eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Hantavirus Pulmonary Syndrome: Treatment & Medication

Author: Vinod K Dhawan, MD, FACP, FRCP(C), Professor, Department of Clinical Medicine, University of California at Los Angeles; Professor of Medicine, Charles R Drew University of Medicine and Science; Chief, Division of Infectious Diseases, MLK-Harbor Hospital
Coauthor(s): Veronica A Mas Casullo, MD, Assistant Professor, Department of Pediatric Infectious Diseases, Mount Sinai School of Medicine
Contributor Information and Disclosures

Updated: Aug 11, 2008

Treatment

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. 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.7 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. Prospective, controlled trials are underway.
  • Hyperimmune serum offers a promising future therapy because survival is correlated with higher neutralizing antibody titers at admission.

Consultations

  • Infectious diseases specialist
  • Pulmonary medicine specialist
  • Critical care specialist

Medication

Drug therapy is not currently a component of the standard of care for this infection. No specific therapy has been found to be of benefit. Ribavirin therapy has proved inconclusive in the open-label studies. A controlled trial of ribavirin in Hantavirus pulmonary syndrome is underway.8

More on Hantavirus Pulmonary Syndrome

Overview: Hantavirus Pulmonary Syndrome
Differential Diagnoses & Workup: Hantavirus Pulmonary Syndrome
Treatment & Medication: Hantavirus Pulmonary Syndrome
Follow-up: Hantavirus Pulmonary Syndrome
Multimedia: Hantavirus Pulmonary Syndrome
References
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References

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Further Reading

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Keywords

Hantavirus pulmonary syndrome, Hantavirus, HPS, HPS disease, hemorrhagic fever with renal syndrome, HFRS, Sin Nombre virus, nameless virus, Peromyscus maniculatus, infectious rodent, pulmonary capillary permeability, severe pulmonary edema, viremia, atypical myocarditis, Hantavirus pulmonary syndrome shock, viral upper respiratory tract infections, rhinorrhea, pharyngitis

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Contributor Information and Disclosures

Author

Vinod K Dhawan, MD, FACP, FRCP(C), Professor, Department of Clinical Medicine, University of California at Los Angeles; Professor of Medicine, Charles R Drew University of Medicine and Science; Chief, Division of Infectious Diseases, MLK-Harbor Hospital
Vinod K Dhawan, MD, FACP, FRCP(C) 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 None None

Coauthor(s)

Veronica A Mas Casullo, MD, Assistant Professor, Department of Pediatric Infectious Diseases, Mount Sinai School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

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 School of Medicine
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.

CME Editor

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: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap 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: None None None

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