eMedicine Specialties > Dermatology > Viral Infections

Viral Hemorrhagic Fevers: Treatment & Medication

Author: Arash Michael Saemi, MD, Department of Internal Medicine, Naval Medical Center San Diego
Coauthor(s): Nili N Alai, MD, FAAD, Assistant Clinical Professor, Department of Dermatology, Clinical Faculty and Preceptor, Department of Family Practice, University of California, Irvine; Clinical Faculty and Preceptor, Department of Family Practice Residency Training, Downey Medical Center; Medical Director, The Skin Center at Laguna; Expert Medical Reviewer, Medical Board of California
Contributor Information and Disclosures

Updated: Oct 1, 2008

Treatment

Medical Care

Intensive supportive care is necessary for most cases of viral hemorrhagic fever. General supportive care principles apply to the treatment of hemodynamic, hematologic, pulmonary, and neurologic manifestations of viral hemorrhagic fever. Supportive care entails maintaining the patient's oxygen status and blood pressure and balancing fluid and electrolyte levels.

  • Blood, platelet, and plasma replacement and management can be crucial, depending on the case. Convalescent plasma infusions may be effective in Argentinian hemorrhagic fever, if they are administered within the first 8 days of onset.
  • The judicious use of sedative, pain-relieving, and amnesic medications can be helpful in managing malaise, confusion, myalgia, and hyperesthesia. Intramuscular injections and the use of aspirin and other anticoagulant drugs should be avoided.
  • Antiviral therapy with ribavirin may be useful in several viral hemorrhagic fevers, especially those caused by Arenaviruses. Although ribavirin inhibits viral DNA and RNA synthesis, it is not sensitive to the replication mechanisms of all RNA viruses. Ribavirin is proven to be effective in the treatment of Lassa fever and Congo-Crimean hemorrhagic fever.10 It is somewhat effective in the treatment of other arenavirus and Hantavirus infections, in which it decreases mortality rates when used early in the course of the disease. Additionally, discovery of compounds with antiflaviviral activity have shown promise. Currently, several ribavirin analogues are undergoing clinical trials.11
  • Vaccination may be considered. The only approved vaccine is for yellow fever. Nonapproved vaccines include that developed for Argentinian viral hemorrhagic fever. This vaccine is a live-attenuated, investigational vaccine. It also seems to offer protection against Bolivian viral hemorrhagic fever. Both inactivated and live-attenuated vaccines for RVF are under investigation. No vaccines are currently available for filovirus infection or dengue. Preliminary results suggest potential for successful prevaccination and postvaccination exposure against Ebola and Marburg viruses8,12,13
  • Persons percutaneously or mucocutaneously exposed to blood, excretions, or secretions of individuals who are infected should wash the affected areas with soap and water. Affected mucous membranes should be irrigated with water or sodium chloride solution.

Consultations

  • Infectious disease specialist
  • Hematologist
  • Pathologist
  • Internal medicine specialist
  • Other specialists as necessary

Diet

Fluid and electrolyte balance should be maintained.

Activity

Malaise and myalgia, among other symptoms, dictate bed rest restrictions.

Medication

The goals of pharmacotherapy are to induce remission, to reduce morbidity, and to prevent complications.

Antiviral agents

Antiviral agents inhibit the replication of RNA and DNA viruses.


Ribavirin (Rebetol)

Ribavirin is suggested drug treatment for Hantavirus infections and Arenavirus infections, especially Lassa fever and Crimean-Congo hemorrhagic fever. It is especially effective when administered in the early course of the disease. It inhibits viral replication by inhibiting DNA and RNA synthesis.

Adult

Loading dose: 2000 mg
Maintenance dose: 1000 mg PO q6h for 4 d initially, followed by 500 mg PO q8h for 6 d

Pediatric

Not established

Coadministration with an antacid containing magnesium, aluminum, and simethicone may decrease ribavirin AUC (clinical relevance unknown)

Documented hypersensitivity; compromised renal function or renal failure; men whose partners may be pregnant; patients with hemoglobinopathies (eg, thalassemia major, sickle cell anemia)

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

Suspend therapy in patients with signs and symptoms of pancreatitis and discontinue in patients with confirmed pancreatitis; perform complete and differential white blood cell counts, platelet count, liver function test, TSH determination, and pregnancy test prior to beginning treatment and periodically thereafter; anemia may occur (effect is reversible if drug is discontinued); depression, psychoses, aggressive behavior, and hallucinations may occur with oral administration; caution in patients with histories of psychiatric disorders

More on Viral Hemorrhagic Fevers

Overview: Viral Hemorrhagic Fevers
Differential Diagnoses & Workup: Viral Hemorrhagic Fevers
Treatment & Medication: Viral Hemorrhagic Fevers
Follow-up: Viral Hemorrhagic Fevers
References
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References

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  2. Southern PJ. Arenaviridae: the viruses and their replication. In: Fields BN, Knipe DN, Howley PM, et al, eds. Fields Virology. 3rd ed. Philadelphia, Pa: Lippincott-Raven; 1996:1505-19.

  3. Peters CJ, Linthicum KJ. Rift valley fever. In: Handbook of Zoonoses. Boca Raton, Fla: CRC Press; 1994:129-43.

  4. Seo JH, Park KH, Lim JY, Youn HS. Hemorrhagic fever with renal syndrome (HFRS, Korean hemorrhagic fever). Pediatr Nephrol. Jan 2007;22(1):156-7. [Medline].

