eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Viral Hemorrhagic Fevers: Treatment & Medication

Author: 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
Coauthor(s): Michelle L Whitner, PA-C, Physician Assistant, pediatrics, Parker Pediatrics and Adolescents
Contributor Information and Disclosures

Updated: Jan 27, 2009

Treatment

Medical Care

  • Early diagnosis and supportive care can be lifesaving for most patients with viral hemorrhagic fever (VHF). The cornerstone of therapy for all these infections is judicious fluid and electrolyte management.
  • Blood, platelet, and plasma replacement may be useful for Crimean-Congo hemorrhagic fever (CCHF). Infusion of convalescent plasma during the first 8 days of illness with Argentine HF reduces the mortality rate from 15-30% to less that 1%.

Consultations

  • Infectious diseases specialist (urgent)
  • Hematologist
  • Others as dictated by the clinical circumstances

Medication

Ribavirin is effective for treating patients with Lassa fever and markedly reduces the mortality rate if used within the first week of illness. Its use is under investigation for the treatment of patients with South American hemorrhagic fever (HF) but it is recommended for infection with all arenaviruses until a more effective alternative treatment becomes available. Widespread clinical trials have not established the efficacy of ribavirin in Crimean-Congo hemorrhagic fever (CCHF). No evidence suggests any benefit of antiviral agents, passive antibodies, or interferon in the treatment for Ebola or Marburg virus infection.

Antiviral agents

Some evidence suggests that ribavirin may be effective in the viral hemorrhagic fevers (VHFs) (in addition to Lassa fever, for which it is effective), particularly among the other arenaviruses. Treatment must be initiated promptly at the onset of the infection to effectively inhibit the replicating virus.


Ribavirin (Virazole)

DOC for VHF caused by arenaviruses, until other more effective drugs are identified and made available. Inhibits viral replication by inhibiting DNA and RNA synthesis.

Adult

Lassa fever and AST >150:
Loading dose: 32 mg/kg IV infused over 30 min
Postloading regimen: 64 mg/kg/d IV divided q6h for 4 d, followed by 24 mg/kg/d IV divided q8h for 6 d
Similar dosing for other indications is reasonable (in the absence of further information)

Pediatric

Few data exist, but likely administer as in adults

Inhibits zidovudine phosphorylation, thus decreasing its effects

Although ribavirin should not be used when renal impairment is present, it may be necessary for severe disease in which the potential benefit may outweigh the risks

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

Anemia (most commonly), insomnia, depression, irritability, and suicidal behavior have been reported with PO administration; with IV administration, reversible suppression of erythropoiesis, mild hemolysis, and mild direct hyperbilirubinemia are expected and generally manageable

More on Viral Hemorrhagic Fevers

Overview: Viral Hemorrhagic Fevers
Differential Diagnoses & Workup: Viral Hemorrhagic Fevers
Treatment & Medication: Viral Hemorrhagic Fevers
Follow-up: Viral Hemorrhagic Fevers
References
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Further Reading

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Keywords

viral hemorrhagic fever, VHF, Alkhurma, Arenaviridae, Argentine hemorrhagic fever, AHF, Bayou virus, Black Creek Canal virus, Bolivian hemorrhagic fever, Brazilian hemorrhagic fever, Bunyaviridae, Chapare virus, Crimean-Congo hemorrhagic fever, CCHF, dengue, dengue fever, dengue hemorrhagic fever, dengue shock syndrome, Dobrava/Belgrade virus, Ebola, Ebola hemorrhagic fever, Filoviridae, Flaviviridae, Four Corners virus, Guanarito virus, Hantaan virus, Hantavirus, Hantavirus pulmonary syndrome, HPS, hemorrhagic fever with renal syndrome, HFRS, Junin virus, Kyasanur Forest disease, Lassa fever, Machupo virus, Marburg virus disease, Muleshoe virus, New York virus, Omsk hemorrhagic fever, Puumala virus, Rift Valley fever, RVF, Sabia virus, Seoul virus, Sin Nombre virus, tropical viral infection, Venezuelan hemorrhagic fever, yellow fever

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Contributor Information and Disclosures

Author

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; Baxter Healthcare Honoraria Speaking and teaching

Coauthor(s)

Michelle L Whitner, PA-C, Physician Assistant, pediatrics, Parker Pediatrics and Adolescents
Michelle L Whitner, PA-C is a member of the following medical societies: American Academy of Physician Assistants
Disclosure: Nothing to disclose.

Medical Editor

Glenn J Fennelly, MD, MPH, Director, Division of Pediatric Infectious Diseases, Jacobi Medical Center; Associate Professor, Department of Pediatrics, Albert Einstein College of Medicine
Glenn J Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society
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 financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Leslie L Barton, MD, Professor, Program Director, Department of Pediatrics, University of Arizona School of Medicine
Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

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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