Hantavirus infection natural history, complications and prognosis

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Patient Information Hantavirus cardiopulmonary syndrome (HCPS) (patient information) Hemorrhagic fever with renal syndrome (HFRS) (patient information)
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Natural History

• Within 24 hours of initial evaluation, most patients develop some degree of hypotension and progressive evidence of pulmonary edema and hypoxia, usually requiring mechanical ventilation.
• The patients with fatal infections appear to have severe myocardial depression which can progress to sinus bradycardia with subsequent electromechanical dissociation, ventricular tachycardia or fibrillation.
• Hemodynamic compromise occurs a median of 5 days after symptom onset--usually dramatically within the first day of hospitalization.
• In contrast to HFRS, overt hemorrhage occurs rarely in HPS, although hemorrhage is occasionally seen in association with disseminated intravascular coagulation.
• If left untreated it may cause multiple organ failure and death.

Complications

Complications that can develop as a result of Hantavirus infection depends on the type of infection and can be summarized in the following table.

Type of hantavirus infection	Complications
Hemorrhagic fever with renal syndrome (HFRS)	Acute encephalomyelitis Bleeding Multiorgan dysfunction Pituitary hemorrhage Glomerulonephritis Pulmonary edema Acute respiratory distress syndrome Disseminated intravascular coagulation
Hantavirus cardiopulmonary syndrome (HCPS)	Renal insufficiency Thrombocytopenia Bleeding Myalgia Vomiting Diarrhea Shock

The overall prognosis of hantavirus infection depends on the clinical syndrome. The hantavirus cardiopulmonary syndrome (HCPS) has 38% mortality rate. Hemorrhagic fever with renal syndrome (HFRS) has better prognosis than hantavirus cardiopulmonary syndrome (HCPS). Depending upon which virus is causing the HFRS, death occurs in less than 1% to as many as 15% of patients. Fatality ranges from 5-15% for HFRS caused by Hantaan virus, and it is less than 1% for disease caused by Puumala virus.