Lassa fever overview: Difference between revisions
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==Other Diagnostic Studies== | ==Other Diagnostic Studies== | ||
Other laboratory tests to confirm the diagnosis of lassa fever includes [[enzyme-linked immunosorbent serologic assays]] ([[ELISA]]), [[reverse transcription]]-[[polymerase chain reaction]] ([[RT-PCR]]) and [[Immunohistochemistry]] of [[skin]], [[tissue]] and [[liver]] cells. [[ELISA test]] for [[antigen]] and [[IgM]] [[antibodies]] gives 88% [[sensitivity]] and 90% [[specificity]] for the presence of the infection. Lassa fever can also be found in [[cerebrospinal fluid]] | Other laboratory tests to confirm the diagnosis of lassa fever includes [[enzyme-linked immunosorbent serologic assays]] ([[ELISA]]), [[reverse transcription]]-[[polymerase chain reaction]] ([[RT-PCR]]) and [[Immunohistochemistry]] of [[skin]], [[tissue]] and [[liver]] cells. [[ELISA test]] for [[antigen]] and [[IgM]] [[antibodies]] gives 88% [[sensitivity]] and 90% [[specificity]] for the presence of the infection. Lassa fever can also be found in [[cerebrospinal fluid]]. [[Immunohistochemistry]] performed on tissue specimens can be used to make a [[post mortem]] diagnosis. The virus can also be detected by [[reverse transcriptase polymerase chain reaction]] ([[RT-PCR]]); however, this method is primarily a research tool.<ref>Lassa Fever Encephalopathy: Lassa Virus in Cerebrospinal Fluid but Not in Serum | ||
Stephan Günther, Boye Weisner, Andreas Roth, Thomas Grewing, Marcel Asper, Christian Drosten, Petra Emmerich, Jochen Petersen, Martin Wilczek and Herbert Schmitz | Stephan Günther, Boye Weisner, Andreas Roth, Thomas Grewing, Marcel Asper, Christian Drosten, Petra Emmerich, Jochen Petersen, Martin Wilczek and Herbert Schmitz | ||
The Journal of Infectious Diseases , Vol. 184, No. 3 (Aug. 1, 2001), pp. 345-349</ref> | The Journal of Infectious Diseases , Vol. 184, No. 3 (Aug. 1, 2001), pp. 345-349</ref> | ||
Revision as of 02:12, 9 June 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Ammu Susheela, M.D. [2]
Overview
Lassa fever is an acute viral hemorrhagic fever first described in 1969 in the town of Lassa, Nigeria.[1] The virus, a member of the virus family Arenaviridae, is a single-stranded RNA virus and is zoonotic, or animal-borne. Clinical cases of the disease had been known for over a decade earlier but not connected with this viral pathogen. The infection is endemic in West African countries, and causes 300-500,000 cases annually with ~5,000 deaths.[2] Outbreaks of the disease have been observed in Nigeria, Liberia, Sierra Leone, Guinea, and the, Central African Republic. It is believed that human infections also exist in Democratic Republic of the Congo, Mali, and Senegal. Lassa fever is also the most common hemorrhagic fever that is exported beyond its endemic area to countries like the United States, the United Kingdom of Great Britain and Northern Ireland, the Netherlands, Japan, and Israel. While Lassa fever is mild or has no observable symptoms in about 80% of people infected with the virus, the remaining 20% have a severe multisystem disease. Lassa fever is also associated with occasional epidemics, during which the case fatality rate can reach 50%.
Historical Perspective
Lassa fever caused by Arenaviridae is an acute viral illness that has been reported at first in West Africa. Although there has been sero-epidemeological evidence of Lassa fever in 1930's-1950's, the first case was reported in 1969 from Nigeria.
Pathophysiology
Lassa fever is a zoonotic disease caused by Lassa virus and spread by multimammate rat vector. It is spread through person-to-person contact and direct contact with rodent excretion. Lassa virus enters the cell by the receptor-mediated endocytosis and undergoes very rapid replication and manifest the disease. After an incubation period of 1-24 days, the disease can manifest as fever, muscle aches, sore throat, nausea, vomiting, chest and abdominal pain, weakness, cough, headache, exudative pharyngitis, anemia, low blood pressure, and diarrhea.
Causes
Lassa fever is caused by the Lassa virus, a member of the Arenaviridae family. It is an enveloped, single-stranded, bisegmented RNA virus. Mastomysrodents shed the virus in urine and droppings. The direct contact with these materials or ingestion or inhalation, can lead to infection.
Differentiating Lassa fever from other Diseases
Clinically, Lassa fever infections are difficult to distinguish from other viral hemorrhagic fevers such as Ebola and Marburg, and from more common febrile illnesses such as malaria.
