Hantavirus: A Comprehensive Contemporary Review of Virology, Global Epidemiology, Clinical Variants, Diagnosis, Treatment, and Intensive Care Management.

Abstract

Background: 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.

Materials and methods: 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.

Findings: 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.

Conclusion: 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.

How to cite this article: 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.