Hantavirus infection medical therapy: Difference between revisions
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{{CMG}}, {{AE}}{{SMP}} | {{CMG}}, {{AE}}{{SMP}} | ||
==Overview== | ==Overview== | ||
There is no specific treatment, cure, or vaccine for hantavirus infection. However | There is no specific treatment, cure, or vaccine for hantavirus infection. However infected individuals who are recognized early and receive medical care in an [[intensive care unit]], may do better. ICU management include careful assessment, monitoring and adjustment of [[volume status]] and [[Cardiac function curve|cardiac function]], including [[inotropic]] and [[vasopressor]] support if needed. [[Extracorporeal membrane oxygenation]] (ECMO) is effective in the treatment of resistant cases. [[Ribavirin]] may be beneficial in the treatment of [[hemorrhagic]] fever with renal syndrome ([[HFRS]]). | ||
==Medical Therapy== | ==Medical Therapy== | ||
There is no specific treatment, cure, or vaccine for hantavirus infection. Early diagnosis, hospitalization, and supportive therapy (mainly for cardio-pulmonary system) are fundamentals of treatment. If there is a high degree of suspicion of hantavirus pulmonary syndrome (HPS), patients should be immediately transferred to an emergency department or intensive care unit (ICU) for close monitoring and care. In intensive care, patients are intubated and given oxygen therapy to help them through the period of severe respiratory distress. The earlier the patient is brought in to intensive care, the better. If a patient is experiencing full distress, it is less likely the treatment will be effective.<ref name="pmid8004332">{{cite journal |vauthors=Levy H, Simpson SQ |title=Hantavirus pulmonary syndrome |journal=Am. J. Respir. Crit. Care Med. |volume=149 |issue=6 |pages=1710–3 |year=1994 |pmid=8004332 |doi=10.1164/ajrccm.149.6.8004332 |url=}}</ref> | There is no specific treatment, cure, or vaccine for hantavirus infection. Early diagnosis, hospitalization, and supportive therapy (mainly for cardio-pulmonary system) are fundamentals of treatment. If there is a high degree of suspicion of hantavirus pulmonary syndrome (HPS), patients should be immediately transferred to an emergency department or [[intensive care unit]] (ICU) for close monitoring and care. In intensive care, patients are [[Intubation|intubated]] and given [[oxygen]] therapy to help them through the period of severe [[respiratory distress]]. The earlier the patient is brought in to intensive care, the better. If a patient is experiencing full distress, it is less likely the treatment will be effective.<ref name="pmid8004332">{{cite journal |vauthors=Levy H, Simpson SQ |title=Hantavirus pulmonary syndrome |journal=Am. J. Respir. Crit. Care Med. |volume=149 |issue=6 |pages=1710–3 |year=1994 |pmid=8004332 |doi=10.1164/ajrccm.149.6.8004332 |url=}}</ref><ref>{{citeweb|title=Hantavirus|url = http://www.cdc.gov/hantavirus/technical/hps/treatment.html|=}}</ref> | ||
=== Supportive therapy === | === Supportive therapy === | ||
::*ICU management should include careful assessment, monitoring and adjustment of volume status and cardiac function, including inotropic and vasopressor support if needed. | ::*ICU management should include careful assessment, monitoring and adjustment of [[volume status]] and cardiac function, including [[inotropic]] and [[vasopressor]] support if needed. | ||
::*Fluids should be administered carefully due to the potential for capillary leakage. | ::*Fluids should be administered carefully due to the potential for [[capillary]] leakage. | ||
::*Supplemental oxygen should be administered if patients become hypoxic. | ::*Supplemental [[oxygen]] should be administered if patients become [[hypoxic]]. | ||
::*Equipment and materials for intubation and mechanical ventilation should be readily available since onset of respiratory failure may be precipitous. | ::*Equipment and materials for [[intubation]] and [[mechanical ventilation]] should be readily available since onset of [[respiratory failure]] may be precipitous. | ||
=== Anti-viral therapy === | === Anti-viral therapy === | ||
| Line 21: | Line 19: | ||
=== ECMO === | === ECMO === | ||
