Hantavirus infection medical therapy: Difference between revisions
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Therefore, if you have been around rodents and have symptoms of fever, deep muscle aches, and severe shortness of breath, see your doctor immediately. Be sure to tell your doctor that you have been around rodents-this will alert your physician to look closely for any rodent-carried disease, such as HPS. | Therefore, if you have been around rodents and have symptoms of fever, deep muscle aches, and severe shortness of breath, see your doctor immediately. Be sure to tell your doctor that you have been around rodents-this will alert your physician to look closely for any rodent-carried disease, such as HPS. | ||
*Hanta virus treatment<ref>{{citeweb|title=Hantavirus|url = http://www.cdc.gov/hantavirus/technical/hps/treatment.html|=}}</ref> | *Hanta virus treatment<ref>{{citeweb|title=Hantavirus|url = http://www.cdc.gov/hantavirus/technical/hps/treatment.html|=}}</ref> | ||
=== 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 === | |||
* 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. | |||
:*Note (3): 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. | :*Note (3): 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. | ||
:*Note (4): If there is a high degree of suspicion of Hantavirus pulmonary syndrome, patients should be immediately transferred to an emergency department or intensive care unit (ICU) for close monitoring and care. | :*Note (4): If there is a high degree of suspicion of Hantavirus pulmonary syndrome, patients should be immediately transferred to an emergency department or intensive care unit (ICU) for close monitoring and care. | ||
Revision as of 18:03, 7 July 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
There is no specific treatment, cure, or vaccine for hantavirus infection. However, we do know that if infected individuals are recognized early and receive medical care in an intensive care unit, they may do better.
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.
Therefore, if you have been around rodents and have symptoms of fever, deep muscle aches, and severe shortness of breath, see your doctor immediately. Be sure to tell your doctor that you have been around rodents-this will alert your physician to look closely for any rodent-carried disease, such as HPS.
- Hanta virus treatment[1]
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.
- Note (3): 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.
- Note (4): If there is a high degree of suspicion of Hantavirus pulmonary syndrome, patients should be immediately transferred to an emergency department or intensive care unit (ICU) for close monitoring and care.
- Note (5): 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[2]
References
- ↑ Template:Citeweb
- ↑ 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.