Hantavirus: A focused review for the emergency medicine clinician

Andes virus (ANDV), a form of hantavirus, is a potentially fatal disease with several cases recently reported aboard an expedition cruise ship in April and May 2026.

This focused narrative review provides a focused overview of the epidemiology, clinical presentation, diagnosis, and management of hantavirus infection, including ANDV, for the emergency clinician.

Human infections with hantavirus primarily occur through contact with aerosolized particles of saliva, feces, or urine of infected rodents or through touching contaminated surfaces. A recent outbreak of ANDV has demonstrated human-to-human transmission in the setting of close, prolonged contact. The incubation period ranges between 4 and 42 days. As hantaviruses target the endothelium of capillaries and small vessels, patients may develop hemorrhagic fever with renal syndrome, predominantly associated with hantaviruses found in Europe and Asia or hantavirus pulmonary syndrome, mainly associated with hantaviruses in the Americas. Both hemorrhagic fever with renal syndrome and hantavirus with pulmonary syndrome present initially with a non-specific viral prodrome (e.g., fever, chills, malaise, myalgias). Following this prodrome, patients with hemorrhagic fever with renal syndrome can demonstrate coagulation abnormalities and change in urine output with renal dysfunction, while hantavirus with pulmonary syndrome presents with cardiopulmonary symptoms with cough, dyspnea, tachycardia, and hypotension that may progress to respiratory failure and cardiogenic shock. Diagnosis incorporates ELISA assay to detect IgG and IgM antibodies. Patients with concern for ANDV should be isolated in a private room (preferably a negative pressure room). Airborne and contact precautions are recommended; strategies similar to those employed for managing patients with viral hemorrhagic fever may be considered. Treatment is primarily supportive, including resuscitation with intravenous fluids and vasopressors, respiratory support (e.g., supplemental oxygen, noninvasive ventilation, endotracheal intubation), antipyretics and analgesics, and hemorrhage control as needed. Mechanical ventilation, extracorporeal membrane oxygenation, and hemodialysis may be necessary.

Hantavirus may initially present with a non-specific viral prodrome, but travel and social history should prompt greater diagnostic suspicion. Patients are managed similarly to those with other viral hemorrhagic fevers.