Lassa fever medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
All persons suspected of Lassa fever infection should be admitted to [[Isolation (health care)|isolation]] facilities and their [[body fluids]] and [[excretion|excreta]] properly disposed of<ref name=CDC>{{cite web | title = The Centers for Disease Control and Prevention | url =http://www.cdc.gov/vhf/lassa/transmission/index.html }}</ref>. | * All persons suspected of Lassa fever infection should be admitted to [[Isolation (health care)|isolation]] facilities and their [[body fluids]] and [[excretion|excreta]] properly disposed of<ref name=CDC>{{cite web | title = The Centers for Disease Control and Prevention | url =http://www.cdc.gov/vhf/lassa/transmission/index.html }}</ref>. | ||
* After extensive testing, it was determined that early administration of [[ribavirin]] is critical to success. Additionally, Ribavirin is almost twice as [[effective dose|effective]] when given [[intravenous]]ly as when taken by mouth.<ref>{{cite journal |author=Fisher-Hoch SP, McCormick JB |title=Lassa fever vaccine |journal=Expert review of vaccines |volume=3 |issue=2 |pages=189-97 |year=2004 |pmid=15056044 |doi=10.1586/14760584.3.4.S189}}</ref> Ribavirin is a [[prodrug]] which appears to interfere with [[viral replication]] by inhibiting [[RNA]]-dependent [[DNA Replication|nucleic acid synthesis]], although the precise [[mechanism of action]] is disputed.<ref>{{cite journal |author=Crotty S, Cameron C, Andino R |title=Ribavirin's antiviral mechanism of action: lethal mutagenesis? |journal=J. Mol. Med. |volume=80 |issue=2 |pages=86-95 |year=2002 |pmid=11907645 |doi=10.1007/s00109-001-0308-0}}</ref> The drug is relatively inexpensive, but the cost of the drug is still very high for many of those in poverty-stricken West African states. [[Fatality rate]]s are continuing to decline because of treatment with [[Ribavirin]]. [[Fluid replacement]], [[blood transfusion]] and fighting [[hypotension]] are usually required. [[Intravenous]] [[interferon]] [[therapy]] has also been used. | |||
After extensive testing, it was determined that early administration of [[ribavirin]] is critical to success. Additionally, Ribavirin is almost twice as [[effective dose|effective]] when given [[intravenous]]ly as when taken by mouth.<ref>{{cite journal |author=Fisher-Hoch SP, McCormick JB |title=Lassa fever vaccine |journal=Expert review of vaccines |volume=3 |issue=2 |pages=189-97 |year=2004 |pmid=15056044 |doi=10.1586/14760584.3.4.S189}}</ref> Ribavirin is a [[prodrug]] which appears to interfere with [[viral replication]] by inhibiting [[RNA]]-dependent [[DNA Replication|nucleic acid synthesis]], although the precise [[mechanism of action]] is disputed.<ref>{{cite journal |author=Crotty S, Cameron C, Andino R |title=Ribavirin's antiviral mechanism of action: lethal mutagenesis? |journal=J. Mol. Med. |volume=80 |issue=2 |pages=86-95 |year=2002 |pmid=11907645 |doi=10.1007/s00109-001-0308-0}}</ref> The drug is relatively inexpensive, but the cost of the drug is still very high for many of those in poverty-stricken West African states. [[Fatality rate]]s are continuing to decline because of treatment with [[Ribavirin]]. [[Fluid replacement]], [[blood transfusion]] and fighting [[hypotension]] are usually required. [[Intravenous]] [[interferon]] [[therapy]] has also been used. | * When Lassa fever infects [[pregnant]] women late in their [[third trimester]], it is necessary to [[abortion|abort]] the pregnancy for the mother to have a good chance of survival.<ref>{{cite journal |author=Price ME, Fisher-Hoch SP, Craven RB, McCormick JB |title=A prospective study of maternal and fetal outcome in acute Lassa fever infection during pregnancy |journal=BMJ |volume=297 |issue=6648 |pages=584–7 |year=1988 |pmid=3139220 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=3139220}}</ref> This is due to the fact that the virus has an affinity for the [[placenta]] and other highly [[vascular]] tissues. The [[fetus]] has only a one in ten chance of survival no matter what course of action is taken; hence focus is always on saving the life of the mother. Following [[abortion]], women should receive the same treatment as other Lassa fever patients. | ||
