title: Treatment of Bolivian hemorrhagic fever with intravenous ribavirin.
abstract: Bolivian hemorrhagic fever (BHF) is a potentially severe febrile illness caused by Machupo virus (family Arenaviridae). Initial symptoms include headache, fever, arthralgia, and myalgia. In the later stages of this illness, patients may develop hemorrhagic manifestations including subconjunctival hemorrhage, epistaxis, hematemesis, melena, and hematuria, as well as neurological signs including tremor, seizures, and coma. During the BHF epidemics of the 1960s, convalescent-phase immune plasma from survivors of BHF was administered to selected patients infected with Machupo virus. However, there is currently a paucity of survivors of BHF who can donate immune plasma, and there is no active program for collection and storage of BHF immune plasma; therefore, we had the opportunity to offer intravenous ribavirin to two of three patients with this potentially life-threatening infection. One patient with laboratory-confirmed Machupo virus infection who received ribavirin recovered without sequelae, as did a second patient with suspected BHF whose epidemiological and clinical features were similar to those of the first patient. This report describes the first use of intravenous ribavirin therapy for BHF in humans, and the results suggest the need for more extensive clinical studies to assess the usefulness of ribavirin for treating BHF.
authors.affiliation: Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases and the Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Kilgore
authors.forename: T G
authors.initials: TG
authors.lastname: Ksiazek
authors.forename: P E
authors.initials: PE
authors.lastname: Rollin
authors.forename: J N
authors.initials: JN
authors.lastname: Mills
authors.forename: M R
authors.initials: MR
authors.lastname: Villagra
authors.forename: M J
authors.initials: MJ
authors.lastname: Montenegro
authors.forename: M A
authors.initials: MA
authors.lastname: Costales
authors.forename: L C
authors.initials: LC
authors.lastname: Paredes
authors.forename: C J
authors.initials: CJ
authors.lastname: Peters
mesh_terms: D000328:Adult; D000956:Antigens, Viral / Q000032:analysis; D000998:Antiviral Agents / Q000627:therapeutic use*; D006477:Arenaviruses, New World / Q000276:immunology / Q000302:isolation & purification; D017809:Fatal Outcome; D006478:Hemorrhagic Fever, American / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D012254:Ribavirin / Q000627:therapeutic use*
chemical_list: D000956:Antigens, Viral; D000998:Antiviral Agents; D012254:Ribavirin