eMedicine Specialties > Infectious Diseases > Viral Infections

Arenaviruses: Treatment & Medication

Author: Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Contributor Information and Disclosures

Updated: May 15, 2009

Treatment

Medical Care

No specific medical care is required for mild infections associated with any of the Arenaviridae. Specific and/or careful symptomatic care is needed in more severe infections associated with those agents linked to hemorrhagic fever.

  • LCM virus infection requires no more than symptomatic treatment.
  • In overt cases of Lassa fever or any of the South American hemorrhagic fevers, aggressive treatment is needed to attempt to diminish morbidity and mortality.
    • The antiviral drug ribavirin is used in Lassa fever and also has shown efficacy in cases of South American hemorrhagic fever.
    • Supportive care related to blood pressure monitoring/control and careful attention to fluid and electrolytic balance can be lifesaving.
    • Convalescent human plasma has been used with some success in the treatment of Junin virus infection. The lack of parallel success in Lassa fever may be related to low and delayed titers of the specific neutralizing antibody in Lassa fever.

Consultations

With a compatible illness and travel history, any individual in whom either Lassa fever or one of the South American hemorrhagic fevers is suggested should have immediate consultation with an infectious disease physician and the local public health authorities.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.6

Antivirals

Clinical experience with ribavirin in the treatment of Arenavirus infections is primarily with Lassa fever, but anecdotal experience in the South American arenaviruses also exists.


Ribavirin (Virazole)

Synthetic guanosine analog (1beta-D-ribofuranosyl- 1H-1,2,4-triazole-3-carboxamide) that inhibits viral replication by inhibiting DNA and RNA synthesis.
Phosphorylated in vivo, and the active form may interfere with viral genomic synthesis. Clinically used in combination with interferon for hepatitis C, as aerosol for respiratory syncytial virus, and as potential prophylaxis and/or treatment of Congo-Crimean hemorrhagic fever, hantavirus infections, and Arenavirus hemorrhagic fevers. In vitro evidence exists for activity against West Nile virus. IV form not readily available and the manufacturer should be contacted if the need arises.

Adult

Lassa fever (with hepatitis and/or hemorrhagic manifestations): 2 g (30 mg/kg) IV initially; 1 g (15 mg/kg) IV q6h for 4 d; then 500 mg (7.5 mg/kg) IV q8h for 6 d
Suggested prophylactic dose: 600 mg PO qid for 10 d

Pediatric

Prophylaxis
<10 years: 400 mg/dose IV
>10 years: Administer as in adults

Zidovudine effects are decreased when administered concurrently

Documented hypersensitivity; women who may become pregnant

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

Closely monitor patients with COPD and asthma for deterioration of respiratory function; systemic ribavirin use causes dose-related anemia and hyperbilirubinemia related to extravascular hemolysis, and at higher doses, a bone marrow suppression of the erythroid elements may occur; caution when administered by aerosol for RSV; teratogenic, mutagenic, and, possibly, gonadotoxic

More on Arenaviruses

Overview: Arenaviruses
Differential Diagnoses & Workup: Arenaviruses
Treatment & Medication: Arenaviruses
Follow-up: Arenaviruses
References
Further Reading
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References

  1. Briese T, Paweska JT, McMullan LK, Hutchison SK, Street C, Palacios G, et al. Genetic detection and characterization of lujo virus, a new hemorrhagic Fever-associated arenavirus from southern Africa. PLoS Pathog. May 2009;5(5):e1000455. [Medline].

  2. Whitby LR, Lee AM, Kunz S, Oldstone MB, Boger DL. Characterization of lassa virus cell entry inhibitors: Determination of the active enantiomer by asymmetric synthesis. Bioorg Med Chem Lett. May 3 2009;[Medline].

  3. Fichet-Calvet E, Rogers DJ. Risk maps of lassa Fever in west Africa. PLoS Negl Trop Dis. 2009;3(3):e388. [Medline].

  4. Cosset FL, Marianneau P, Verney G, Gallais F, Tordo N, Pécheur EI, et al. Characterization of Lassa virus cell entry and neutralization with Lassa virus pseudoparticles. J Virol. Apr 2009;83(7):3228-37. [Medline].

  5. Bateman C. Arenavirus deaths--emergency air services tighten up. S Afr Med J. Dec 2008;98(12):910, 912, 914. [Medline].

  6. Furuta Y, Takahashi K, Shiraki K, Sakamoto K, Smee DF, Barnard DL, et al. T-705 (favipiravir) and related compounds: Novel broad-spectrum inhibitors of RNA viral infections. Antiviral Res. Jun 2009;82(3):95-102. [Medline].

