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Hantavirus Pulmonary Syndrome: Treatment & Medication
Updated: Aug 11, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
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
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| 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
CDC. Update: hantavirus pulmonary syndrome--United States, 1993. MMWR Morb Mortal Wkly Rep. Oct 29 1993;42(42):816-20. [Medline].
Mori M, Rothman AL, Kurane I, et al. High levels of cytokine-producing cells in the lung tissues of patients with fatal hantavirus pulmonary syndrome. J Infect Dis. Feb 1999;179(2):295-302. [Medline].
Kilpatrick ED, Terajima M, Koster FT, et al. Role of specific CD8+ T cells in the severity of a fulminant zoonotic viral hemorrhagic fever, hantavirus pulmonary syndrome. J Immunol. Mar 1 2004;172(5):3297-304. [Medline]. [Full Text].
Mills JN, Ksiazek TG, Ellis BA, et al. Patterns of association with host and habitat: antibody reactive with Sin Nombre virus in small mammals in the major biotic communities of the southwestern United States. Am J Trop Med Hyg. Mar 1997;56(3):273-84. [Medline].
Kuenzi AJ, Douglass RJ, Bond CW. Sin nombre virus in deer mice captured inside homes, southwestern Montana. Emerg Infect Dis. Jul-Aug 2000;6(4):386-8. [Medline].
Armstrong LR, Zaki SR, Goldoft MJ, et al. Hantavirus pulmonary syndrome associated with entering or cleaning rarely used, rodent-infested structures. J Infect Dis. Oct 1995;172(4):1166. [Medline].
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. Mar 2008;135(3):579-84. [Medline].
Jonsson CB, Hooper J, Mertz G. Treatment of hantavirus pulmonary syndrome. Antiviral Res. Apr 2008;78(1):162-9. [Medline].
Cho HW, Howard CR. Antibody responses in humans to an inactivated hantavirus vaccine (Hantavax). Vaccine. Jun 4 1999;17(20-21):2569-75. [Medline].
Abbott KD, Ksiazek TG, Mills JN. Long-term hantavirus persistence in rodent populations in central Arizona. Emerg Infect Dis. Jan-Feb 1999;5(1):102-12. [Medline].
Abel Borges A, Figueiredo LT. Mechanisms of shock in hantavirus pulmonary syndrome. Curr Opin Infect Dis. Jun 2008;21(3):293-7. [Medline].
Bartholomew DM, Hansen LA, Frank JJ, Farver DK. Case report of hantavirus pulmonary syndrome and review. S D Med. May 2007;60(5):189-91, 193-5. [Medline].
Bennett SG, Webb JP Jr, Madon MB, et al. Hantavirus (Bunyaviridae) infections in rodents from Orange and San Diego counties, California. Am J Trop Med Hyg. Jan 1999;60(1):75-84. [Medline].
Brillman J, Talan DA, Moran GJ, Pinner R. Update on emerging infections from the Centers for Disease Control and Prevention. Hantavirus pulmonary syndrome--five states, 2006. Ann Emerg Med. Nov 2006;48(5):593-4; discussion 594-5. [Medline].
CDC. From the Centers for Disease Control and Prevention. Hantavirus pulmonary syndrome--Panama, 1999-2000. JAMA. May 3 2000;283(17):2232-3. [Medline].
CDC. Update: hantavirus pulmonary syndrome--United States, 1999. MMWR Morb Mortal Wkly Rep. Jun 25 1999;48(24):521-5. [Medline].
Chang B, Crowley M, Campen M, Koster F. Hantavirus cardiopulmonary syndrome. Semin Respir Crit Care Med. Apr 2007;28(2):193-200. [Medline].
Cheney PR. Update on emerging infections from the Centers for Disease Control and Prevention. Hantavirus pulmonary syndrome--Colorado and New Mexico, 1998. Ann Emerg Med. Jan 1999;33(1):121-3. [Medline].
Chin C, Chiueh TS, Yang WC, et al. Hantavirus infection in Taiwan: the experience of a geographically unique area. J Med Virol. Feb 2000;60(2):237-47. [Medline].
Douglass RJ, Calisher CH, Bradley KC. State-by-state incidences of hantavirus pulmonary syndrome in the United States, 1993-2004. Vector Borne Zoonotic Dis. Summer 2005;5(2):189-92. [Medline].
