Hantavirus infection: A narrative review focusing on epidemiology, diagnosis, infection control and treatment in the era of globalisation.

Hantavirus infection remains a major challenge in intensive care medicine because of its rapid progression, high mortality, and limited therapeutic options. This narrative review summarizes current evidence regarding the epidemiology, diagnosis, infection control, and critical care management of hantavirus cardiopulmonary syndrome (HCPS), with particular focus on Andes virus (ANDV) infection in South America. Hantaviruses are zoonotic RNA viruses transmitted mainly through inhalation of aerosolized rodent excreta. Unlike other hantaviruses, ANDV has demonstrated sustained person-to-person transmission, particularly in Argentina and Chile, creating important implications for infection prevention and hospital isolation measures. HCPS is characterized by a prodromal febrile phase followed by abrupt cardiopulmonary deterioration with non-cardiogenic pulmonary edema, shock, and respiratory failure. Early recognition is essential and relies on epidemiological exposure combined with laboratory findings such as thrombocytopenia, hemoconcentration, neutrophilia, immunoblasts in peripheral blood, and elevated lactate dehydrogenase. Confirmatory diagnosis is based on serology and RT-qPCR. Management remains primarily supportive. Careful fluid administration, vasopressor support, invasive mechanical ventilation with lung-protective strategies, and early transfer to experienced intensive care units are critical. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as a potentially lifesaving therapy in refractory cases, with encouraging survival outcomes in specialized centers. Current evidence does not support routine corticosteroid use, although they may be considered in selected patients with acute respiratory distress syndrome. Ribavirin has not demonstrated benefit during the cardiopulmonary phase, whereas convalescent plasma remains a promising but still investigational therapy. Prevention, rapid diagnosis, strict infection control, and timely organ support remain the cornerstones of HCPS management.