Hantavirus cardiopulmonary syndrome: an emerging fatal zoonotic infection

Hantavirus cardiopulmonary syndrome is a potentially fatal respiratory zoonotic infection caused by New World hantaviruses, and it is acquired mostly via inhaling aerosolized excreta from infected rodents. Over the past 30 years, HCPS has expanded beyond its initial foci, and recent events suggest a potential for spread beyond traditionally endemic regions. The disease rapidly progresses from a vague prodrome to acute cardiopulmonary failure with a high fatality rate despite optimum supportive treatment. Pathophysiology involves endothelial failure, increased vascular permeability, acute thrombocytopenia and excessive immunological responses resulting in capillary leak syndrome and cardiogenic shock. It is still hard to clinically suspect early since the prodromal symptoms are vague and mirror common viral infections and respiratory disorders. Diagnostic confirmation needs serological testing or genetic approaches, which are typically unavailable in resource-limited endemic situations, leading to considerable diagnostic delays. Management is generally supportive, with early ICU admission, judicious hydration management, mechanical breathing and cardiopulmonary support including extracorporeal membrane oxygenation in refractory patients. The recent multi-country Andes virus epidemic on a cruise ship in May 2026 highlights the potential for fast worldwide transmission of HCPS outside of usual endemic settings. This review summarizes the current information on the epidemiology, pathophysiology, clinical presentation, diagnostic techniques, and treatment options for HCPS. We also highlight the pressing need for improved global surveillance, rapid point-of-care diagnostics, global awareness among health care workers, and ongoing development of preventive vaccines and effective antiviral therapies to address this significant public health threat.