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Hantavirus cardiopulmonary syndrome

Brian Hjelle, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Sheila Bond, MD


Of the more than 20 known species of rodent-borne viruses within the genus Hantavirus, family Bunyaviridae, at least 11 are associated with human disease. Two major forms of hantavirus disease are recognized: hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS, also called HPS) [1].

Among the agents of HCPS, the most severe forms are associated with Sin Nombre virus (SNV) and the southern (prototypical) form of Andes virus; slightly milder forms are caused by the northern form of Andes virus (Andes-Nort), Laguna Negra virus (LNV), and Choclo virus [1,2]. In general, case-fatality ratios of HCPS range from 30 to 50 percent for severe forms and 10 to 30 percent for milder forms. The illness caused by Choclo virus (Panama) is the mildest form of HPS in that it nearly always or always lacks a significant component of cardiac insufficiency and is associated with a markedly lower case-fatality ratio.

The clinical manifestations of HCPS will be discussed here. The clinical manifestations of HFRS are discussed elsewhere (see "Renal involvement with hantavirus infection (hemorrhagic fever with renal syndrome)"). The etiologic agents of other human hantavirus diseases and the diagnosis of these pathogens are reviewed elsewhere (see "Pathogenesis of hantavirus infections" and "Epidemiology and diagnosis of hantavirus infections").


In May 1993, clinicians working with the Indian Health Service in the Four Corners region of the southwestern United States noted a cluster of cases of a severe and acute respiratory illness affecting previously healthy young adults. The syndrome was characterized by a nonspecific prodrome, followed by the rapid development of noncardiogenic pulmonary edema and hemodynamic compromise, and carried a high mortality [3].

A rapid response to the newly described syndrome was initiated by the Indian Health Service, the University of New Mexico School of Medicine, state health officials, and the United States Centers for Disease Control and Prevention. Within weeks, sera from patients were demonstrated to be broadly reactive to conserved regions of viruses of the genus Hantavirus [3,4]. Members of this genus previously had been identified as the etiologic agents of hemorrhagic fever with renal syndrome (HFRS), which occurs principally in Europe and Asia [2,5,6].

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Literature review current through: Nov 2017. | This topic last updated: Jun 04, 2017.
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