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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
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).
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.
References
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Avšič-Županc T, Saksida A, Korva M. Hantavirus infections. Clin Microbiol Infect. 2019;21S:e6‐e16.
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CDC - Hantavirus Pulmonary Syndrome (HPS) 2015 Case Definition
Centers for Disease Control and Prevention. NNDSS: Hantavirus pulmonary syndrome (HPS) 2015 case definition. Accessed Jun 2020.
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CDC - Hantavirus: diagnostics
Centers for Disease Control and Prevention. Hantavirus: diagnostics. Last reviewed Mar 2020; accessed Jun 2020.
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CDC - Hantavirus Pulmonary Syndrome (HPS): Diagnosis & Treatment
Centers for Disease Control and Prevention. Hantavirus pulmonary syndrome (HPS): diagnosis & treatment. Last reviewed Aug 2012; accessed Jun 2020.
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CDC - Hantavirus: histopathology
Centers for Disease Control and Prevention. Hantavirus: histopathology. Last reviewed Aug 2012; accessed Jun 2020.