Objective: To highlight the rising threat of Hantavirus pulmonary syndrome (HPS) in the post-coronavirus disease 2019 (COVID-19) era and the urgent need for better treatment and management strategies.
Key points:
1. Rising mortality rates associated with HPS, especially in American regions.
2. Limited effective management and treatment options are available to cure this rare zoonotic illness.
3. Urgent need for public health initiatives to reduce rodent-human transmission.
Conclusion: This rapidly emerging group of rare zoonotic viruses causes HPS, with a significant mortality rate, underscoring the urgent need for effective treatment plans, preventive strategies, and awareness campaigns to curb this disease and reduce the global health burden.

In the aftermath of the COVID-19 pandemic, another zoonotic virus has begun to gain attention: Orthohantaviruses. Orthohantaviruses, a rare but deadly group of zoonotic viruses, are responsible for hantavirus pulmonary syndrome HPS.[1] a severe respiratory disease with a mortality rate of up to 50%. This virus is rapidly showing increasing trends in South America and North America, with a significant mortality rate.[2] In Argentina, most of the cases required hospitalization, as more than 84% developed severe respiratory failure, requiring mechanical ventilation.[3] Up to now, only supportive and limited treatment options are available.

Transmission
Exposure to rodents, faeces, or rodent bites is the predominant cause of HPS. Moreover, people in forestry occupations, those with a history of cleaning rodent-infested areas, and farmers are at the highest risk of developing this infection.[4]

Clinical presentation
Initially, the patient presents with a raised temperature, nausea, vomiting, myalgia, headache, abdominal discomfort, and eventually diarrhea. Later, pulmonary symptoms develop, such as a non-productive cough and a shortness of breath, with mild to moderate respiratory compromise, pulmonary infiltration, and pleural effusion, which can lead to respiratory failure with hemodynamic compromise abruptly and cause a sudden death.[4]

Current treatment
As mentioned above, despite having supportive treatment options available in intensive care units, such as ventilation, fluid balance, inotropic agents, and extracorporeal membrane oxygenation, which pump the deoxygenated blood outside the body and add oxygen, thus balancing the oxygen/carbon dioxide (O₂/CO₂) ratio in blood, one-third of the patients still expire within the first 48 hours following admission. Regarding ribavirin, while a few studies have explored potential treatment options, none have been conclusively proven effective. Recently, numerous vaccines have been introduced and used in China and Korea; however, their long-term consequences remain unknown.[5,6] Thus, sufficient studies on treatment and management approaches must be conducted to curb this contagious disease effectively.

Hantavirus pulmonary syndrome, Orthohantaviruses, Extracorporeal membrane oxygenation, Contagious disease, Hemodynamic compromise.

Globally, Hantavirus is now emerging as a lethal infection, especially in American regions. It causes multi-organ syndrome, leading to respiratory system failure. Despite optimal treatment, morbidity and mortality rates are high, which increases the global health burden. So, to deal with this deadliest virus, new vaccines with good outcomes are necessary. The government and health authorities must also introduce awareness campaigns, make Standard Operating Procedures (SOPs), and educate people to minimize human-rodent contact. These combined approaches will significantly help to eradicate this illness in the shortest possible time.

The authors declare no acknowledgments.

The authors declare that there was no funding for this study.

Corresponding Author:
Kainat Kousar
Department of Medicine
Bahria University Health Sciences (BUHS), Karachi, Pakistan
Email: kainat.kousar12@gmail.com

Co-Authors:
Karan Chaman Lal
Department of Medicine
Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Pakistan

Ayesha Khan
Department of Medicine
Bahria University Health Sciences, Karachi, Pakistan

Puja
Independent Researcher, Northampton, United Kingdom

Conceptualization: Karan Chaman Lal, Kainat Kousar. Original draft: Karan Chaman Lal, Puja. Literature review: Karan Chaman Lal, Kainat Kousar, Ayesha Khan. Writing—review and editing: Karan Chaman Lal, Kainat Kousar. Final approval of manuscript: Karan Chaman Lal, Kainat Kousar, Ayesha Khan, Puja.

Not applicable

The Authors declare no conflict of interest.

None

https://doi.org/10.63096/medtigo3062327

Karan CL, Kainat K, Ayesha K, Puja. Letter to the Editor: Revisiting Hantavirus Pulmonary Syndrome: Why Are We Still Unprepared for This Emerging Threat? medtigo J Med. 2025;3(2):e3062327. doi:10.63096/medtigo3062327 Crossref