Neurological Manifestations of Hantavirus Infection

Importance: Hantaviruses have caused several recent human disease outbreaks. They carry a high mortality rate, and some species can spread from person to person although they are typically spread from rodents to humans. Neurological complications have been documented but are poorly understood. Observations: Broadly, 2 types of syndromes have been associated with hantaviruses. The pulmonary syndrome carries a high mortality rate and can result in pulmonary and cardiac failure. Neurological involvement is typically secondary to hypoxic and ischemic injury or metabolic dysfunction. Another manifestation of the infection that is associated with some species of the virus is termed hemorrhagic fever with renal syndrome. Some patients may develop a meningoencephalitis or pituitary apoplexy resulting in sudden visual loss and pituitary dysfunction. Rarely, seizures, myelitis, and peripheral neuropathy may occur. Although there are no specific antiviral drugs approved for treatment of hantavirus, there are several that showed efficacy in preclinical trials. Management is supportive care and treatment of symptoms. Conclusions and Relevance: Neurological manifestations of hantavirus infection are uncommon but can be severe. Prospective studies and experimental models are needed to better characterize these manifestations, understand pathophysiology, identify therapeutic targets, and develop guidelines for management.