Andes virus–associated cardiopulmonary syndrome: diagnostic approaches, clinical management, and evidence gaps—a scoping review

BACKGROUND: Andes virus-associated hantavirus cardiopulmonary syndrome (ANDV-HCPS) is a severe zoonotic disease endemic to South America, characterized by high mortality and a unique capacity for person-to-person transmission. The 2026 MV Hondius cruise ship outbreak underscored its potential for international dissemination. OBJECTIVES: To map the available evidence on diagnostic approaches and clinical management of ANDV-HCPS, and to identify key knowledge gaps and research priorities. METHODS: Data sources: PubMed/MEDLINE, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov, searched from 1 January 1993 to 13 May 2026. STUDY ELIGIBILITY CRITERIA: Original studies reporting clinical data on confirmed or probable ANDV-HCPS, including clinical trials, observational studies, surveillance cohorts, case series, and case reports. PARTICIPANTS: Patients with confirmed or probable ANDV-HCPS. TESTS: Diagnostic approaches, clinical management strategies, and therapeutic interventions evaluated across included studies. REFERENCE STANDARD: Not applicable; this scoping review did not assess diagnostic test accuracy against a common reference standard. Case confirmation criteria were those reported in the included studies, mainly ANDV-specific serology and/or molecular testing. ASSESSMENT OF RISK OF BIAS: No formal risk-of-bias assessment was performed. Studies were assessed for eligibility against predefined inclusion and exclusion criteria and charted using a predefined extraction framework, consistent with the scoping-review objective of mapping available evidence rather than weighting studies by methodological quality. METHODS OF DATA SYNTHESIS: Data were charted using a predefined extraction framework and synthesized narratively by clinical domain. RESULTS: Forty studies were included, predominantly retrospective cohorts and case reports from Chile and Argentina. Across the included studies, serology served as the primary diagnostic modality in routine practice, with RT-PCR reserved for diagnostically challenging cases; however, no validated ANDV-specific point-of-care test was identified. Management was entirely supportive, with mechanical ventilation, vasopressors, and extracorporeal membrane oxygenation (ECMO) used in severe cases; ECMO-based management was associated with improved survival in specialist centres, although evidence remains observational. No approved antiviral therapy exists; evidence for corticosteroids and immune plasma remains limited and inconclusive. Long-term outcomes are poorly characterized, with recent data suggesting substantial post-discharge morbidity. DISCUSSION: ANDV-HCPS remains a high-mortality disease with limited evidence across diagnostic and therapeutic domains. The decline over time in case fatality rates reflects accumulated clinical expertise rather than pharmacological advances. Key priorities include strengthening early diagnostic pathways, standardizing clinical escalation criteria, and generating prospective multicentre evidence on therapeutic interventions, building on prior experience and research efforts in endemic settings.