Incorporation of extracorporeal membrane oxygenation (ECMO) may be effective in treatment of HPS. Good candidates for ECMO are patients with a cardiac index of <2.5 L/min/m2 despite attempts to resuscitate with pressors and inotropic agents.<ref name="pmid16940866">{{cite journal |vauthors=Mertz GJ, Hjelle B, Crowley M, Iwamoto G, Tomicic V, Vial PA |title=Diagnosis and treatment of new world hantavirus infections |journal=Curr. Opin. Infect. Dis. |volume=19 |issue=5 |pages=437–42 |year=2006 |pmid=16940866 |doi=10.1097/01.qco.0000244048.38758.1f |url=}}</ref><ref name="pmid9468181">{{cite journal |vauthors=Crowley MR, Katz RW, Kessler R, Simpson SQ, Levy H, Hallin GW, Cappon J, Krahling JB, Wernly J |title=Successful treatment of adults with severe Hantavirus pulmonary syndrome with extracorporeal membrane oxygenation |journal=Crit. Care Med. |volume=26 |issue=2 |pages=409–14 |year=1998 |pmid=9468181 |doi= |url=}}</ref><ref name="pmid18329474">{{cite journal |vauthors=Dietl CA, Wernly JA, Pett SB, Yassin SF, Sterling JP, Dragan R, Milligan K, Crowley MR |title=Extracorporeal membrane oxygenation support improves survival of patients with severe Hantavirus cardiopulmonary syndrome |journal=J. Thorac. Cardiovasc. Surg. |volume=135 |issue=3 |pages=579–84 |year=2008 |pmid=18329474 |doi=10.1016/j.jtcvs.2007.11.020 |url=}}</ref> | Incorporation of [[extracorporeal membrane oxygenation]] (ECMO) may be effective in treatment of HPS. Good candidates for ECMO are patients with a [[cardiac index]] of <2.5 L/min/m2 despite attempts to resuscitate with pressors and inotropic agents.<ref name="pmid16940866">{{cite journal |vauthors=Mertz GJ, Hjelle B, Crowley M, Iwamoto G, Tomicic V, Vial PA |title=Diagnosis and treatment of new world hantavirus infections |journal=Curr. Opin. Infect. Dis. |volume=19 |issue=5 |pages=437–42 |year=2006 |pmid=16940866 |doi=10.1097/01.qco.0000244048.38758.1f |url=}}</ref><ref name="pmid9468181">{{cite journal |vauthors=Crowley MR, Katz RW, Kessler R, Simpson SQ, Levy H, Hallin GW, Cappon J, Krahling JB, Wernly J |title=Successful treatment of adults with severe Hantavirus pulmonary syndrome with extracorporeal membrane oxygenation |journal=Crit. Care Med. |volume=26 |issue=2 |pages=409–14 |year=1998 |pmid=9468181 |doi= |url=}}</ref><ref name="pmid18329474">{{cite journal |vauthors=Dietl CA, Wernly JA, Pett SB, Yassin SF, Sterling JP, Dragan R, Milligan K, Crowley MR |title=Extracorporeal membrane oxygenation support improves survival of patients with severe Hantavirus cardiopulmonary syndrome |journal=J. Thorac. Cardiovasc. Surg. |volume=135 |issue=3 |pages=579–84 |year=2008 |pmid=18329474 |doi=10.1016/j.jtcvs.2007.11.020 |url=}}</ref> | ||
===Specific considerations=== | ===Specific considerations=== | ||
*Patients should receive appropriate, broad-spectrum antibiotic therapy while awaiting confirmation of a diagnosis of HPS. Care during the initial stages of the disease should include antipyretics and analgesia as needed. | *Patients should receive appropriate, [[broad-spectrum antibiotic]] therapy while awaiting confirmation of a diagnosis of HPS. Care during the initial stages of the disease should include [[antipyretics]] and [[analgesia]] as needed. | ||
*If the individual is experiencing fever and fatigue and has a history of potential rural rodent exposure, together with shortness of breath, would be strongly suggestive of Hantavirus pulmonary syndrome<ref name="pmid94681812">{{cite journal| author=Crowley MR, Katz RW, Kessler R, Simpson SQ, Levy H, Hallin GW et al.| title=Successful treatment of adults with severe Hantavirus pulmonary syndrome with extracorporeal membrane oxygenation. | journal=Crit Care Med | year= 1998 | volume= 26 | issue= 2 | pages= 409-14 | pmid=9468181 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9468181 }}</ref> | *If the individual is experiencing [[fever]] and [[fatigue]] and has a history of potential rural rodent exposure, together with [[Dyspnea|shortness of breath]], would be strongly suggestive of Hantavirus pulmonary syndrome<ref name="pmid94681812">{{cite journal| author=Crowley MR, Katz RW, Kessler R, Simpson SQ, Levy H, Hallin GW et al.| title=Successful treatment of adults with severe Hantavirus pulmonary syndrome with extracorporeal membrane oxygenation. | journal=Crit Care Med | year= 1998 | volume= 26 | issue= 2 | pages= 409-14 | pmid=9468181 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9468181 }}</ref> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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[[Category:Viral diseases]] | [[Category:Viral diseases]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Emergency mdicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Nephrology]] | |||
[[Category:Cardiology]] | |||
[[Category:Pulmonology]] | |||
Latest revision as of 21:57, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
There is no specific treatment, cure, or vaccine for hantavirus infection. However infected individuals who are recognized early and receive medical care in an intensive care unit, may do better. ICU management include careful assessment, monitoring and adjustment of volume status and cardiac function, including inotropic and vasopressor support if needed. Extracorporeal membrane oxygenation (ECMO) is effective in the treatment of resistant cases. Ribavirin may be beneficial in the treatment of hemorrhagic fever with renal syndrome (HFRS).
