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></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></ref> | ||
* The antiviral drug ribavirin seems to be an effective treatment for Lassa fever if given early on in the course of clinical illness<ref name=who>Fact sheet N°179: Lassa Fever. World Health Organization. [http://www.who.int/mediacentre/factsheets/fs179/en/ Accessed on June 09, 2015.] </ref>. | * The antiviral drug ribavirin seems to be an effective treatment for Lassa fever if given early on in the course of clinical illness<ref name=who>Fact sheet N°179: Lassa Fever. World Health Organization. [http://www.who.int/mediacentre/factsheets/fs179/en/ Accessed on June 09, 2015.] </ref>. Ribavirin is almost twice as [[effective dose|effective]] when administered [[intravenous]]ly compared to orally .<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 controversial.<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> [[Fluid replacement]] and [[blood transfusions]] may also be required. | ||
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|'''Ribavarin''' | |'''Ribavarin''' | ||
Loading dose: 30 mg/kg (max. 2g) IV | Loading dose: 30 mg/kg (max. 2g) IV | ||
Concentration dose: 16 mg/kg (max. 1g) IV Q6H X 4 days, then 8 mg/kg (max. 500mg) IV Q8H X 6 days | Concentration dose: 16 mg/kg (max. 1g) IV Q6H X 4 days, then 8 mg/kg (max. 500mg) IV Q8H X 6 days | ||
|10 days | |10 days | ||
|- align="center" | |- align="center" | ||
|} | |}<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> | ||
==Special Patients== | |||
* When Lassa fever infects [[pregnant]] women late in their [[third trimester]], the risk of death is very high (odds ratio for death 5.57). Among these patients, emergent evacuation of the uterus (by induction or surgically) has been demonstrated to decrease the risk of death.<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> It is hypothesized that evacuating the uterus decreases the viral load significantly as the virus has high affinity for the [[placenta]] and other highly [[vascular]] tissues. Observational studies have demonstrated that the [[fetus]] has only a one in ten chance of survival irrespective of the therapies used or the interventions attempted. For that reason, the main focus is on reducing the risk of death in the mother. Following active obstetrical intervention, treatment with ribavirin should be initiated immediately. | |||
==References== | ==References== | ||
Revision as of 18:57, 9 June 2015
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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.[1]
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]
- The antiviral drug ribavirin seems to be an effective treatment for Lassa fever if given early on in the course of clinical illness[2]. Ribavirin is almost twice as effective when administered intravenously compared to orally .[3] 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 controversial.[4] Fluid replacement and blood transfusions may also be required.
| Optimal Treatment | Duration of Treatment |
| Ribavarin
Loading dose: 30 mg/kg (max. 2g) IV Concentration dose: 16 mg/kg (max. 1g) IV Q6H X 4 days, then 8 mg/kg (max. 500mg) IV Q8H X 6 days |
10 days |
Special Patients
- When Lassa fever infects pregnant women late in their third trimester, the risk of death is very high (odds ratio for death 5.57). Among these patients, emergent evacuation of the uterus (by induction or surgically) has been demonstrated to decrease the risk of death.[6] It is hypothesized that evacuating the uterus decreases the viral load significantly as the virus has high affinity for the placenta and other highly vascular tissues. Observational studies have demonstrated that the fetus has only a one in ten chance of survival irrespective of the therapies used or the interventions attempted. For that reason, the main focus is on reducing the risk of death in the mother. Following active obstetrical intervention, treatment with ribavirin should be initiated immediately.
References
- ↑ 1.0 1.1 Lassa Fever:Treatment. Centers for Disease Control and Prevention. Accessed on June 09, 2015.
- ↑ Fact sheet N°179: Lassa Fever. World Health Organization. Accessed on June 09, 2015.
- ↑ 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.
- ↑ 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.
- ↑ 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.