Hantavirus hemorrhagic fever

Hantavirus hemorrhagic fever with renal syndrome is a hemorrhagic fever arising from infection with hantaviruses, a group of rodent-borne viruses that produce vascular syndromes in humans ^[1][2]. The illness is characterized by renal impairment and systemic vascular leakage rather than primary pulmonary or dermatologic disease ^[1][2].

Symptoms typically begin about two weeks after exposure and unfold through five stages: febrile, hypotensive, oliguric, diuretic, and recovery ^[1]. Early manifestations include headache, lower back pain, nausea, vomiting, diarrhea, bloody stool, skin petechiae, respiratory bleeding, and renal signs such as kidney swelling, proteinuria, and hematuria ^[1]. During the hypotensive phase, blood pressure falls from microvascular leakage, and renal failure drives the oliguric phase before gradual improvement ^[1]. Facial or upper-torso flushing, conjunctival and pharyngeal injection, petechiae, purpura, and mucosal bleeding may appear in the febrile or hemorrhagic phases ^[2].

The disease is caused mainly by four viruses across Asia and Europe: Hantaan, Seoul, Puumala, and Dobrava-Belgrade ^[1]. Hantaan virus is the predominant and most severe cause in East Asia and is spread by striped field mice, while Seoul virus accounts for roughly a quarter of cases worldwide via brown rats ^[1]. Puumala virus is the leading cause in Russia and northern and central Europe and is carried by bank voles, whereas Dobrava-Belgrade virus predominates in southern Europe with genotype-dependent reservoirs and severity ^[1]. Case fatality varies by virus from under 1% to 15% ^[1].

Rodents maintain hantaviruses as persistent, asymptomatic infections and transmit them to humans through aerosols or droplets from feces, urine, saliva, and blood, as well as contaminated food, grooming, biting, and scratching ^[1]. Fecal-oral spread and vertical transmission across the placenta have been described, and the viruses can survive in the environment for over a week under common conditions ^[1]. Human infection is therefore linked to exposure to rodent excretions, secretions, or direct contact rather than person-to-person spread ^[1].

Exposure reduction at home, workplaces, and campsites is the primary means of preventing hantavirus infection ^[1]. Rodent population control using rodenticides, traps, or predators, together with removing food sources and nesting sites, limits contamination of living spaces by infectious excretions and secretions ^[1]. Additional measures include preventing rodent entry, cleaning likely infested areas, covering trash, cutting grass, damping dust before activity, and disinfecting surfaces ^[1].

1. 1 Wikipedia contributors. Hantavirus hemorrhagic fever with renal syndrome - Wikipedia [Internet]. Wikipedia. cited 23 Oct 2026. Available from: https://en.wikipedia.org/wiki/Hantavirus_hemorrhagic_fever_with_renal_syndrome
2. 2 Gallo G et al. Beyond the Kidney and Lung: Cutaneous and Mucosal Clues to Human Hantavirus Disease. Int J Dermatol. 2026 Oct. PMID: 42265829. doi: 10.1111/ijd.70523. PubMed: https://pubmed.ncbi.nlm.nih.gov/42265829/