Virus

Lassa Fever

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Lassa Fever

  • See Also
  • Pathophysiology
  1. Lassa virus is an arenavirus that is classified as a hemorrhagic fever
  2. First recognized Outbreak: Lassa, Nigeria (1969)
  3. Endemic to West Africa
    1. Nigeria
    2. Liberia
    3. Sierra Leone
    4. Senegal
    5. Gambia
    6. Guinea
    7. Ghana
    8. Burkina Faso (Upper Volta)
    9. Mali
    10. Ivory Coast
  4. Transmission
    1. Multimammate Rats (Mastomys natalensis) are reservoir
      1. Contamination of food with rodent urine
    2. Person to person blood or body fluid contact
      1. Urine
      2. Feces
      3. Vomit
      4. Saliva
  5. Incubation: 1-24 days
  • Symptoms
  1. Early, Insidious symptoms
    1. Fever (100%)
    2. Chills
    3. Rigors
    4. Headache (50%)
    5. Malaise (100%)
    6. Myalgia (50%)
  2. Second week symptoms
    1. Lower Abdominal Pain
    2. Intractable Vomiting
  3. Other symptoms
    1. Tinnitus
    2. Epistaxis
    3. Bleeding Gums
    4. Maculopapular rash
    5. Cough
    6. Dizziness
  • Signs
  1. Early
    1. Fever
    2. Flushing of face and V-neck area
    3. Pharyngitis (progressive over first week)
      1. Raised patch of whitish exudate on Tonsillar Pillar
      2. Pseudomembranes may develop
      3. Oral Ulcerations (50%)
    4. Generalized non-tender Lymphadenopathy (50%)
  2. Later
    1. Facial and neck swelling
    2. Conjunctivitis
  3. Severe, Acute Phase
    1. Systolic Blood Pressure below 90 (60-80%)
    2. Pulse Pressure less than 20
    3. Relative Bradycardia
  • Labs
  1. Complete Blood Count
    1. Hematocrit normal
    2. White Blood Cell Count low (Leukopenia)
      1. Relative Neutrophilia
  2. Erythrocyte Sedimentation Rate normal
  3. Liver Function Tests
    1. Aspartate Aminotransferase (AST, SGOT) elevated
    2. Creatinine phosphokinase (CPK) elevated
    3. Lactate Dehydrogenase (LDH) elevated
  4. Urinalysis
    1. Severe Proteinuria
  5. Lassa Virus Antibody titer
    1. Fourfold rise between acute and convalescent phase
  • Radiology
  1. Chest XRay
    1. Basilar pneumonitis
    2. Pleural Effusions
  • Diagnostics
  • Complications
  1. Oculogyric Crisis (rapid involuntary eye movement)
  2. Deafness
  3. Alopecia
  • Course
  1. Illness lasts 7 to 31 days (average 12-15 days)
  • Prognosis
  1. Mortality: 8 to 52%
  2. Signs suggestive of poor prognosis or death
    1. Shock
    2. Altered Level of Consciousness
    3. Auscultated Rales
    4. Pleural Effusion
    5. Grand Mal Seizures
  • Differential Diagnosis
  1. Hemorrhagic FeverViruses
  • Management
  1. Supportive care
  2. Ribavirin (appears to be highly effective)
    1. Adult
      1. Load: 2 grams
      2. First Maintenance: 1 gram every 6 hours for 4 days
      3. Next Maintenance: 0.5 grams every 8 hours for 6 days
    2. Child
      1. Initial Dose: 30 mg/kg
  3. Infusion of immune plasma from convalescent patients
  4. Isolation Procedures
    1. Respiratory isolation
    2. Blood and Body fluid precautions
  • References
  1. Seeyave (2015) Crit Dec Emerg Med 29(5): 13-21
  2. Wilson (1991) Harrison's PIM, Mcgraw Hill, pp. 740-1