What are the symptoms of hantavirus infection?

Hantavirus infection typically presents in two phases (CDC). The early febrile phase, lasting 1-7 days, includes fever, severe muscle aches (thighs, hips, back, shoulders), fatigue, headache, dizziness, chills, and sometimes nausea, vomiting, or abdominal pain. The late cardiopulmonary phase, 4-10 days after onset in HPS cases (Andes, Sin Nombre), brings cough, shortness of breath, fluid in the lungs, and rapidly progressing respiratory failure. HFRS variants (Puumala, Hantaan, Seoul) additionally cause acute kidney injury and bleeding manifestations. The clinical hallmark distinguishing hantavirus from influenza or COVID-19 is the abrupt transition to severe respiratory deterioration in HPS cases.