Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.^[12]

Class Summary

Clinical experience with ribavirin in the treatment of Arenavirus infections is primarily with Lassa fever, but anecdotal experience in the South American arenaviruses also exists.

One study demonstrated a reduction in mortality from 55% to 5% in severe Lassa fever with intravenous ribavirin when administered within the first 6 days. Oral ribavirin may also be effective, although it has less bioavailability compared with intravenous formulations. Oral ribavirin is also sometimes used as postexposure prophylaxis, although data are limited.

Ribavirin (Virazole)

View full drug information

Synthetic guanosine analog (1beta-D-ribofuranosyl- 1H-1,2,4-triazole-3-carboxamide) that inhibits viral replication by inhibiting DNA and RNA synthesis.

Phosphorylated in vivo, and the active form may interfere with viral genomic synthesis. Clinically used in combination with interferon for hepatitis C, as aerosol for respiratory syncytial virus, and as potential prophylaxis and/or treatment of Congo-Crimean hemorrhagic fever, hantavirus infections, and Arenavirus hemorrhagic fevers. In vitro evidence exists for activity against West Nile virus. IV form not readily available and the manufacturer should be contacted if the need arises.

Follow-up

Sarute N, Ross SR. New World Arenavirus Biology. Annu Rev Virol. 2017 Sep 29. 4 (1):141-158. [Medline]. [Full Text].
Moraes F, Góes A. A decade of human genome project conclusion: Scientific diffusion about our genome knowledge. Biochem Mol Biol Educ. 2016 May 6. 44 (3):215-23. [Medline].
Bateman C. Arenavirus deaths--emergency air services tighten up. S Afr Med J. 2008 Dec. 98(12):910, 912, 914. [Medline].
Whitby LR, Lee AM, Kunz S, Oldstone MB, Boger DL. Characterization of lassa virus cell entry inhibitors: Determination of the active enantiomer by asymmetric synthesis. Bioorg Med Chem Lett. 2009 May 3. [Medline].
Fichet-Calvet E, Rogers DJ. Risk maps of lassa Fever in west Africa. PLoS Negl Trop Dis. 2009. 3(3):e388. [Medline].
Cosset FL, Marianneau P, Verney G, Gallais F, Tordo N, Pécheur EI, et al. Characterization of Lassa virus cell entry and neutralization with Lassa virus pseudoparticles. J Virol. 2009 Apr. 83(7):3228-37. [Medline].
Vanzee BE, Douglas RG, Betts RF, et al. Lymphocytic choriomeningitis in university hospital personnel. Clinical features. Am J Med. 1975 Jun. 58(6):803-9. [Medline].
CDC. Lymphocytic Choriomeningitis (LCM). Centers for Disease Control and Prevention. Available at https://www.cdc.gov/vhf/lcm/index.html. 6 May 2014; Accessed: 11 May 2019.
Holmes GP, McCormick JB, Trock SC. Lassa fever in the United States. Investigation of a case and new guidelines for management. N Engl J Med. 1990 Oct 18. 323(16):1120-3. [Medline].
CDC. Viral Hemorrhagic Fevers. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/vhf/index.html. 29 Jan 2014; Accessed: 11 May 2019.
Pasquato A, Kunz S. Novel drug discovery approaches for treating arenavirus infections. Expert Opin Drug Discov. 2016. 11 (4):383-93. [Medline].
Furuta Y, Takahashi K, Shiraki K, Sakamoto K, Smee DF, Barnard DL, et al. T-705 (favipiravir) and related compounds: Novel broad-spectrum inhibitors of RNA viral infections. Antiviral Res. 2009 Jun. 82(3):95-102. [Medline].
King BR, Hershkowitz D, Eisenhauer PL, Weir ME, Ziegler CM, Russo J, et al. A Map of the Arenavirus Nucleoprotein-Host Protein Interactome Reveals that Junín Virus Selectively Impairs the Antiviral Activity of Double-Stranded RNA-Activated Protein Kinase (PKR). J Virol. 2017 Aug 1. 91 (15):[Medline]. [Full Text].
Banerjee C, Allen LJ, Salazar-Bravo J. Models for an arenavirus infection in a rodent population: consequences of horizontal, vertical and sexual transmission. Math Biosci Eng. 2008 Oct. 5(4):617-45. [Medline].
Biggar RJ, Woodall JP, Walter PD, Haughie GE. Lymphocytic choriomeningitis outbreak associated with pet hamsters. Fifty-seven cases from New York State. JAMA. 1975 May 5. 232(5):494-500. [Medline].
Briese T, Paweska JT, McMullan LK, Hutchison SK, Street C, Palacios G, et al. Genetic detection and characterization of lujo virus, a new hemorrhagic Fever-associated arenavirus from southern Africa. PLoS Pathog. 2009 May. 5(5):e1000455. [Medline].
