Hantavirus Pulmonary Syndrome (HPS) vs Haemorrhagic Fever with Renal Syndrome (HFRS)
Hantavirus disease has historically been split into two clinical buckets defined by which organ system fails first. HPS is the New World presentation and is much more lethal; HFRS is the Old World presentation and is more renal-dominated. Both share an initial prodrome and the underlying pathophysiology of vascular leak, but diverge at the critical-care management level: HPS needs lung support (often ECMO), HFRS needs renal support (dialysis).
| HPS | HFRS | |
|---|---|---|
| Region | Americas | Eurasia |
| Causative serotypes | Sin Nombre, Andes, Bayou, Black Creek Canal, Laguna Negra, Choclo | Hantaan, Seoul, Puumala, Dobrava-Belgrade, Saaremaa |
| Predominant organ | Lungs (non-cardiogenic oedema) | Kidneys (acute kidney injury) |
| Case-fatality | 30–50% (ANDV), ~38% (SNV) | 5–15% (HTNV/DOBV); <1% (PUUV) |
| Classical course | Prodrome → cardiopulmonary collapse (rapid) | Five stages: febrile, hypotensive, oliguric, diuretic, convalescent |
| Lab hallmark | Thrombocytopenia + immunoblasts + haemoconcentration | Thrombocytopenia + AKI + bleeding |
| ICU duration | Often <1 week (rapid course) | 1–3 weeks (renal recovery) |
| Long-term sequelae | Pulmonary function usually recovers in 6–12 months | ~5–10% persistent renal impairment |