Epidemiology and Demographics
Lassa fever is endemic in parts of west Africa including Sierra Leone, Liberia, Guinea and Nigeria; however, other neighboring countries are also at risk, as the animal vector for Lassa virus, the "multimammate rat" (Mastomys natalensis) is distributed throughout the region. Lassa fever causes 100,000-300,000 infections and approximately 5,000 deaths annually.[3]
Risk Factors
Individuals at risk are those who live or visit areas with a high population of Mastomys rodents infected with Lassa virus or are exposed to infected humans. Hospital staff are not at great risk for infection as long as protective measures are taken.
Natural History, Complications and Prognosis
The most common complication of Lassa fever is deafness. Various degrees of deafness occur in approximately one-third of cases, and in many cases hearing loss is permanent. Spontaneous abortion is another serious complication. Approximately 15%-20% of patients hospitalized for Lassa fever die from the illness. However, overall only about 1% of infections with Lassa virus result in death. The death rates are particularly high for women (greater than 80%) in the third trimester of pregnancy, and for fetuses, about 95% of which die in the uterus of infected pregnant mothers.
Diagnosis
History and Symptoms
Lassa fever after an incubation period of six to twenty-one days, manifest as an acute illness with multiorgan involvement and patients present with gastrointestinal, neurological and pulmonary symptoms.
Physical Examination
Lassa fever is commonly associated with fever on physical examination at admission. At advanced stages of the disease, physical examination findings are more pertinent and often include unstable vital signs, such as tachycardia or relative bradycardia, hypotension, and tachypnea. Physical examination may also be remarkable for abdominal tenderness, abdominal distension and neurological impairment.
Laboratory Findings
There is a range of laboratory investigations that are performed to diagnose the disease and assess its course and complications. In West Africa, where Lassa is most prevalent, it is difficult for doctors to diagnose due to the absence of proper equipment to perform tests.[4] Research has been done in the last few years, by a team of specialists, in order to diagnose the Lassa fever on a molecular level.[5]
Other Diagnostic Studies
Other laboratory tests to confirm the diagnosis of lassa fever includes enzyme-linked immunosorbent serologic assays (ELISA), reverse transcription-polymerase chain reaction (RT-PCR) and Immunohistochemistry of skin, tissue and liver cells. ELISA test for antigen and IgM antibodies gives 88% sensitivity and 90% specificity for the presence of the infection. Lassa fever can also be found in cerebrospinal fluid. Immunohistochemistry performed on tissue specimens can be used to make a post mortem diagnosis. The virus can also be detected by reverse transcriptase polymerase chain reaction (RT-PCR); however, this method is primarily a research tool.[6]
Treatment
Medical Therapy
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.
Primary 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. 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 and educating people comes under primary prevention.
Cost-Efectiveness of Therapy
Adequate preventive measures must be implemented to curtail the spread of Lassa fever. If timely and adequate cost effective therapy was implemented 5 decades ago in Lassa, would have prevented devastating consequences of the disease pervading now.
Future or Investigational Therapies
Extensive studies are being conducted to find new and improved mode of treatment for Lassa virus which include vaccines, medicine and other novel approaches including vaccine development. An antiviral drug that has been shown to be more effective than ribavirin in treating experimentally infected guinea pigs is under investigation.
References
- ↑ Frame JD, Baldwin JM, Gocke DJ, Troup JM (1970). "Lassa fever, a new virus disease of man from West Africa. I. Clinical description and pathological findings". Am. J. Trop. Med. Hyg. 19 (4): 670–6. PMID 4246571.
- ↑ Ogbu O, Ajuluchukwu E, Uneke CJ (2007). "Lassa fever in West African sub-region: an overview". Journal of vector borne diseases. 44 (1): 1–11. PMID 17378212.
- ↑ "The Centers for Disease Control and Prevention facts sheets" (PDF).
- ↑ Mojeed, Momoh (14 Nov. 2012.). "Molecular Diagnostics For Lassa Fever At Irrua Specialist Teaching Hospital, Nigeria: Lessons Learnt From Two Years Of Laboratory Operation". Plos Neglected Tropical Diseases. Check date values in:
|date=(help);|access-date=requires|url=(help) - ↑ Ehichioya, Deborah U.; Asogun, Danny A.; Ehimuan, Jacqueline; Okokhere, Peter O.; Pahlmann, Meike; Ölschläger, Stephan; Becker-Ziaja, Beate; Günther, Stephan; Omilabu, Sunday A. Tropical Medicine & International Health. Aug2012, Vol. 17 Issue 8, p1001-1004. 4p. DOI: 10.1111/j.1365-3156.2012.03010.x.
- ↑ Lassa Fever Encephalopathy: Lassa Virus in Cerebrospinal Fluid but Not in Serum Stephan Günther, Boye Weisner, Andreas Roth, Thomas Grewing, Marcel Asper, Christian Drosten, Petra Emmerich, Jochen Petersen, Martin Wilczek and Herbert Schmitz The Journal of Infectious Diseases , Vol. 184, No. 3 (Aug. 1, 2001), pp. 345-349