Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Hantavirus Cardiopulmonary Syndrome Medication

  • Author: Juliet D Caldwell, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
 
Updated: Apr 01, 2015
 

Medication Summary

Currently, no Food and Drug Administration-approved antiviral drugs, vaccines, or immunotherapeutic agents are available for Hantavirus cardiopulmonary syndrome (HCPS). Though ribavirin, a nucleoside analogue, has shown a statistically significant 7-fold reduction in mortality when initiated early in the treatment of hemorrhagic fever with renal syndrome (HFRS),[42] no benefit has been demonstrated when used for HCPS. One double-blind, placebo-controlled study and one nonrandomized trial showed no survival benefit of ribavirin in the treatment of HCPS,[43, 44] though questions remain regarding study design and lack of power. Nonetheless, no evidence exists to support an off-label use of ribavirin in the treatment of HCPS.

Based on a study involving 60 Chilean patients with HCPS, glucocorticoids are not recommended as treatment for HCPS.[45]

Some indirect evidence supports the use of neutralizing antibodies, or passive immunotherapy, for HCPS. Bharadwaj et al found that patients who had higher titers of neutralizing antibodies suffered milder disease.[46] Studies addressing the role of passive immunotherapy for treatment or postexposure prophylaxis of HCPS have not yet been published.

Liberal employment of high-dose vasopressors and inotropes, as well as standard administration of antibiotics, is strongly encouraged. (See Emergency Department Care.)

Next

Inotropes

Class Summary

Used in the implementation of hemodynamic support.

Dopamine (Intropin)

 

Stimulates beta1- and alpha1-adrenergic and dopaminergic receptors in a dose-dependent fashion; stimulates release of norepinephrine. Lower doses (2-5 mcg/kg/min) mainly stimulate dopamine receptors, producing renal and mesenteric vasodilation. Doses between 5 and 10 mcg/kg/min predominantly stimulate beta1-receptors, causing increased chronotropy, inotropy, and cardiac output. Doses >10 mcg/kg/min stimulate alpha1-receptors, causing marked vasoconstriction. After initiating therapy, dose may be increased by 1-4 mcg/kg/min q5min until optimal response.

Dobutamine (Dobutrex)

 

Stimulates alpha1-, beta1-, and beta 2-adrenergic receptors; has potent inotropic effects with minimal chronotropic effect; causes vasodilation; is vasopressor of choice in HCPS.

Norepinephrine (Levophed)

 

Stimulates alpha1- and beta 1-adrenergic receptors; increases inotropy and chronotropy; is potent vasoconstrictor.

Epinephrine (Adrenalin, EpiPen)

 

Stimulates alpha1-, alpha2-, beta1-, and beta2-adrenergic receptors, increasing cardiac muscle contractility and heart rate as well as vasoconstriction. As a result, increases systemic BP and coronary blood flow.

Previous
Next

Antivirals

Class Summary

These agents inhibit or reduce severity of some viral infections but have no demonstrable effect in HCPS as of yet.

Ribavirin (Virazole)

 

Proven effective in HFRS caused by Old World Hantaviruses; no demonstrated benefit in HCPS.

Previous
 
 
Contributor Information and Disclosures
Author

Juliet D Caldwell, MD Assistant Professor, Department of Emergency Medicine, Weill Cornell Medical College; Attending Physician, Department of Emergency Medicine, New York Presbyterian Hospital, Weill-Cornell Medical Center; Attending Physician, Department of Emergency Medicine, Long Island College Hospital

Juliet D Caldwell, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Barry J Sheridan, DO Chief Warrior in Transition Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician, Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Palmetto Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, South Carolina Medical Association, Columbia Medical Society, South Carolina College of Emergency Physicians, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Chief Editor for Medscape.

Acknowledgements

Scott Cameron, MD Consulting Staff, Department of Emergency Medicine, Regions Hospital

Disclosure: Nothing to disclose.

Michelle Ervin, MD Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Maureen Gang, MD Assistant Professor, Department of Emergency Medicine, New York University Medical Center

Disclosure: Nothing to disclose.

Mana Lumumba Kasongo, MD, MS Consulting Staff, Southwest Emergency Physicians

Disclosure: Nothing to disclose.

References
  1. Sheedy JA, Froeb HF, Batson HA, et al. The clinical course of epidemic hemorrhagic fever. Am J Med. 1954 May. 16(5):619-28. [Medline].

