, transmitted to people by infected rodents, are part of the Bunyavirales order of viruses and can cause either hemorrhagic fever with renal syndrome (HFRS) or hantavirus cardiopulmonary syndrome (HCPS).  Hantaviruses that cause HFRS are found throughout the world, whereas those that cause HCPS, including the Sin Nombre hantavirus, are found in the Americas.  Early symptoms of both HRFS and HCPS include fever, chills, headaches, nausea, abdominal pain, and muscle soreness.  A more developed infection may cause hypotension, thrombocytopenia, and renal failure (in cases of HFRS) or shortness of breath, tachycardia, pulmonary edema, and eventual respiratory failure (in cases of HCPS).  Hantavirus diagnoses are most commonly confirmed by serology. 

Quick Answers for Clinicians

Who should be tested for hantavirus infection?

Because early symptoms of hantavirus infection are vague and similar to those of the flu (ie, fever, fatigue, muscle aches), testing should be performed only for symptomatic individuals who also have a history of rodent exposure.  An individual with appropriate symptoms, rodent exposure, AND shortness of breath should see a healthcare professional immediately.  These are indications of hantavirus cardiopulmonary syndrome (HCPS). 

Which tests are available to confirm a clinical diagnosis of hantavirus infection?

Serologic testing is generally recommended for confirmation of hantavirus infection. Current commercially available tests do not distinguish the subtype (eg, Sin Nombre or Seoul virus). For virus subtyping, refer to state and local health departments. All positive results are reported to the CDC. 

Indications for Testing

Individuals with symptoms of hantavirus infection and a history of exposure to a rodent or its droppings, urine, or nest, should be tested for confirmation.  See the CDC 2015 case definition for more information on HCPS. 

Laboratory Testing

A positive test result for a patient with compatible history is considered diagnostic. See the CDC Diagnostics page for more information on available testing. 

Recommended Testing

Serologic Testing

The current commercially available serologic test detects combined immunoglobulin G (IgG) and IgM antibodies but does not distinguish subtype. For subtyping (eg, Sin Nombre or Seoul virus), refer to state or local health departments. 

Other Testing

Immunohistochemical Staining

Immunohistochemical (IHC) testing is available for tissue samples. See the CDC Hantavirus Histopathology page for more information. 

 

Medical Experts

Contributor

Jackson

Brian R. Jackson, MD, MS
Associate Professor of Clinical Pathology; Adjunct Associate Professor, Biomedical Informatics, University of Utah
Medical Director, Support Services, IT, and Business Development, ARUP Laboratories

References