  5. Feldmann H. Marburg hemorrhagic fever--the forgotten cousin strikes. N Engl J Med. Aug 31 2006;355(9):866-9. [Medline].

  6. Green S, Rothman A. Immunopathological mechanisms in dengue and dengue hemorrhagic fever. Curr Opin Infect Dis. Oct 2006;19(5):429-36. [Medline].

  7. No Authors Listed. Dengue haemorrhagic fever: early recognition, diagnosis and hospital management--an audiovisual guide for health-care workers responding to outbreaks. Wkly Epidemiol Rec. Sep 22 2006;81(38):362-3. [Medline].

  8. Bausch DG, Sprecher AG, Jeffs B, Boumandouki P. Treatment of Marburg and Ebola hemorrhagic fevers: a strategy for testing new drugs and vaccines under outbreak conditions. Antiviral Res. Apr 2008;78(1):150-61. [Medline].

  9. Noisakran S, Perng GC. Alternate hypothesis on the pathogenesis of dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS) in dengue virus infection. Exp Biol Med (Maywood). Apr 2008;233(4):401-8. [Medline].

  10. Ergonul O. Treatment of Crimean-Congo hemorrhagic fever. Antiviral Res. Apr 2008;78(1):125-31. [Medline].

  11. Ghosh D, Basu A. Present perspectives on flaviviral chemotherapy. Drug Discov Today. Jul 2008;13(13-14):619-24. [Medline].

  12. Daddario-DiCaprio KM, Geisbert TW, Geisbert JB, Ströher U, Hensley LE, Grolla A, et al. Cross-protection against Marburg virus strains by using a live, attenuated recombinant vaccine. J Virol. Oct 2006;80(19):9659-66. [Medline].

  13. Martin JE, Sullivan NJ, Enama ME, Gordon IJ, Roederer M, Koup RA, et al. A DNA vaccine for Ebola virus is safe and immunogenic in a phase I clinical trial. Clin Vaccine Immunol. Nov 2006;13(11):1267-77. [Medline].

  14. Kothari VM, Karnad DR, Bichile LS. Tropical infections in the ICU. J Assoc Physicians India. Apr 2006;54:291-8. [Medline].

  15. Collier L, Oxford J. Human Virology. 2nd ed. Oxford, England: Oxford University Press; 2000:171-97.

  16. Craighead JE, John E. Pathology and Pathogenesis of Human Viral Disease. San Diego, Calif: Academic Press; 2000:277-93.

  17. Fields BN, Knipe DM. Fundamental Virology. 2nd ed. New York, NY: Raven Press; 1991:19-24.

  18. Gear JH. Clinical aspects of African viral hemorrhagic fevers. Rev Infect Dis. May-Jun 1989;11 Suppl 4:S777-82. [Medline].

  19. Gear JH. Handbook of Viral and Rickettsial Hemorrhagic Fevers. Boca Raton, Fla: CRC Press; 1988:5-240.

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Further Reading

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Keywords

viral hemorrhagic fever, Ebola virus, dengue fever, Marburg virus, yellow fever, VHFs, Arenaviridae, Bunyaviridae, Filoviridae, Flaviviridae, Guanarito, Junin, Machupo, Lassa, Sabia, Nairovirus, Phlebovirus, Hantavirus, Flavivirus, Marburg, Ebola, Venezuelan fever, Argentinian fever, Bolivian fever, West African fever, Brazilian fever, Sao Paulo fever, Crimean-Congo fever, Congo-Crimean hemorrhagic fever, CCHF, Rift Valley fever, RVF, Korean fever, Seoul fever, Chikungunya fever, Omsk fever, dengue hemorrhagic shock syndrome, DHSS, Kyanasur Forest disease, Kyasanur Forest disease, arthropods, rodents

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Contributor Information and Disclosures

Author

Arash Michael Saemi, MD, Department of Internal Medicine, Naval Medical Center San Diego
Arash Michael Saemi, MD is a member of the following medical societies: American College of Physicians, Radiological Society of North America, Sigma Xi, and Society of Interventional Radiology
Disclosure: Nothing to disclose.

Coauthor(s)

Nili N Alai, MD, FAAD, Assistant Clinical Professor, Department of Dermatology, Clinical Faculty and Preceptor, Department of Family Practice, University of California, Irvine; Clinical Faculty and Preceptor, Department of Family Practice Residency Training, Downey Medical Center; Medical Director, The Skin Center at Laguna; Expert Medical Reviewer, Medical Board of California
Nili N Alai, MD, FAAD is a member of the following medical societies: American Academy of Dermatology and American Society for MOHS Surgery
Disclosure: Nothing to disclose.

Medical Editor

James Fulton Jr, MD, PhD, Center for Cosmetic Dermatology; Consultant, Vivant Pharmaceuticals, LLC
James Fulton Jr, MD, PhD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Society for Laser Medicine and Surgery, Dermatology Foundation, International Society of Cosmetic and Laser Surgeons, and Skin Cancer Foundation
Disclosure: vivant pharmaceuticals Ownership interest Consulting

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Genetech Honoraria Consulting; Celgene Honoraria Consulting

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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