Hantavirus cardiopulmonary syndrome successfully treated with high-volume hemofiltration

Abstract

Hantavirus cardiopulmonary syndrome has a high mortality rate, and early connection to extracorporeal membrane oxygenation has been suggested to improve outcomes. We report the case of a patient with demonstrated Hantavirus cardiopulmonary syndrome and refractory shock who fulfilled the criteria for extracorporeal membrane oxygenation and responded successfully to high volume continuous hemofiltration. The implementation of high volume continuous hemofiltration along with protective ventilation reversed the shock within a few hours and may have prompted recovery. In patients with Hantavirus cardiopulmonary syndrome, a short course of high volume continuous hemofiltration may help differentiate patients who can be treated with conventional intensive care unit management from those who will require more complex therapies, such as extracorporeal membrane oxygenation.

Hantavirus induced cardiopulmonary syndrome: A public health concern

“…According to one of the many case reports, a patient was transferred in prone position by a specialized team . Recently a patient with confirmed hantavirus cardiopulmonary syndrome who qualified for ECMO was successfully treated with high volume continuous hemofiltration . The implementation of high volume continuous hemofiltration along with protective ventilation reversed the shock within few hours and might have prompted the patient's recovery .…”

“…64 The implementation of high volume continuous hemofiltration along with protective ventilation reversed the shock within few hours and might have prompted the patient's recovery. 64 Thus, it is possible that short course of high volume continuous hemofiltration might help differentiate patients that can be treated with conventional intensive care management from those who require more intense therapy such as ECMO. Inhalational NO has been postulated to help such patients based on an antipodal report.…”

Antiviral therapy and prevention against hantavirus infections

“…Therapy of hantavirus diseases is usually based on the supportive care such as hemodialysis in HFRS (Bren et al, 1996), mechanical ventilation, extracorporeal membrane oxygenation (Guilfoyle and Macnab, 2008;Wernly et al, 2011) and hemofiltration in HCPS (Bugedo et al, 2016), and/ or shock therapy in both of them. Ribavirin is still the only established drug with approved in vitro and in vivo effects against hantavirus replication (Ogg et al, 2013;Krüger et al, 2011;Westover et al 2016).…”

Hantavirus Infections in the European Region: A Mini-Review of the Literature

“…Supplemental oxygen or mechanical ventilation when indicated, as well as ECMO should be considered [26,27]. Ribavirin, a nucleoside analogue, has been shown to inhibit the expression of viral cRNA, mRNA and protein of Hantaan virus through the formation of ribavirin triphosphate intracellularly [28].…”

“…Within the European region, according to Eurosurveillance data, during the period 2008-2015, 27.155 cases of Hantavirus infections were reported, with the majority of patients being between 25-65 years old [10]. Their spatial distribution is shown on Figure 1.…”