Medical Therapy
There is no specific treatment, cure, or vaccine for hantavirus infection. Early diagnosis, hospitalization, and supportive therapy (mainly for cardio-pulmonary system) are fundamentals of treatment. If there is a high degree of suspicion of hantavirus pulmonary syndrome (HPS), patients should be immediately transferred to an emergency department or intensive care unit (ICU) for close monitoring and care. In intensive care, patients are intubated and given oxygen therapy to help them through the period of severe respiratory distress. The earlier the patient is brought in to intensive care, the better. If a patient is experiencing full distress, it is less likely the treatment will be effective.[1][2]
Supportive therapy
- ICU management should include careful assessment, monitoring and adjustment of volume status and cardiac function, including inotropic and vasopressor support if needed.
- Fluids should be administered carefully due to the potential for capillary leakage.
- Supplemental oxygen should be administered if patients become hypoxic.
- Equipment and materials for intubation and mechanical ventilation should be readily available since onset of respiratory failure may be precipitous.
Anti-viral therapy
- Preferred regimen: Ribavirin IV infusion 30 mg/kg loading dose, then 16 mg/kg every 6 h for 4 d, then 8 mg/kg every 8 h for 3 d.
- Note: Intravenous ribavirin, a guanosine analogue, has not been shown to be effective for treatment of HPS despite its effects on a related disease, hemorrhagic fever with renal syndrome (HFRS), which is caused by Old World hantaviruses.
ECMO
Incorporation of extracorporeal membrane oxygenation (ECMO) may be effective in treatment of HPS. Good candidates for ECMO are patients with a cardiac index of <2.5 L/min/m2 despite attempts to resuscitate with pressors and inotropic agents.[3][4][5]
Specific considerations
- Patients should receive appropriate, broad-spectrum antibiotic therapy while awaiting confirmation of a diagnosis of HPS. Care during the initial stages of the disease should include antipyretics and analgesia as needed.
- If the individual is experiencing fever and fatigue and has a history of potential rural rodent exposure, together with shortness of breath, would be strongly suggestive of Hantavirus pulmonary syndrome[6]
References
- ↑ Levy H, Simpson SQ (1994). "Hantavirus pulmonary syndrome". Am. J. Respir. Crit. Care Med. 149 (6): 1710–3. doi:10.1164/ajrccm.149.6.8004332. PMID 8004332.
- ↑ Template:Citeweb
- ↑ Mertz GJ, Hjelle B, Crowley M, Iwamoto G, Tomicic V, Vial PA (2006). "Diagnosis and treatment of new world hantavirus infections". Curr. Opin. Infect. Dis. 19 (5): 437–42. doi:10.1097/01.qco.0000244048.38758.1f. PMID 16940866.
- ↑ Crowley MR, Katz RW, Kessler R, Simpson SQ, Levy H, Hallin GW, Cappon J, Krahling JB, Wernly J (1998). "Successful treatment of adults with severe Hantavirus pulmonary syndrome with extracorporeal membrane oxygenation". Crit. Care Med. 26 (2): 409–14. PMID 9468181.
- ↑ Dietl CA, Wernly JA, Pett SB, Yassin SF, Sterling JP, Dragan R, Milligan K, Crowley MR (2008). "Extracorporeal membrane oxygenation support improves survival of patients with severe Hantavirus cardiopulmonary syndrome". J. Thorac. Cardiovasc. Surg. 135 (3): 579–84. doi:10.1016/j.jtcvs.2007.11.020. PMID 18329474.
- ↑ Crowley MR, Katz RW, Kessler R, Simpson SQ, Levy H, Hallin GW; et al. (1998). "Successful treatment of adults with severe Hantavirus pulmonary syndrome with extracorporeal membrane oxygenation". Crit Care Med. 26 (2): 409–14. PMID 9468181.