International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 8(16), August, 2016

Pages: 26-29

Date of Publication: 22-Aug-2016


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EFFECT OF RIBAVIRIN ON HOSPITAL STAY OF MEASLES CASES

Author: Indrajit Mandal, Malay Acharyya, Mainak Mukhopadhyay

Category: Healthcare

Abstract:Objectives: We evaluated the effect of Ribavirin \? a broad spectrum virustatic agent, in the hospital stay of measles cases both with and without complications.
Materials and Methods: This is a retrospective study where we examined the Bed Head Tickets of 100 randomly selected measles cases. One group was treated with Ribavirin along with antibiotic and other supportive measures and another group was treated with antibiotic and supportive measures only. We tried to evaluate the effect of Ribavirin on the hospital stay of Measles patients with or without complication.
Results: We found that there was absolute reduction in hospital stay for Ribavirin group than group treated without Ribavirin (4.018 \? 1.92 days versus 6.934 \? 2 days. p= 0.4). Mean hospital stay of measles with pneumonia treated with Rivavirin was 3.909 \? 1.02 days among 22 cases which was 8.5 \? 2.5 days among 10 cases treated without Ribavirin. This reduction was statistically significant (p= 0.02). Mean hospital stay of 12 cases of measles with encephalitis treated with Ribavirin was 5\? 1.15 days while it was 8.16\?2.07 days for 6 patients received antibiotic and supportive measures only (p=0.35). Case fatality rate in Ribavirin group was 0 %, against 4.34% for the group without Ribavirin.
Conclusion: Reduction in the hospital stay of measles cases even in those who had complications, is an encouraging finding. Further studies with large sample size and ramdomized controlled trials are required to evaluate the effectiveness of Ribavirin in measles along with other RNA viruses.

Keywords: Ribavirin, Measles, Measles pneumonia, Hospital stay

Full Text:

INTRODUCTION
Ribavirin is a broad spectrum non interferon inducing virustatic chemotherapeutic agent, demonstrates activity against a wide range of RNA and DNA viruses including measles viruses. To date the best success as occurred in the use of Ribavirin to treat respiratory syncytial virus infection in infant and young children and to treat influenza A and B virus infection in young adult. Viral infection particularly viral pneumonia, are often life threatening in patients with Severe Combined Immunodeficiency Disease (SCID) and Ribavirin aerosol has been used successfully to treat RSV and parainfluenza virus infection in the immunodeficient children. The drug has also shown significant clinical benefit in treating Lassa fever virus. Additional studies demonstrate the drug efficacy in acute viral hepatitis, herpes virus infection and measles. Controlled clinical trials are underway to test the drug in patients infected with AIDS virus1 . Measles is a highly contagious disease which was responsible for high infant mortality before the advent of effective vaccine in 1963. In immuno-competent individual, measles virus infection triggers an effective immunoresponse that start with innate response and than leads to successful adaptive immunity, including cell mediated immunity and humoral immunity. The virus is cleared and life long protection is acquired. However, changing epidemiology of measles due to vaccination as well as severe immunodeficiency has created new pockets of individuals venerable to measles2 . In this study we tried to evaluate the effect of oral Ribavirin in the hospital stay of immuno- competent measles with or without complication.

MATERIALS AND METHOD
This study was conducted at Infectious Disease and Beliaghata General Hospital (ID and BGH) where measles cases are referred from different parts of West Bengal and different North Eastern States of India. We retrospectively examined the BHT of 100 randomly selected measles cases. one group was treated with Ribavirin along with antibiotic and other supportive measures and another group was treated with antibiotic and supportive measures only. We tried to evaluate the effect of Ribavirin on the hospital stay of Measles patients with or without complication. Case definition of measles - cases with 2-4 days of respiratory prodrome like malaise, cough, coryza, conjunctivitis with lacrymation and fever followed by appearance of erythematius, nonpruritic ,maculopapular rash which begins behind the hairline and spreads down the trunk ,limbs ,including palm and sole. Ribavirin was administered in a dose of 10 mg/kg/day for 5 days. Discharge criteria- when the patients became afebrile and became asymptomatic. Presenting symptom: Many of the cases had multiple symptoms at a time. Vomiting was a presenting symptom especially among infants. Clinical case definition for pneumonia was tachypnea with or without sub-costal suction with or without cyanosis or stupor. Suspected cases were confirmed radiologically.

