HPS vs HFRS: the two faces of human hantavirus disease

Hantaviruses cause two main human syndromes that look very different at the bedside despite being caused by closely related viruses. Hantavirus pulmonary syndrome (HPS / HCPS): - Geography: predominantly the Americas (Argentina, Chile, Brazil, Bolivia, USA, Canada, Panama). - Dominant viruses: Sin Nombre (USA), Andes (Argentina, Chile), Laguna Negra (Bolivia, Paraguay), Choclo (Panama). - Organs: lungs and cardiovascular system. After 1-8 weeks of incubation, a non-specific febrile prodrome of 3-5 days transitions abruptly into pulmonary edema, severe hypoxemia, and cardiogenic shock. - Case-fatality: 25-40% even with intensive care. - Treatment: supportive only — no approved antiviral. Early ICU transfer, careful fluid management, ECMO in severe cases. Hemorrhagic fever with renal syndrome (HFRS): - Geography: predominantly Europe, Russia, China, Korea, Scandinavia. - Dominant viruses: Hantaan (Korea, China), Dobrava (Balkans, severe), Seoul (urban worldwide), Puumala (Scandinavia, mild). - Organs: kidneys and vascular endothelium. Five classical phases: febrile, hypotensive, oliguric, polyuric, convalescent. - Case-fatality: ranges from <1% (Puumala) to 5-10% (Hantaan), up to 12% (Dobrava). - Treatment: supportive plus dialysis if needed. Ribavirin has evidence of benefit in HFRS (unlike HPS). Both syndromes require notification to public health authorities in most jurisdictions. Diagnosis is by serology (IgM/IgG) or RT-PCR. Vaccines exist for HFRS in some countries (Korea, China) but not for HPS.