Hantavirus Pulmonary Syndrome Treatment & Management

Updated: Oct 01, 2018
  • Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Michael Stuart Bronze, MD  more...
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Treatment

Approach Considerations

Currently, treatment for Hantavirus pulmonary syndrome (HPS) is primarily supportive in nature. The attending physician must pay careful attention to acid-base disturbances and fluid balance, as well as respiratory status. HPS is a nationally reportable condition, and the state health department should be contacted immediately for instructions on reporting and submitting samples.

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Medical Care

The nucleoside analogue ribavirin has been shown to be effective in a related disease, hemorrhagic fever with renal failure syndrome (HFRS), which is also caused by the Hantaviruses. Ribavirin has also been shown to be effective against HPS in animal studies. However, a meta-analysis of only two small trials showed no mortality benefit for HPS in humans. Additional studies are underway. [10]

Extracorporeal membrane oxygenation (ECMO) has been used successfully in several patients. [11] ECMO was most effective when initiated prior to the development of hemodynamic instability and major coagulopathy. [12]

Some experts have suggested that VEGF antagonists may be effective for hantaviral infections based on the observed up-regulation of VEGF during infection. However, this has not been studied clinically. [13]

Treatment with corticosteroids has not been shown to affect mortality. [14]

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Consultations

An infectious disease specialist should be consulted for every patient considered to have HPS or a zoonotic infectious disease, and a pulmonologist and critical care specialist should be involved intubation and mechanical ventilation may be required. 

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Activity

 Some suggestion has also been made to reduce physical activity.

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Prevention

Caution patients against having contact with rodents or aerosolized rodent urine or excreta. Dead rodents should not be handled without taking proper precautions and wearing protection. Make dwellings rodent-proof; follow cleanliness and maintenance procedures such that dwellings do not attract small rodents.

Currently, there are no widely available vaccines against Hantavirus infection, although a controversial inactivated Hantavirus vaccine has been used in Korea with some effect. [15]

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Long-Term Monitoring

Continue monitoring patients with mild Hantavirus pulmonary syndrome (HPS) in an outpatient setting until they are completely well.

Patients with mild HPS often complain of substernal discomfort. In patients with such symptoms, perform an ECG and/or cardiac enzyme test to help exclude myocardial infarction. Substernal discomfort that is oppressive in character is common in patients recovering from HPS. Although a cardiac explanation for the chest pain is suggested by its sternal location, myocardial infarction is not a complication of HPS.

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