Haemorrhagic fever with renal syndrome (HFRS) is caused by Old World hantaviruses: Hantaan and Seoul viruses (Asia, severe), Dobrava virus (Balkans, severe), and Puumala virus (Europe, nephropathia epidemica, mild).

Reservoirs: striped field mouse, brown rat, and bank vole. Infection through inhaled aerosols of rodent excreta.
Over 150,000 cases yearly worldwide, mostly in China. Case fatality: Hantaan 5 to 15%, Seoul 1 to 2%, Puumala under 0.5%.

Five phases: febrile (3 to 7 days; fever, headache, back pain, flushing, conjunctival injection, petechiae), hypotensive (hours to 3 days; shock), oliguric (3 to 7 days; acute kidney injury, haemorrhage, hypertension), polyuric (days to weeks; diuresis, dehydration), and convalescent (weeks to months).
Haemorrhage (petechiae, haematuria, GI bleeding), acute myopia and visual blurring (Puumala), thrombocytopenia, and proteinuria.
Complications: uraemia, pulmonary oedema, pituitary haemorrhage, and kidney rupture.

Supportive management is central: careful fluid balance (fluids in the hypotensive phase, restricted in the oliguric phase), vasopressors, correction of electrolytes, blood and platelet transfusion for bleeding.
Renal replacement therapy (haemodialysis) in oliguric AKI with uraemia, hyperkalaemia, and fluid overload (needed in 5 to 15%).
Ribavirin: early IV administration (within the first 4 days) lowers mortality in Hantaan HFRS: 33 mg/kg loading dose, then 16 mg/kg every 6 hours for 4 days, then 8 mg/kg every 8 hours for 3 days.
Monitor blood pressure, urine output, and electrolytes closely; manage hypertension.
Rodent control, hygiene, and safe storage of food; vaccines available in China and Korea.

Hantavirus Haemorrhagic Fever with Renal Syndrome

Overview

Clinical Features

Diagnosis

Management