  2. Lee HW, Baek LJ, Johnson KM. Isolation of Hantaan virus, the etiologic agent of Korean hemorrhagic fever, from wild urban rats. J Infect Dis. 1982 Nov. 146(5):638-44. [Medline].

  3. Brummer-Korvenkontio M, Vaheri A, Hovi T, et al. Nephropathia epidemica: detection of antigen in bank voles and serologic diagnosis of human infection. J Infect Dis. 1980 Feb. 141(2):131-4. [Medline].

  4. Avsic-Zupanc T, Xiao SY, Stojanovic R, Gligic A, van der Groen G, LeDuc JW. Characterization of Dobrava virus: a Hantavirus from Slovenia, Yugoslavia. J Med Virol. 1992 Oct. 38(2):132-7. [Medline].

  5. Tsai TF, Bauer SP, Sasso DR, et al. Serological and virological evidence of a Hantaan virus-related enzootic in the United States. J Infect Dis. 1985 Jul. 152(1):126-36. [Medline].

  6. Glass GE, Watson AJ, LeDuc JW, Childs JE. Domestic cases of hemorrhagic fever with renal syndrome in the United States. Nephron. 1994. 68(1):48-51. [Medline].

  7. Centers for Disease Control and Prevention. From the Centers for Disease Control and Prevention. Infectious diseases update: outbreak, hantavirus infection--southwestern United States, 1993. JAMA. 1993 Jul 7. 270(1):25. [Medline].

  8. Centers for Disease Control and Prevention. All About Hantavirus Web site. Available at http://www.cdc.gov/ncidod/diseases/hanta/hps.

  9. Klein SL, Calisher CH. Emergence and persistence of hantaviruses. Curr Top Microbiol Immunol. 2007. 315:217-52. [Medline].

  10. Hjelle B, Glass GE. Outbreak of hantavirus infection in the Four Corners region of the United States in the wake of the 1997-1998 El Nino-southern oscillation. J Infect Dis. 2000 May. 181(5):1569-73. [Medline].

  11. Trencseni T, Keleti B. Clinical aspects and epidemiology of haemorrhagic fever with renal syndrome. Budapest. Akademai Kiado. 1971.

  12. Lazaro ME, Cantoni GE, Calanni LM, et al. Clusters of hantavirus infection, southern Argentina. Emerg Infect Dis. 2007 Jan. 13(1):104-10. [Medline]. [Full Text].

  13. Ferres M, Vial P, Marco C, Yanez L, Godoy P, Castillo C. Prospective evaluation of household contacts of persons with hantavirus cardiopulmonary syndrome in chile. J Infect Dis. 2007 Jun 1. 195(11):1563-71. [Medline].

  14. Terajima M, Hendershot JD 3rd, Kariwa H, et al. High levels of viremia in patients with the Hantavirus pulmonary syndrome. J Infect Dis. 1999 Dec. 180(6):2030-4. [Medline].

  15. Xiao R, Yang S, Koster F, Ye C, Stidley C, Hjelle B. Sin Nombre viral RNA load in patients with hantavirus cardiopulmonary syndrome. J Infect Dis. 2006 Nov 15. 194(10):1403-9. [Medline].

  16. Mertz GJ, Hjelle BL, Bryan RT. Hantavirus infection. Adv Intern Med. 1997. 42:369-421. [Medline].

  17. Maes P, Clement J, Gavrilovskaya I, Van Ranst M. Hantaviruses: immunology, treatment, and prevention. Viral Immunol. 2004. 17(4):481-97. [Medline].

  18. Peters CJ, Simpson GL, Levy H. Spectrum of hantavirus infection: hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome. Annu Rev Med. 1999. 50:531-45. [Medline].

  19. Li Y, Wang W, Wang JP, Pan L, Zhang Y, Yu HT. Elevated vascular endothelial growth factor levels induce hyperpermeability of endothelial cells in hantavirus infection. J Int Med Res. 2012. 40(5):1812-21. [Medline].

  20. Nolte KB, Feddersen RM, Foucar K, et al. Hantavirus pulmonary syndrome in the United States: a pathological description of a disease caused by a new agent. Hum Pathol. 1995 Jan. 26(1):110-20. [Medline].

  21. Hallin GW, Simpson SQ, Crowell RE, et al. Cardiopulmonary manifestations of hantavirus pulmonary syndrome. Crit Care Med. 1996 Feb. 24(2):252-8. [Medline].

