Venezuelan hemorrhagic fever (VHF) is a zoonotic human illness first identified in 1989. The disease is most prevalent in several rural areas of central Venezuela and is caused by Guanarito mammarenavirus (GTOV) which belongs to the Arenaviridae family. The short-tailed cane mouse (Zygodontomys brevicauda) is the main host for GTOV  which is spread mostly by inhalation of aerosolized droplets of saliva, respiratory secretions, urine, or blood from infected rodents. Person-to-person spread is possible, but uncommon. Presentation
VHF has many similarities to Lassa fever and to the arenavirus hemorrhagic fevers that occur in Argentina and Bolivia. It causes fever and malaise followed by hemorrhagic manifestations and convulsions. Some presentations of the virus are also characterized by vascular damage, bleeding diathesis, fever, and multiple organ involvement. Clinical diagnosis of VHF has proven to be difficult based on the nonspecific symptoms. The disease is fatal in 30% of cases and is endemic to Portuguesa state and Barinas state in Venezuela. Treatment and prevention for the VHF virus are limited and there are currently no licensed vaccines available that can act to prevent the disease. However, once infected, ribavirin, an anti-viral drug given intravenously, is one way to treat VHF. Virus
Arenaviruses are enveloped, single-stranded, bisegmented RNA viruses with antisense genomes. Based on their antigenic properties, arenaviruses have been classified into two major groups: the Old World arenaviruses, and the New World arenaviruses. Old World arenaviruses include lymphocytic choriomeningitis virus and Lassa virus.
After Pfizers sale of the UK marketing licence to Flynn Pharma, the price of a 28-pack of 25 mg phenytoin sodium capsules marked Epanutin rose from 66p (about $0.88) to £15.74 (about $25.06). Capsules of other strengths also went up in price by the same factor—2,384%, costing the UKs National Health Service an extra £43 million (about $68.44 million) a year. The companies were referred to the Competition and Markets Authority (CMA) who found that they had exploited their dominant position in the market to charge "excessive and unfair" prices.The CMA imposed a record £84.2 million fine on the manufacturer Pfizer, and a £5.2 million fine on the distributor Flynn Pharma and ordered the companies to reduce their prices. Trade names
Phenytoin is marketed under many brand names worldwide. Research
Tentative evidence suggests that topical phenytoin is useful in wound healing in people with chronic skin wounds. A meta-analysis also supported the use of phenytoin in managing various ulcers.Some clinical trials have explored whether phenytoin can be used as neuroprotector in multiple sclerosis. References
Further reading
Dean L (2016). "Phenytoin Therapy and HLA-B*15:02 and CYP2C9 Genotypes". In Pratt VM, McLeod HL, Rubinstein WS,  et al. (eds.). Medical Genetics Summaries. National Center for Biotechnology Information (NCBI). PMID 28520374. Bookshelf ID: NBK385287. External links
"Phenytoin". Drug Information Portal. U.S. National Library of Medicine. English translation of 1908 German article on phenytoin synthesis by Heinrich Biltz