Lassa fever (patient information)

Lassa fever
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Lassa fever?
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
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Directions to Hospitals Treating Lassa fever
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

Lassa fever is an acute viral illness that occurs in West Africa. The cause of the illness was found to be Lassa virus, named after the town in Nigeria where the first cases originated. The virus, a member of the virus family Arenaviridae and the reservoir, or host, of Lassa virus is a rodent known as the "multimammate rat" of the genus Mastomys. It is transmitted through direct contact with these materials, through touching objects or eating food contaminated. It can present as fever, chest pain, sore throat, back pain, cough, abdominal pain, vomiting, diarrhea, facial swelling and bleeding and 15%-20% of patients hospitalized for Lassa fever die from the illness.

What are the symptoms of Lassa fever?

• Mild symptoms include slight fever, general malaise and weakness, and headache. In 20% of infected individuals, however, disease may progress to more serious symptoms including hemorrhaging (in gums, eyes, or nose, as examples), respiratory distress, repeated vomiting, facial swelling, pain in the chest, back, and abdomen, and shock. Neurological problems have also been described, including hearing loss, tremors, and encephalitis. Death may occur within two weeks after symptom onset due to multi-organ failure.

What causes Lassa fever?

• Lassa fever is caused by the Lassa virus, a member of the Arenaviridae family. The reservoir, or host, of Lassa virus is a rodent known as the "multimammate rat" (Mastomys natalensis). Once infected, this rodent is able to excrete virus in urine for an extended time period, maybe for the rest of its life. Transmission of the virus occurs through ingestion of contaminated food, open cut wounds, aerosol inhalation and direct contact with rodents. Mastomys rodents are sometimes consumed as a food source and infection may occur when rodents are caught and prepared. Casual contact (including skin to-skin contact without exchange of body fluids) does not spread Lassa virus. Person-to-person transmission is common in health care settings (called nosocomial transmission) where proper personal protective equipment (PPE) is not available or not used. Lassa virus may be spread in contaminated medical equipment, such as reused needles.

Who is at highest risk?

• Individuals at greatest risk of Lassa virus infection are those who live in or visit endemic regions, including Sierra Leone, Liberia, Guinea, and Nigeria and have exposure to the multimammate rat. Risk of exposure may also exist in other west African countries where Mastomys rodents exist. Hospital staff are not at great risk for infection as long as protective measures and proper sterilization methods are used.

Diagnosis

• Lassa fever is most often diagnosed by using enzyme-linked immunosorbent serologic assays (ELISA), which detect IgM and IgG antibodies as well as Lassa antigen. Reverse transcription-polymerase chain reaction (RT-PCR) can be used in the early stage of disease. The virus itself may be cultured in 7 to 10 days, but this procedure should only be done in a high containment laboratory with good laboratory practices. Immunohistochemistry, performed on formalin-fixed tissue specimens, can be used to make a postmortem diagnosis.

When to seek urgent medical care?

• If you or your family members become ill with fever or develop other symptoms such as chills, muscle aches, nausea, vomiting, or rashes, visit a health-care provider immediately. The nearest U.S. Embassy or Consular Office can help you find a health-care provider in the area. You are encouraged to identify these resources in advance. When traveling to a health-care provider, limit your contact with others. All other travel should be avoided.

Treatment options

• Ribavirin, an antiviral drug, has been used with success in Lassa fever patients. It has been shown to be most effective when given early in the course of the illness. Patients should also receive supportive care consisting of maintenance of appropriate fluid and electrolyte balance, oxygenation and blood pressure, as well as treatment of any other complicating infections.

Where to find medical care for Lassa fever?

• Directions to Hospitals Treating Lassa fever

Prevention

• Primary transmission of the Lassa virus from its host to humans can be prevented by avoiding contact with Mastomys rodents, especially in the geographic regions where outbreaks occur.
• Putting food away in rodent-proof containers and keeping the home clean help to discourage rodents from entering homes. Using these rodents as a food source is not recommended.
• Trapping in and around homes can help reduce rodent populations; however, the wide distribution of Mastomys in Africa makes complete control of this rodent reservoir impractical.
• When caring for patients with Lassa fever, further transmission of the disease through person-to-person contact or nosocomial routes can be avoided by taking preventive precautions against contact with patient secretions (called VHF isolation precautions or barrier nursing methods). Such precautions include wearing protective clothing, such as masks, gloves, gowns, and goggles; using infection control measures, such as complete equipment sterilization; and isolating infected patients from contact with unprotected persons until the disease has run its course.
• Further, educating people in high-risk areas about ways to decrease rodent populations in their homes will aid in the control and prevention of Lassa fever. Other challenges include developing more rapid diagnostic tests and increasing the availability of the only known drug treatment, ribavirin. Research is presently under way to develop a vaccine for Lassa fever.

What to expect (Outlook/Prognosis)?

• Approximately 15%-20% of patients hospitalized for Lassa fever die from the illness. However, only 1% of all Lassa virus infections result in death. The death rates for women in the third trimester of pregnancy are particularly high. Spontaneous abortion is a serious complication of infection with an estimated 95% mortality in fetuses of infected pregnant mothers. Because the symptoms of Lassa fever are so varied and nonspecific, clinical diagnosis is often difficult. Lassa fever is also associated with occasional epidemics, during which the case-fatality rate can reach 50% in hospitalized patients. Some survivors experience lasting effects of the disease.

Possible complications

• The most common complication of Lassa fever is deafness. Various degrees of deafness occur in approximately one-third of infections, and in many cases hearing loss is permanent. As far as is known, severity of the disease does not affect this complication: deafness may develop in mild as well as in severe cases.
• Approximately 15%-20% of patients hospitalized for Lassa fever die from the illness. However, only 1% of all Lassa virus infections result in death.
• The death rates for women in the third trimester of pregnancy are particularly high. Spontaneous abortion is a serious complication of infection with an estimated 95% mortality in fetuses of infected pregnant mothers. Because the symptoms of Lassa fever are so varied and nonspecific, clinical diagnosis is often difficult. Lassa fever is also associated with occasional epidemics, during which the case-fatality rate can reach 50% in hospitalized patients.

Sources

http://www.cdc.gov/vhf/lassa/pdf/factsheet.pdf Template:WH Template:WS