  7. Banerjee C, Allen LJ, Salazar-Bravo J. Models for an arenavirus infection in a rodent population: consequences of horizontal, vertical and sexual transmission. Math Biosci Eng. Oct 2008;5(4):617-45. [Medline].

  8. Biggar RJ, Woodall JP, Walter PD, Haughie GE. Lymphocytic choriomeningitis outbreak associated with pet hamsters. Fifty-seven cases from New York State. JAMA. May 5 1975;232(5):494-500. [Medline].

  9. Buckley SM, Casals J. Pathobiology of Lassa fever. Int Rev Exp Pathol. 1978;18:97-136. [Medline].

  10. Centers for Disease Control and Prevention. Arenavirus infection--Connecticut, 1994. MMWR Morb Mortal Wkly Rep. Sep 2 1994;43(34):635-6. [Medline].

  11. Centers for Disease Control and Prevention. Fatal illnesses associated with a new world arenavirus--California, 1999-2000. MMWR Morb Mortal Wkly Rep. Aug 11 2000;49(31):709-11. [Medline].

  12. Cummins D, McCormick JB, Bennett D, et al. Acute sensorineural deafness in Lassa fever. JAMA. Oct 24-31 1990;264(16):2093-6. [Medline].

  13. Fischer SA, Graham MB, Kuehnert MJ. Transmission of lymphocytic choriomeningitis virus by organ transplantation. N Engl J Med. 2006;354:2208-11.

  14. Hinman AR, Fraser DW, Douglas RG, et al. Outbreak of lymphocytic choriomeningitis virus infections in medical center personnel. Am J Epidemiol. Feb 1975;101(2):103-10. [Medline].

  15. Holmes GP, McCormick JB, Trock SC. Lassa fever in the United States. Investigation of a case and new guidelines for management. N Engl J Med. Oct 18 1990;323(16):1120-3. [Medline].

  16. Jay MT, Glaser C, Fulhorst CF. The arenaviruses. J Am Vet Med Assoc. 2005;227:904-15.

  17. Kiley MP, Lange JV, Johnson KM. Protection of rhesus monkeys from Lassa virus by immunisation with closely related Arenavirus. Lancet. Oct 6 1979;2(8145):738. [Medline].

  18. Kunz S, de la Torre JC. Novel antiviral strategies to combat human Arenavirus infections. Curr Mol Med. 2005;5:735-51.

  19. Lan S, McLay Schelde L, Wang J, Kumar N, Ly H, Liang Y. Development of infectious clones for virulent and avirulent Pichinde viruses - a model virus to study arenavirus-induced hemorrhagic fevers. J Virol. Apr 22 2009;[Medline].

  20. Maiztegui JI. Clinical and epidemiological patterns of Argentine haemorrhagic fever. Bull World Health Organ. 1975;52(4-6):567-75. [Medline].

  21. McCormick JB, King IJ, Webb PA, et al. Lassa fever. Effective therapy with ribavirin. N Engl J Med. Jan 2 1986;314(1):20-6. [Medline].

  22. Stinebaugh BJ, Schloeder FX, Johnson KM, et al. Bolivian hemorrhagic fever. A report of four cases. Am J Med. Feb 1966;40(2):217-30. [Medline].

  23. Vanzee BE, Douglas RG, Betts RF, et al. Lymphocytic choriomeningitis in university hospital personnel. Clinical features. Am J Med. Jun 1975;58(6):803-9. [Medline].

  24. Zweighaft RM, Fraser DW, Hattwick MA, et al. Lassa fever: response to an imported case. N Engl J Med. Oct 13 1977;297(15):803-7. [Medline].

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Further Reading

Clinical guidelines

Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee.
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]. 2003 Jun 6. 42 pages. NGC:003059

Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings 2007. Standard precautions.
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]. 1996 Jan (revised 2007 Jun). 17 pages. NGC:005766

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CBRNE - Viral Hemorrhagic Fevers

Viral Hemorrhagic Fevers

Viral Encephalitis

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Keywords

arenaviruses, lymphocytic choriomeningitis virus, Lassa fever virus, Machupo virus, Junin virus, Guanarito virus, viral hemorrhagic fever

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Contributor Information and Disclosures

Author

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Daniel R Lucey, MD, MPH, Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences
Daniel R Lucey, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American College of Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Joseph F John Jr, MD, FACP, FIDSA, FSHEA, Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center
Disclosure: BioMerieux Honoraria Review panel membership; Cubist Honoraria Review panel membership; Pfizer Honoraria Speaking and teaching; Merck Stock dividends stock holdings

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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