  22. Entwisle G, Hale E. Hemodynamic alterations in hemorrhagic fever. Circulation. 1957 Mar. 15(3):414-25. [Medline].

  23. Centers for Disease Control and Prevention. Outbreak of Hantavirus Infection in Yosemite National Park. Available at http://www.cdc.gov/hantavirus/outbreaks/yosemite-national-park-2012.html. Accessed: April 17, 2013.

  24. Padula PJ, Edelstein A, Miguel SD, Lopez NM, Rossi CM, Rabinovich RD. [Epidemic outbreak of Hantavirus pulmonary syndrome in Argentina. Molecular evidence of person to person transmission of Andes virus]. Medicina (B Aires). 1998. 58 Suppl 1:27-36. [Medline].

  25. Young JC, Hansen GR, Graves TK, et al. The incubation period of hantavirus pulmonary syndrome. Am J Trop Med Hyg. 2000 Jun. 62(6):714-7. [Medline].

  26. Johnson AM, Bowen MD, Ksiazek TG, et al. Laguna Negra virus associated with HPS in western Paraguay and Bolivia. Virology. 1997 Nov 10. 238(1):115-27. [Medline].

  27. Chang B, Crowley M, Campen M, Koster F. Hantavirus cardiopulmonary syndrome. Semin Respir Crit Care Med. 2007 Apr. 28(2):193-200. [Medline].

  28. Centers for Disease Control and Prevention. Reported Cases of HPS. Available at http://www.cdc.gov/hantavirus/surveillance/index.html. Accessed: April 17, 2013.

  29. MMWR Hantavirus Pulmonary Syndrome in Five Pediatric Patients --- Four States, 2009. December 25th 2009. 58 (50):1409-1412.

  30. Castillo C, Naranjo J, Sepulveda A, Ossa G, Levy H. Hantavirus pulmonary syndrome due to Andes virus in Temuco, Chile: clinical experience with 16 adults. Chest. 2001 Aug. 120(2):548-54. [Medline].

  31. Fulhorst CF, Milazzo ML, Armstrong LR, et al. Hantavirus and arenavirus antibodies in persons with occupational rodent exposure. Emerg Infect Dis. 2007 Apr. 13(4):532-8. [Medline]. [Full Text].

  32. Koster F, Foucar K, Hjelle B, Scott A, Chong YY, Larson R. Rapid presumptive diagnosis of hantavirus cardiopulmonary syndrome by peripheral blood smear review. Am J Clin Pathol. 2001 Nov. 116(5):665-72. [Medline].

  33. Jenison S, Hjelle B, Simpson S, Hallin G, Feddersen R, Koster F. Hantavirus pulmonary syndrome: clinical, diagnostic, and virologic aspects. Semin Respir Infect. 1995 Dec. 10(4):259-269. [Medline].

  34. Hjelle B. Hantavirus Cardiopulmonary Syndrome. UpToDate. 2008.

  35. Duchin JS, Koster FT, Peters CJ, et al. Hantavirus pulmonary syndrome: a clinical description of 17 patients with a newly recognized disease. The Hantavirus Study Group. N Engl J Med. 1994 Apr 7. 330(14):949-55. [Medline].

  36. Ketai LH, Williamson MR, Telepak RJ, et al. Hantavirus pulmonary syndrome: radiographic findings in 16 patients. Radiology. 1994 Jun. 191(3):665-8. [Medline].

  37. Dietl CA, Wernly JA, Pett SB, et al. Extracorporeal membrane oxygenation support improves survival of patients with severe Hantavirus cardiopulmonary syndrome. J Thorac Cardiovasc Surg. 2008 Mar. 135(3):579-84. [Medline].

  38. Dull SM, Brillman JC, Simpson SQ, Sklar DP. Hantavirus pulmonary syndrome: recognition and emergency department management. Ann Emerg Med. 1994 Sep. 24(3):530-6. [Medline].

  39. Levy H, Simpson SQ. Hantavirus pulmonary syndrome. Am J Respir Crit Care Med. 1994 Jun. 149(6):1710-3. [Medline].

  40. Crowley MR, Katz RW, Kessler R, et al. Successful treatment of adults with severe Hantavirus pulmonary syndrome with extracorporeal membrane oxygenation. Crit Care Med. 1998 Feb. 26(2):409-14. [Medline].

  41. Hjelle B, Jenison S, Mertz G, et al. Emergency of hantaviral disease in southwestern United States. West J Med. 1994. 161:467.

