Orthohantavirus Infection Mimicking Acute Viral Hepatitis: An Underrecognized Clinical Presentation

Area of Science:

• Infectious Diseases
• Hepatology
• Virology

Background:

• Orthohantavirus infections classically cause hemorrhagic fever with renal syndrome (HFRS) or hantavirus cardiopulmonary syndrome (HCPS).
• Evidence shows a broader clinical spectrum, including significant hepatic involvement that can mimic acute viral hepatitis.
• This mimicry leads to diagnostic challenges and underrecognition of orthohantavirus infections.

Purpose of the Study:

• To synthesize evidence on hepatic involvement in orthohantavirus infection.
• To focus on clinical presentation, pathogenic mechanisms, differential diagnosis, biomarkers, and public health implications.
• To increase awareness among clinicians regarding this underrecognized manifestation.

Main Methods:

• Systematic literature search of peer-reviewed articles.
• Emphasis on studies reporting hypertransaminasemia, hepatitis-like illness, and liver injury in confirmed hantavirus infections.
• Synthesis of findings on clinical features, pathology, and diagnostics.

Main Results:

• Mild to moderate aminotransferase elevations are common in acute orthohantavirus infection.
• Some patients present with fever, thrombocytopenia, and hepatitis-like symptoms, resembling dengue, leptospirosis, or viral hepatitis.
• Hepatic injury results from systemic endothelial dysfunction and inflammation, not direct viral attack on liver cells.

Conclusions:

• Orthohantavirus infection should be considered in the differential diagnosis of acute febrile illness with hypertransaminasemia and thrombocytopenia, especially with rodent exposure history.
• Recognizing hepatic involvement as a systemic endothelial syndrome improves diagnostic accuracy and facilitates timely supportive care.
• Increased awareness among hepatologists, infectious disease specialists, and emergency physicians is essential.