RESULTS
Total 100 cases were examined retrospectively. Among them the minimum age was 6 month and maximum age was 62 years. Among the 100 cases, 62 were male, 38 were female, 68 were hindu, 32 were muslim. Incidence of complication: Among the 100 cases retrospectively examined 93 cases were having different complications and only 7 cases had no complications. Some of the cases had multiple complications present simultaneously. Effect of Ribavirin in hospital stay: Among the 100 cases 54 (Male – 38, Female -16) were treated with Ribavirin and their mean hospital stay was 4.018 ± 1 .92 days. 46 cases (M – 24, Female – 22) were treated without Ribavirin and there mean hospital stay was 6.934±2 days and there was an absolute reduction in hospital stay among Ribavirin group but it was not statistically significant (p= 0.4)

Effect of Ribavirin in hospital stay of measles with pneumonia : Among 32 pneumonia cases (M – 22, F-10) 22 were (M – 18, F – 4) treated with Ribavirin along with other supportive measures along with antibiotic and 10 (M – 4, F – 6) were not given Ribavirin and they were treated only with supportive measures and antibiotic. Mean hospital stay of pneumonia patients (n = 32) treated with or without Ribavirin was 5.34± 1.50 days. Whereas those treated with Ribavirin (n = 22) the hospital stay was 3.909 ±1.02 days and those treated without Ribavirin (n = 10), mean hospital stay was 8.5± 2.5 days. The reduction in hospital stay was statistically significant ( p= 0.02). Effect of Ribavirin is hospital stay of measles with encephalitis: Total case of measles with encephalitis was 18 among them 12 (M = 8, F = 4) were treated with Ribavirin and 6 (M = 4, F = 2) were treated without Ribavirin. Mean hospital stay in all cases (n = 18) was 6.65± 1.90 days whereas those treated with Ribavirin (n=12) it was 5± 1.15 days, and those without Ribavirin it was 8.16± 2.07 days. This reduction in hospital stay was not statistically significant (p=0.35) Effect of Ribavirin on out come of measles cases Case fatality rate(CFR) in the group treated with ribavirin was 0% but CFR in the group treated without ribavirin was 4.34 %. Though sample size was small it was a significant finding.

DISCUSSION
Measles with its complication can sometimes prove fatal. There is very few available specific therapy for measles pneumonia or encephalitis other than supportive care3 . Oguz Uzen et al. reported a case in Turkish Respiratory Journal in 2002 a case of severe measles pneumonia which is a rare condition in an immuno-competent adult. They reported a case, of 20 year old man. Diagnosis was based on clinical, radiologic and serological findings. Corticosteroid, Vit. A, Ribavirin where used in previous cases. But supportive care in this case completely improve the condition. S Gururangan et al from Dept. of Pediatric Oncology, Royal Manchester Children’s Hospital, Manchester, UK4 reported a case of 9 year old boy with Hodgkin’s lymphoma developed measles 1 month after completing 8 cycles of intensive anti cancer chemotherapy. 7 days of nebulized Ribavirin and intravenous Ribavirin therapy produced apparent recovery. 2 weeks later child presented with measles giant cell pneu-monia diagnosed on open lung biopsy. Ribavirin therapy was once again successful. Mustafa MM et al5 reported 2 young patients with sub-acute measles encephalitis in 20 year old male and 9 year old girl with acute leukemia. Histologic examination of brain tissue proved useful in establishing the diagnosis. They concluded therapy with iv Ribavirin is effective when administered early. In our study Ribavirin was administered orally but it has shown statistically significant reduction in hospital stay even in complicated cases of measles. And there was a favorable outcome pattern in patients who were treated with Ribavirin.