Drebot MA, Artsob H, Werker D. Hantavirus pulmonary syndrome in Canada, 1989-1999. Can Commun Dis Rep. Apr 15 2000;26(8):65-9. [Medline].
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. Apr 7 1994;330(14):949-55. [Medline].
Ferreira MS, Nishioka Sd, Santos TL, et al. Hantavirus pulmonary syndrome in Brazil: clinical aspects of three new cases. Rev Inst Med Trop Sao Paulo. Jan-Feb 2000;42(1):41-6. [Medline].
Hallin GW, Simpson SQ, Crowell RE, et al. Cardiopulmonary manifestations of hantavirus pulmonary syndrome. Crit Care Med. Feb 1996;24(2):252-8. [Medline].
Hantavirus pulmonary syndrome--five states, 2006. MMWR Morb Mortal Wkly Rep. Jun 9 2006;55(22):627-9. [Medline].
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. May 2000;181(5):1569-73. [Medline].
Khan AS, Gaviria M, Rollin PE, et al. Hantavirus pulmonary syndrome in Florida: association with the newly identified Black Creek Canal virus. Am J Med. Jan 1996;100(1):46-8. [Medline].
Khan AS, Khabbaz RF, Armstrong LR, et al. Hantavirus pulmonary syndrome: the first 100 US cases. J Infect Dis. Jun 1996;173(6):1297-303. [Medline].
Klein SL, Calisher CH. Emergence and persistence of hantaviruses. Curr Top Microbiol Immunol. 2007;315:217-52. [Medline].
Koraka P, Avsic-Zupanc T, Osterhaus AD, Groen J. Evaluation of two commercially available immunoassays for the detection of hantavirus antibodies in serum samples. J Clin Virol. Sep 1 2000;17(3):189-96. [Medline].
Maeda K, West K, Toyosaki-Maeda T, et al. Identification and analysis for cross-reactivity among hantaviruses of H-2b-restricted cytotoxic T-lymphocyte epitopes in Sin Nombre virus nucleocapsid protein. J Gen Virol. Jul 2004;85(Pt 7):1909-19. [Medline].
Maes P, Clement J, Gavrilovskaya I, Van Ranst M. Hantaviruses: immunology, treatment, and prevention. Viral Immunol. 2004;17(4):481-97. [Medline].
Mertz GJ, Hjelle B, Crowley M, Iwamoto G, Tomicic V, Vial PA. Diagnosis and treatment of new world hantavirus infections. Curr Opin Infect Dis. Oct 2006;19(5):437-42. [Medline].
Mills JN, Corneli A, Young JC, et al. Hantavirus pulmonary syndrome--United States: updated recommendations for risk reduction. Centers for Disease Control and Prevention. MMWR Recomm Rep. Jul 26 2002;51(RR-9):1-12. [Medline].
Saggioro FP, Rossi MA, Duarte MI, et al. Hantavirus infection induces a typical myocarditis that may be responsible for myocardial depression and shock in hantavirus pulmonary syndrome. J Infect Dis. May 15 2007;195(10):1541-9. [Medline].
Seitsonen E, Hynninen M, Kolho E, et al. Corticosteroids combined with continuous veno-venous hemodiafiltration for treatment of hantavirus pulmonary syndrome caused by Puumala virus infection. Eur J Clin Microbiol Infect Dis. Mar 21 2006;[Medline].
Shope RE. A midcourse assessment of hantavirus pulmonary syndrome. Emerg Infect Dis. Jan-Feb 1999;5(1):172-4. [Medline].
Terajima M, Hayasaka D, Maeda K, Ennis FA. Immunopathogenesis of hantavirus pulmonary syndrome and hemorrhagic fever with renal syndrome: Do CD8+ T cells trigger capillary leakage in viral hemorrhagic fevers?. Immunol Lett. Nov 15 2007;113(2):117-20. [Medline].
Wells RM, Sosa Estani S, Yadon ZE, et al. An unusual hantavirus outbreak in southern Argentina: person-to-person transmission? Hantavirus Pulmonary Syndrome Study Group for Patagonia. Emerg Infect Dis. Apr-Jun 1997;3(2):171-4. [Medline].
Zaki SR, Greer PW, Coffield LM, et al. Hantavirus pulmonary syndrome. Pathogenesis of an emerging infectious disease. Am J Pathol. Mar 1995;146(3):552-79. [Medline].
Further Reading
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
Treatment & Medication: Hantavirus Pulmonary Syndrome