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Pathogenesis of hantavirus infections

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


The genus Hantavirus is comprised of a group of more than 20 distinct species of rodent-borne viruses of the family Bunyaviridae. Two major forms of hantavirus disease are recognized, hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS, also called HPS).

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]. The known etiologic agents for the more serious forms of HFRS are Hantaan virus (HTNV) and Dobrava virus (DOBV); a form of intermediate severity is caused by Seoul virus (SEOV); and a milder form of HFRS is caused by a vole-borne hantavirus, Puumala virus (PUUV) [3].

The pathology and pathogenesis of hantavirus infections, with a special emphasis on HCPS, will be reviewed here. The composition of these enveloped viruses and their epidemiology, clinical manifestations, and prevention are discussed separately. (See "Epidemiology and diagnosis of hantavirus infections" and "Renal involvement with hantavirus infection (hemorrhagic fever with renal syndrome)" and "Hantavirus cardiopulmonary syndrome".)


Hantaviruses appear to exhibit similar replicative kinetics and to elicit similar immune responses in both rodents and humans, but rodent infection leads to a persistent state of infection with no overt clinical or pathologic consequence. By contrast, human infection often leads to overt signs and symptoms, subsequent resolution of disease and viremia, and probable immunity to future infection with the same viral strain [4,5]. Levels of plasma viral RNA appear to be higher in patients with severe clinical manifestations [5]; titers decline during convalescence [6]. The possibility of a persistent state in humans has been raised by a study of immune responses in 78 patients with Andes virus infections in which both T cell and neutralizing antibody responses failed to decline in intensity during years of convalescence [7]. Viremia was not present in convalescent subjects, so the location of any long-term reservoir of Andes virus replication within the host, if present, is not known. Further study is necessary to elucidate whether the persistence of these responses is due to ongoing infection.

Tissue tropism — The hantaviruses show very similar tissue tropism in both human and rodent hosts, with consistent involvement of the vascular endothelium of the heart, kidney, lung, and lymphoid organs [8]. Involvement of the central nervous system is rare.

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Literature review current through: Nov 2017. | This topic last updated: Jun 06, 2017.
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