* Shown below is a table summarizing the preferred treatment for Lassa fever<ref name="pmid11988060">{{cite journal| author=Borio L, Inglesby T, Peters CJ, Schmaljohn AL, Hughes JM, Jahrling PB et al.| title=Hemorrhagic fever viruses as biological weapons: medical and public health management. | journal=JAMA | year= 2002 | volume= 287 | issue= 18 | pages= 2391-405 | pmid=11988060 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11988060 }} </ref>. | |||
When Lassa fever infects [[pregnant]] women late in their [[third trimester]], it is necessary to [[abortion|abort]] the pregnancy for the mother to have a good chance of survival.<ref>{{cite journal |author=Price ME, Fisher-Hoch SP, Craven RB, McCormick JB |title=A prospective study of maternal and fetal outcome in acute Lassa fever infection during pregnancy |journal=BMJ |volume=297 |issue=6648 |pages=584–7 |year=1988 |pmid=3139220 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=3139220}}</ref> This is due to the fact that the virus has an affinity for the [[placenta]] and other highly [[vascular]] tissues. The [[fetus]] has only a one in ten chance of survival no matter what course of action is taken; hence focus is always on saving the life of the mother. Following [[abortion]], women should receive the same treatment as other Lassa fever patients. | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Synonyms and keywords: Lassa hemorrhagic fever; LHF
Overview
Ribavirin, an antiviral drug, has been used with success in Lassa fever patients. It has been shown to be most effective when given early in the course of the illness. Patients should also receive supportive care consisting of maintenance of appropriate fluid and electrolyte balance, oxygenation and blood pressure, as well as treatment of any other complicating infections.
Medical Therapy
- All persons suspected of Lassa fever infection should be admitted to isolation facilities and their body fluids and excreta properly disposed of[1].
- After extensive testing, it was determined that early administration of ribavirin is critical to success. Additionally, Ribavirin is almost twice as effective when given intravenously as when taken by mouth.[2] Ribavirin is a prodrug which appears to interfere with viral replication by inhibiting RNA-dependent nucleic acid synthesis, although the precise mechanism of action is disputed.[3] The drug is relatively inexpensive, but the cost of the drug is still very high for many of those in poverty-stricken West African states. Fatality rates are continuing to decline because of treatment with Ribavirin. Fluid replacement, blood transfusion and fighting hypotension are usually required. Intravenous interferon therapy has also been used.
- When Lassa fever infects pregnant women late in their third trimester, it is necessary to abort the pregnancy for the mother to have a good chance of survival.[4] This is due to the fact that the virus has an affinity for the placenta and other highly vascular tissues. The fetus has only a one in ten chance of survival no matter what course of action is taken; hence focus is always on saving the life of the mother. Following abortion, women should receive the same treatment as other Lassa fever patients.
- Shown below is a table summarizing the preferred treatment for Lassa fever[5].
| Optimal Treatment | Duration of Treatment |
| Ribavarin
Loading dose: 30 mg/kg (max. 2g) IV
|
10 days |
References
- ↑ "The Centers for Disease Control and Prevention".
- ↑ Fisher-Hoch SP, McCormick JB (2004). "Lassa fever vaccine". Expert review of vaccines. 3 (2): 189–97. doi:10.1586/14760584.3.4.S189. PMID 15056044.
- ↑ Crotty S, Cameron C, Andino R (2002). "Ribavirin's antiviral mechanism of action: lethal mutagenesis?". J. Mol. Med. 80 (2): 86–95. doi:10.1007/s00109-001-0308-0. PMID 11907645.
- ↑ Price ME, Fisher-Hoch SP, Craven RB, McCormick JB (1988). "A prospective study of maternal and fetal outcome in acute Lassa fever infection during pregnancy". BMJ. 297 (6648): 584–7. PMID 3139220.
- ↑ Borio L, Inglesby T, Peters CJ, Schmaljohn AL, Hughes JM, Jahrling PB; et al. (2002). "Hemorrhagic fever viruses as biological weapons: medical and public health management". JAMA. 287 (18): 2391–405. PMID 11988060.