Hantavirus: A Comprehensive Contemporary Review of Virology, Global Epidemiology, Clinical Variants, Diagnosis,...

Hantaviruses are negative-sense, single-stranded RNA viruses of the family Hantaviridae that cause two potentially lethal zoonotic syndromes: Hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). With approximately 2,00,000 reported cases of HFRS annually worldwide and case-fatality rates reaching 36-40% in severe HCPS, hantaviruses constitute a significant global public health burden. Rodent excreta are the principal source of human infection through inhalation of infectious aerosols.

A comprehensive literature search was conducted using PubMed, Embase, WHO databases, and CDC surveillance reports (1993-2025) to synthesize current evidence on hantavirus taxonomy, epidemiology, pathogenesis, clinical features, diagnosis, treatment, and intensive care unit (ICU) management.

More than 50 distinct hantavirus species are now recognized, classified broadly into Old World (HFRS-causing) and New World (HCPS-causing) viruses. Sin Nombre virus (SNV) dominates in North America, while Andes virus (ANDV)-the only hantavirus documented to spread person-to-person-causes the majority of HCPS cases in South America. Hantaan virus (HTNV) remains the most common HFRS pathogen in Asia. Diagnosis relies on reverse transcriptase polymerase chain reaction (RT-PCR) during the 1st week of illness and immunoglobulin M (IgM)/immunoglobulin G (IgG) serology thereafter. Ribavirin reduces mortality in HFRS when given early; no antiviral is definitively proven for HCPS. Extracorporeal membrane oxygenation (ECMO) has transformed survival in severe HCPS. Favipiravir and monoclonal antibody therapies are under active investigation.

Hantavirus infections demand a high index of clinical suspicion, especially in occupationally exposed or rural populations. Timely diagnosis, evidence-based ICU protocols, and stringent rodent control are the cornerstones of management.

Kumar ASA, John J. Hantavirus: A Comprehensive Contemporary Review of Virology, Global Epidemiology, Clinical Variants, Diagnosis, Treatment, and Intensive Care Management. Indian J Crit Care Med 2026;30(5):430-442.