CONCLUSION
Incidence of measles has significantly reduced following introduction of measles vaccination. But it is still responsible for significant morbidity and mortality. In these days of increasing health care expenditure reduction in hospital stay even in complicated cases along with favorable outcome pattern in cases treated with Ribavirin is an encouraging finding, keeping in mind that his complication has no specific therapy other than supportive care which can alter the course of the disease. Further studies with large sample size and ramdomized controlled trials are required to evaluate the effectiveness of Ribavirin in measles along with other RNA viruses.

References:

1. Ribavirin : A Clinical Overview. H Fernandez et al., Dept of Drug Development – University of California at Los Angeles California 90024

2. D Nadlle et al. Barcelona center for International Health Research

3. Severe measles pneumonia in a immuno competent adult. Oguz Uzen et al. Turkish Respiratory Journal 2002; 3(1): 32-34

4. Ribvirin response in measles pneumonia. S Gururangan et al. Dept of Pediatric Oncology, Royal Manchester Children Hospital, Manchester UK, 1989

5. Clinical infectious disease 1993 16(5): 654-60. Mustafa MM et al. Sub-acute measles encephalitis in the young immuno compromised host, Reports of 2 cases diagnosed by PCR and treated with Ribavirin.


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A study by Dorothy Ebere Adimora et al. entitled \"Remediation for Effects of Domestic Violence on Psychological well-being, Depression and Suicide among Women During COVID-19 Pandemic: A Cross-cultural Study of Nigeria and Spain\" is awarded Best Article of Vol 14 issue 23
A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
A study by Saurabh Suvidha entitled \"A Case of Mucoid Degeneration of Uterine Fibroid with Hydrosalphinx and Ovarian Cyst\" is awarded Best article of Vol 14 issue 21
A study by Alice Alice entitled \"Strengthening of Human Milk Banking across South Asian Countries: A Next Step Forward\" is awarded Best article of Vol 14 issue 20
A study by Sathyanarayanan AR et al. entitled \"The on-task Attention of Individuals with Autism Spectrum Disorder-An Eye Tracker Study Using Auticare\" is awarded Best article of Vol 14 issue 19
A study by Gupta P. et al. entitled \"A Short Review on \"A Novel Approach in Fast Dissolving Film & their Evaluation Studies\" is awarded Best Article of Vol 14 issue 18.
A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
A study by Ali Nawaz et al. entitled \"A Comparative Study of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) \? A Randomized Controlled Study\" is awarded Best Article for Vol 14 issue 16.
A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12
A Study by Vidya S. Bhat et al. entitled "Effect of an Indigenous Cleanser on the Microbial Biofilm on Acrylic Denture Base - A Pilot Study" is awarded Best Article for Vol 14 issue 11
A Study by Pandya S. et al. entitled "Acute and 28-Day Repeated Dose Subacute Toxicological Evaluation of Coroprotect Tablet in Rodents" is awarded Best Article for Vol 14 issue 10
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A Study by Vinita S & Ayushi S entitled "Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding" is awarded Best Article for Vol 14 issue 08
A Study by Prabhu A et al. entitled "Awareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study" is awarded Best Article for Vol 14 issue 07
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A Study by Mbungu Mulaila AP et al. entitled "Ovarian Pregnancy in Kindu City, D.R. Congo - A Case Report" is awarded Best Article for Vol 14 issue 03
A Study by Maryam MJ et al. entitled "Evaluation Serum Chemerin and Visfatin Levels with Rheumatoid Arthritis: Possible Diagnostic Biomarkers" is awarded Best Article for Vol 14 issue 02
A Study by Shanthan KR et al. entitled "Comparison of Ultrasound Guided Versus Nerve Stimulator Guided Technique of Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries" is awarded Best Article for Vol 14 issue 01
A Study by Amol Sanap et al. entitled "The Outcome of Coxofemoral Bypass Using Cemented Bipolar Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fracture of Femur in a Rural Setup" is awarded Best Article Award of Vol 13 issue 24
A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
A Study by Karimova II et al. entitled "Changes in the Activity of Intestinal Carbohydrases in Alloxan-Induced Diabetic Rats and Their Correction with Prenalon" is awarded Best Article of Vol 13 issue 22
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A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
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A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
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A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
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A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
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A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
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A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
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A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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