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Treatment

Take-home Message for Care Providers:

  • Rapid transfer to ICU
  • Careful monitoring
  • Fluid balance
  • Electrolyte balance
  • Blood pressure

There is no specific treatment or cure for hantavirus infection. Treatment of patients with HPS remains supportive in nature. Patients should receive appropriate, broad-spectrum antibiotic therapy while awaiting confirmation of a diagnosis of HPS. Care during the initial stages of the disease should include antipyretics and analgesia as needed.

If there is a high degree of suspicion of HPS, patients should be immediately transferred to an emergency department or intensive care unit (ICU) for close monitoring and care. Patients presenting with fulminant illness due to HPS have a poor prognosis despite ICU care. ICU management should include careful assessment, monitoring and adjustment of volume status and cardiac function, including inotropic and vasopressor support if needed. Fluids should be administered carefully due to the potential for capillary leakage. Supplemental oxygen should be administered if patients become hypoxic. Equipment and materials for intubation and mechanical ventilation should be readily available since onset of respiratory failure may be precipitous.

Intravenous ribavirin, a guanosine analogue, has not been shown to be effective for treatment of HPS despite its effects on a related disease, hemorrhagic fever with renal syndrome (HFRS), which is caused by Old World hantaviruses. Controlled trials showed a reduction in case-fatality for HFRS patients treated with ribavirin. However, despite in vitro activity of ribavirin against SNV, neither an open-label trial conducted during the 1993 outbreak nor an attempted placebo-controlled trial demonstrated clinical benefit for HPS. Ribavirin is not recommended for treatment of HPS and is not available for this use under any existing research protocol.

 

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