Pediatric Hantavirus Pulmonary Syndrome Treatment & Management

  • Author: Vinod K Dhawan, MD, FACP, FRCP(C), FIDSA; Chief Editor: Russell W Steele, MD   more...
 
Updated: May 9, 2012
 

Medical Care

  • Treatment of Hantavirus pulmonary syndrome (HPS) remains supportive, requiring invasive hemodynamic monitoring with an arterial line and a pulmonary artery catheter and intensive support.[10] Prompt treatment is of critical importance. Treatment initiated after the onset of severe respiratory distress is less likely to favorably impact the outcome.
  • Mechanical ventilation may be necessary for survival during the period of severe respiratory insufficiency.
  • Excessive administration of fluids should be avoided despite the fact that patients may be hemoconcentrated and hypotensive. Overzealous fluid administration may aggravate respiratory insufficiency because of increased vascular leak of fluid into the lungs.
  • Early use of pressors is recommended to correct hypotension.
  • Extracorporeal membrane oxygenation may be considered for patients with refractory shock. In one report, almost two thirds of the patients with severe Hantavirus pulmonary syndrome, with predicted mortality of 100%, who were supported with extracorporeal circulation survived and completely recovered.[11] However, the validity of this treatment is not well established through controlled trials.
  • No specific treatment is available for Hantavirus pulmonary syndrome. Treatment with intravenous ribavirin, a guanosine analogue, conferred no survival benefit in an open-label trial. Hyperimmune serum offers a promising future therapy because survival is correlated with higher neutralizing antibody titers at admission.
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Consultations

  • Infectious diseases specialist
  • Pulmonary medicine specialist
  • Critical care specialist
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Contributor Information and Disclosures
Author

Vinod K Dhawan, MD, FACP, FRCP(C), FIDSA  Professor, Department of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Infectious Diseases, Rancho Los Amigos National Rehabilitation Center

Vinod K Dhawan, MD, FACP, FRCP(C), FIDSA is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Royal College of Physicians and Surgeons of Canada

Disclosure: Pfizer Inc Honoraria Speaking and teaching

Specialty Editor Board

Rosemary Johann-Liang, MD  Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration

Rosemary Johann-Liang, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD  American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Maria A Horga, MD and Veronica A Mas Casullo, MD to the development and writing of this article.

References

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Deer mouse, Peromyscus maniculatus. Courtesy of the Centers for Disease Control and Prevention.
Transmission electron micrograph of Sin Nombre virus. Courtesy of the Centers for Disease Control and Prevention.
Centers for Disease Control and Prevention: Cumulative case count of Hantavirus pulmonary syndrome in the United States per state, valid as of March 9, 2012.
Characteristics of 465 Hantavirus pulmonary syndrome cases in the United States, March 26, 2007. Courtesy of the Centers for Disease Control and Prevention.
Histopathology of the lung in Hantavirus pulmonary syndrome. Courtesy of the Centers for Disease Control and Prevention.
Table 1. Hantaviruses That Cause HFRS, Rodent Hosts and Geographic Distribution
Hantavirus TypeRodent HostGeographic Distribution
HantaanApodemus agrarius (striped field mouse)Far East, Russia, Northern Asia, Balkans
DobravaApodemus flavicollis (yellow-necked field mouse)Balkans
SeoulRattus norvegicus (urban rats)Worldwide
PuumalaClathrionomys glariolus (bank vole)Europe, Scandinavia, Western Russia
Table 2. Hantavirus Pulmonary Syndrome Virus Types, Rodent Hosts, and Distribution in the United States
Hantavirus TypeRodent HostGeographic Distribution of the Rodent Host in the United States
Sin Nombre virus, monongahela virusDeer mouse, P maniculatusThroughout the United States, except the Southeast and Atlantic seaboard
Bayou virusRice rat, Oryzomys palustrisSoutheastern United States
Black Creek Canal virusCotton rat, Sigmodon hispidusSoutheastern United States
New York-1 virusWhite-footed mouse, Peromyscus leucopusSouthern New England, mid-Atlantic states, Southern states, and Midwest
Table 3. Hantavirus Types, Rodent Hosts, and Geographic Distribution in the Western Hemisphere (other than the United States)
Hantavirus TypeRodent HostGeographic Distribution
AndesOligoryzomys longicaudatusArgentina and Chile
OranO longicaudatusNorthwest Argentina
LechiguanasOligoryzomys flavescensCentral Argentina
Hu39694UnknownCentral Argentina
Laguna NegraCalomys lauchaParaguay and Bolivia
JuquitibaUnknownBrazil
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