Emerging treatments

Immunotherapy

One trial found that immunotherapy, via passive simultaneous transfer of two different specific immunoglobulin preparations (intramuscular CCHF-bulin and intravenous CCHF-venin) prepared from the plasma of CCHF survivor donors boosted with a dose of CCHF vaccine, resulted in the recovery of all seven patients with severe CCHF.[101] Investigators subsequently suggested that the intravenous preparation be used for the treatment of CCHF.[64][102]​ Another study suggested prompt administration of CCHF virus hyperimmunoglobulin may be an alternative treatment approach, especially for high-risk individuals.[40][103]​ Further studies are needed to determine whether these treatments have a role in the management of CCHF.

Corticosteroids

Corticosteroids have been found to be beneficial in one observational study and one small case series. Corticosteroids were found to decrease mortality in patients with severe disease in the observational study.[79] In the case series, all six patients survived when corticosteroids were added to standard treatment early in the disease course.[104] One clinical trial involving 35 people with CCHF revealed the beneficial use of corticosteroids in addition to other treatments in patients with severe thrombocytopenia.[105]​ Another study revealed the efficacy of corticosteroids on the clinical outcome of five patients with CCHF.[106]​ Adjuvant use of corticosteroids may be useful for decreasing the acute inflammatory response caused by the course of the disease.[107][108]​​ Further studies are needed to further clarify role of corticosteroids in the management of CCHF.

Favipiravir

Animal studies have shown the antiviral agent favipiravir to be effective in the treatment of CCHF, either alone or in combination with ribavirin.[109][110][111][112][113]​​

Plasma exchange

Therapeutic plasma exchange was associated with decreased mortality rates and may be a useful adjunct to antiviral therapy in patients with severe disease. However, evidence is limited (case reports and one small clinical trial).[114][115][116][117][118][119]​​​​​​​​ Further studies are needed to determine whether this treatment has a role in the management of CCHF.

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