  42. Huggins JW, Hsiang CM, Cosgriff TM, et al. Prospective, double-blind, concurrent, placebo-controlled clinical trial of intravenous ribavirin therapy of hemorrhagic fever with renal syndrome. J Infect Dis. 1991 Dec. 164(6):1119-27. [Medline].

  43. Chapman LE, Mertz GJ, Peters CJ, et al. Intravenous ribavirin for hantavirus pulmonary syndrome: safety and tolerance during 1 year of open-label experience. Ribavirin Study Group. Antivir Ther. 1999. 4(4):211-9. [Medline].

  44. Mertz GJ, Miedzinski L, Goade D, et al. Placebo-controlled, double-blind trial of intravenous ribavirin for the treatment of hantavirus cardiopulmonary syndrome in North America. Clin Infect Dis. 2004 Nov 1. 39(9):1307-13. [Medline].

  45. Vial PA, Valdivieso F, Ferres M, Riquelme R, Rioseco ML, Calvo M, et al. High-dose intravenous methylprednisolone for hantavirus cardiopulmonary syndrome in Chile: a double-blind, randomized controlled clinical trial. Clin Infect Dis. 2013 Oct. 57(7):943-51. [Medline]. [Full Text].

  46. Bharadwaj M, Nofchissey R, Goade D, Koster F, Hjelle B. Humoral immune responses in the hantavirus cardiopulmonary syndrome. J Infect Dis. 2000 Jul. 182(1):43-8. [Medline].

  47. Jonsson CB, Hooper J, Mertz G. Treatment of hantavirus pulmonary syndrome. Antiviral Res. 2008 Apr. 78(1):162-9. [Medline].

  48. Custer DM, Thompson E, Schmaljohn CS, Ksiazek TG, Hooper JW. Active and passive vaccination against hantavirus pulmonary syndrome with Andes virus M genome segment-based DNA vaccine. J Virol. 2003 Sep. 77(18):9894-905. [Medline].

  49. Hooper JW, Custer DM, Smith J, Wahl-Jensen V. Hantaan/Andes virus DNA vaccine elicits a broadly cross-reactive neutralizing antibody response in nonhuman primates. Virology. 2006 Mar 30. 347(1):208-16. [Medline].

  50. Schmaljohn CS, Chu YK, Schmaljohn AL, Dalrymple JM. Antigenic subunits of Hantaan virus expressed by baculovirus and vaccinia virus recombinants. J Virol. 1990 Jul. 64(7):3162-70. [Medline].

  51. Xu X, Ruo SL, McCormick JB, Fisher-Hoch SP. Immunity to Hantavirus challenge in Meriones unguiculatus induced by vaccinia-vectored viral proteins. Am J Trop Med Hyg. 1992 Oct. 47(4):397-404. [Medline].

  52. Vial PA, Valdivieso F, Calvo M, Rioseco ML, Riquelme R, Araneda A, et al. A non-randomized multicentre trial of human immune plasma for treatment of hantavirus cardiopulmonary syndrome by ANDV. Antivir Ther. 2014 Oct 15. [Medline].

  53. Howard MJ, Doyle TJ, Koster FT, et al. Hantavirus pulmonary syndrome in pregnancy. Clin Infect Dis. 1999 Dec. 29(6):1538-44. [Medline].

  54. CDC. Hantavirus pulmonary syndrome in five pediatric patients - four states, 2009. MMWR Morb Mortal Wkly Rep. 2009 Dec 25. 58(50):1409-12. [Medline].

  55. Pergam SA, Schmidt DW, Nofchissey RA, et al. Potential renal sequelae in survivors of hantavirus cardiopulmonary syndrome. Am J Trop Med Hyg. 2009 Feb. 80(2):279-85. [Medline].

 
Previous
Next
 
Hantavirus cardiopulmonary syndrome (HCPS) precautions during the 1993 outbreak.
Peromyscus maniculatus - The deer mouse.
Geographic distribution and viral cause of Hantavirus cardiopulmonary syndrome (HCPS).
Hantavirus pulmonary syndrome cases by state of exposure.
Geographic distribution of Hantavirus cardiopulmonary syndrome (HCPS) and Peromyscus maniculatus.
Hantavirus pulmonary syndrome cases by outcome.
Hantavirus cardiopulmonary syndrome (HCPS) immunoblast.
Chest radiographic progression of Hantavirus cardiopulmonary syndrome (HCPS).
Clinical progression of hantavirus cardiopulmonary syndrome.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.