Buchmeier MJ, et al. Arenaviridae: the viruses and their replication. Knipe DL, and Howley, PM. Field's Virology. 4. Philadelphia, PA: Lippencott-Raven; 2007. 1791-1828.
Buckley SM, Casals J. Pathobiology of Lassa fever. Int Rev Exp Pathol. 1978. 18:97-136. [Medline].
Cao W, Henry MD, Borrow P, et al. Identification of alpha-dystroglycan as a receptor for lymphocytic choriomeningitis virus and Lassa fever virus. Science. 1998 Dec 11. 282(5396):2079-81. [Medline].
Centers for Disease Control and Prevention. Arenavirus infection--Connecticut, 1994. MMWR Morb Mortal Wkly Rep. 1994 Sep 2. 43(34):635-6. [Medline].
Centers for Disease Control and Prevention. Fatal illnesses associated with a new world arenavirus--California, 1999-2000. MMWR Morb Mortal Wkly Rep. 2000 Aug 11. 49(31):709-11. [Medline].
Charrel RN, Coutard B, Baronti C, et al. Arenaviruses and hantaviruses: From epidemiology and genomics to antivirals. Antiviral Res. 2011 May. 90(2):102-14. [Medline].
Cummins D, McCormick JB, Bennett D, et al. Acute sensorineural deafness in Lassa fever. JAMA. 1990 Oct 24-31. 264(16):2093-6. [Medline].
Delgado S, Erickson BR, Agudo R, et al. Chapare virus, a newly discovered arenavirus isolated from a fatal hemorrhagic fever case in Bolivia. PLoS Pathog. 2008 Apr. 4(4):e1000047. [Medline].
Fischer SA, Graham MB, Kuehnert MJ. Transmission of lymphocytic choriomeningitis virus by organ transplantation. N Engl J Med. 2006. 354:2208-11.
Hinman AR, Fraser DW, Douglas RG, et al. Outbreak of lymphocytic choriomeningitis virus infections in medical center personnel. Am J Epidemiol. 1975 Feb. 101(2):103-10. [Medline].
Ibraghimov-Beskrovnaya O, Ervasti JM, Leveille CJ, et al. Primary structure of dystrophin-associated glycoproteins linking dystrophin to the extracellular matrix. Nature. 1992 Feb 20. 355(6362):696-702. [Medline].
Inegbenebor U, Okosun J, Inegbenebor J. Prevention of lassa Fever in Nigeria. Trans R Soc Trop Med Hyg. 2010 Jan. 104(1):51-4. [Medline].
Jay MT, Glaser C, Fulhorst CF. The arenaviruses. J Am Vet Med Assoc. 2005. 227:904-15.
Khan SH, Goba A, Chu M, et al. New opportunities for field research on the pathogenesis and treatment of Lassa fever. Antiviral Res. 2008 Apr. 78(1):103-15. [Medline].
Kiley MP, Lange JV, Johnson KM. Protection of rhesus monkeys from Lassa virus by immunisation with closely related Arenavirus. Lancet. 1979 Oct 6. 2(8145):738. [Medline].
Kunz S, de la Torre JC. Novel antiviral strategies to combat human Arenavirus infections. Curr Mol Med. 2005. 5:735-51.
Lan S, McLay Schelde L, Wang J, Kumar N, Ly H, Liang Y. Development of infectious clones for virulent and avirulent Pichinde viruses - a model virus to study arenavirus-induced hemorrhagic fevers. J Virol. 2009 Apr 22. [Medline].
Maiztegui JI. Clinical and epidemiological patterns of Argentine haemorrhagic fever. Bull World Health Organ. 1975. 52(4-6):567-75. [Medline].
Maiztegui JI, McKee KT Jr, Barrera Oro JG, et al. Protective efficacy of a live attenuated vaccine against Argentine hemorrhagic fever. AHF Study Group. J Infect Dis. 1998 Feb. 177(2):277-83. [Medline].
McCormick JB, King IJ, Webb PA, et al. Lassa fever. Effective therapy with ribavirin. N Engl J Med. 1986 Jan 2. 314(1):20-6. [Medline].
Paweska JT, Sewlall NH, Ksiazek TG, et al. Nosocomial outbreak of novel arenavirus infection, southern Africa. Emerg Infect Dis. 2009 Oct. 15(10):1598-602. [Medline]. [Full Text].
Peters CJ. Lymphocytic Choriomeningitis Virus, Lassa Virus, and the South American Hemorrhagic Fevers. Gerald L. Mandell, John E. Bennett, Raphael Dolin. Principles and Practice of Infectious Diseases. 7. Philadelphia, PA: Churchill Livingstone Elsevier; 2010. 2: 2295-2302.
Radoshitzky SR, Abraham J, Spiropoulou CF, et al. Transferrin receptor 1 is a cellular receptor for New World haemorrhagic fever arenaviruses. Nature. 2007 Mar 1. 446(7131):92-6. [Medline].
Stinebaugh BJ, Schloeder FX, Johnson KM, et al. Bolivian hemorrhagic fever. A report of four cases. Am J Med. 1966 Feb. 40(2):217-30. [Medline].
Zweighaft RM, Fraser DW, Hattwick MA, et al. Lassa fever: response to an imported case. N Engl J Med. 1977 Oct 13. 297(15):803-7. [Medline].
Shao J, Liang Y, Ly H. Human hemorrhagic Fever causing arenaviruses: molecular mechanisms contributing to virus virulence and disease pathogenesis. Pathogens. 2015 May 21. 4 (2):283-306. [Medline].

