Clinical Practice guidelines
Three Low-Dose Antihypertensive Agents in a Single Pill after Intracerebral Hemorrhage:
☑️
Among patients with intracerebral hemorrhage
👉
treatment with a combination of three low-dose antihypertensive agents in a single pill
👉
in addition to standard care
👉
was associated with a lower incidence of recurrent stroke and major cardiovascular events than placebo.
Tuberculosis kills a child every 3 minutes. But it doesn’t have to.
👆
😳
Antiviral therapy: —
✔️
Ribavirin is a nucleoside analog that is
👉
effective
👉
in hemorrhagic fever
👉
with renal syndrome due to Hantaan virus
👉
a different strain of hantavirus
Management strategies of HFRS include careful
👉
monitoring of clinical signs
👉
fluid and electrolyte balance
👉
blood pressure,
👉
and urine production.
✔️
Treatments include analgesic drugs
👉
✔️
intravenous fluid against hypotension
✔️
oxygenation against hypoxia
✔️
and correction of electrolyte imbalances.
🔴
👉
Dialysis is required in 15% of patients with DOBV
👉
😳
👉
but in less than 5% of patients with PUUV.
🟤
Mechanical ventilation
🟤
and renal replacement
therapy
👉
might be necessary in severe cases with
✔️
acute respiratory distress syndrome
👉
and overt kidney failure.
⏫
Patients with hypotension and shock receive vasoactive drugs together with fluid.
☑️
Favipiravir was effective in ANDV and SNV animal models when given
👉
before onset of viraemia
👉
and icatibant acetate
👉
a bradykinin receptor antagonist
👉
has been used in several patients with severe HFRS.
✔️
✔️
Notably
👉
an association has been shown between low concentrations of specific antibodies
👉
in serum during the acute phase
👉
and severe or fatal outcomes in patients infected with
👉
PUUV, ANDV, or SNV.
🟤
In an open study in Chile, mortality in patients infected with ANDV treated with convalescent plasma was lower than
Treatment and supportive care:
🔴
There is no specific effective
👉
antiviral
👉
or immunomodulatory treatment available
👉
✔️
treatment of patients admitted to
👉
😳
👉
hospital is supportive.
🚨
Intravenous ribavirin reduced mortality in one controlled trial for
👉
👉
haemorrhagic fever with renal syndrome (HFRS)
in China
👉
❌
but these trials are insufficient.
🟤
Ribavirin was ineffective against HFRS caused by
👉
PUUV
👉
and a small, placebo-controlled trial that used intravenous ribavirin
👉
for HCPS (in the cardiopulmonary phase) in North America suggested
❌
👉
no survival benefit.
🟤
Similarly
👉
high-dose intravenous methylprednisolone was ineffective
❌
👉
in a controlled trial for HCPS (in the cardiopulmonary phase) in Chile.
✔️
The serological standard method for confirmation is enzyme-linked immunosorbent assay (EIA).
✔️
Immuno-chromatographic IgM assays prepared with nucleocapsid protein have been used for diagnosis of HFRS
😳
👉
caused by
✔️
PUUV
✔️
HTNV
✔️
and DOBV (in one virus or combined formats)
☑️
with assay performance greater than 90% compared with EIA IgM assays.
☑️
The immunochromatographic IgM test for PUUV has also been used to test for SNV and ANDV
👉
although immunochromatographic tests should be confirmed with
👉
specific EIA to minimise the false positive results.
IgG EIA tests are used alongside IgM EIA tests for acute diagnosis
👉
and for seroprevalence studies.