Media Gallery

Transmission electron microscopic (TEM) image depicting an arenavirus. Courtesy of the Public Health Image Library (PHIL)/Charles Humphrey, the Centers for Disease Control and Prevention (CDC).

of 1

Author

Sandra G Gompf, MD, FACP, FIDSA Professor of Infectious Disease and International Medicine, University of South Florida Morsani College of Medicine; Chief, Infectious Diseases Section, Director, Occupational Health and Infection Control Programs, James A Haley Veterans Hospital

Sandra G Gompf, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Kevin M Smith, MD Fellow in Infectious Disease and International Medicine, University of South Florida College of Medicine

Kevin M Smith, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Ulyee Choe, DO Fellow, Department of Infectious Diseases, University of South Florida College of Medicine

Ulyee Choe, DO is a member of the following medical societies: American College of Physicians, American Osteopathic Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Joseph F John, Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Joseph F John, Jr, MD, FACP, FIDSA, FSHEA is a member of the following medical societies: Charleston County Medical Association, Infectious Diseases Society of America, South Carolina Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Daniel R Lucey, MD, MPH, MD, MPH

Daniel R Lucey, MD, MPH, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Larry I Lutwick, MD, to the development and writing of this article.

Arenaviruses Medication

Medication Summary

Antivirals

Class Summary

Ribavirin (Virazole)

Ribavirin (Virazole)

References

Tables

Contributor Information and Disclosures

What would you like to print?