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===Development of Clinical Manifestations===
===Development of Clinical Manifestations===
*The majority of patients experience no or mild symptoms. Only a minority (approximately 15-20%) of patients experience multiorgan dysfunction, and typically 5-15% of infected patients die of Lassa fever.
*The majority of patients experience no or mild symptoms. Only a minority (approximately 15-20%) of patients experience multiorgan dysfunction, and typically 5-15% of infected patients die of Lassa fever.
*Patients typically first develop [[fever]] and other non-specific symptoms of viral illnesses, such as [[muscle aches]], [[conjunctival injection]], [[headache]], [[sore throat]], [[nausea]], and [[vomiting]].
*Patients typically first develop high-grade [[fever]] (39 °C to 41 °C) and other non-specific symptoms, such as [[muscle aches]], [[conjunctival injection]], [[headache]], [[sore throat]], [[nausea]], and [[vomiting]].
[[abdominal pain]], [[weakness]], [[cough]], [[headache]], [[exudative pharyngitis]], [[anemia]], low [[blood pressure]], and [[diarrhea]]. Because its symptoms are similar to other febrile illness found in Africa, Lassa virus is hard to diagnose.
*If left untreated, the majority of patients self-resolve without any intervention.
*If left untreated, the majority of patients self-resolve without any intervention.
*In a minority of cases, patients may develop worsening abdominal/chest pain, temporary/permanent deafness, facial edema, mucosal bleeding, pulmonary edema, pleural/pericardial effusions or ascites, multi-organ failure, and shock.
*In a minority of cases, patients may develop worsening abdominal/chest pain, temporary/permanent deafness, facial edema, mucosal bleeding, pulmonary edema, pleural/pericardial effusions or ascites, multi-organ failure, and shock.
*Prolonged and worsening symptoms are usually associated with worsening prognosis, typically resulting in convulsions, encephalitis, seizures, coma and finally death.  
*Prolonged and worsening symptoms are usually associated with worsening prognosis, typically resulting in convulsions, encephalitis, seizures, coma and finally death.  
 
<br>
* Clinical stages of Lassa fever <SMALL>(adapted from McCarthy)<ref name="pmid12296302">{{cite journal| author=McCarthy M| title=USA moves quickly to push biodefence research. | journal=Lancet | year= 2002 | volume= 360 | issue= 9335 | pages= 732 | pmid=12296302 | doi=10.1016/S0140-6736(02)09938-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12296302  }} </ref></SMALL>
* The following table demonstrates the 4 clinical stages of Lassa fever <SMALL>(adapted from McCarthy et al. 2002<ref name="pmid12296302">{{cite journal| author=McCarthy M| title=USA moves quickly to push biodefence research. | journal=Lancet | year= 2002 | volume= 360 | issue= 9335 | pages= 732 | pmid=12296302 | doi=10.1016/S0140-6736(02)09938-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12296302  }} </ref>)</SMALL>
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
| align="center" style="background:#4479BA; width: 50px;"|{{fontcolor|#FFF|'''Stage'''}}
| align="center" style="background:#4479BA; width: 50px;"|{{fontcolor|#FFF|'''Stage'''}}
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| align="center" style="background:#4479BA; width: 80px;"|{{fontcolor|#FFF|'''Days'''}}
| align="center" style="background:#4479BA; width: 80px;"|{{fontcolor|#FFF|'''Days'''}}
|-
|-
| style="padding: 5px 5px; background: #EBEBEB;"| Stage 1||style="padding: 5px 5px; background: #EBEBEB;"|High [[fever]] of 39°C with peaks of 40°C-41°C, [[malaise]], [[weakness]] ||style="padding: 5px 5px; background: #F2F2F2;"|Day1 -day 3
| style="padding: 5px 5px; background: #EBEBEB;"| Stage 1||style="padding: 5px 5px; background: #EBEBEB;"|High-grade [[fever]] (39-41 °C), [[malaise]], [[weakness]] ||style="padding: 5px 5px; background: #F2F2F2;"|Day1 -day 3
|-
|-
| style="padding: 5px 5px; background: #EBEBEB;"| Stage 2||style="padding: 5px 5px; background: #EBEBEB;"|[[Headache]], [[backache]], [[chest pain]], exudative [[sore throat]] with white [[patches]], [[abdominal pain]], [[diarrhea]], [[nausea]], [[vomiting]], low [[blood pressure]], [[anemia]], [[proteinuria]], [[conjunctivitis]]||style="padding: 5px 5px; background: #F2F2F2;"|Day4 -day 7
| style="padding: 5px 5px; background: #EBEBEB;"| Stage 2||style="padding: 5px 5px; background: #EBEBEB;"|[[Headache]], [[backache]], [[chest pain]], [[sore throat]] with exudation, [[abdominal pain]], [[diarrhea]], [[nausea]], [[vomiting]], [[hypotension]], [[anemia]], [[proteinuria]], [[conjunctivitis]]||style="padding: 5px 5px; background: #F2F2F2;"|Day4 -day 7
|-
|-
| style="padding: 5px 5px; background: #EBEBEB;"| Stage 3||style="padding: 5px 5px; background: #EBEBEB;"|[[Mucosal bleeding]], internal [[bleeding]], [[facial edema]], [[confusion]], [[disorientation]] and [[convulsion]]||style="padding: 5px 5px; background: #F2F2F2;"|>7 days
| style="padding: 5px 5px; background: #EBEBEB;"| Stage 3||style="padding: 5px 5px; background: #EBEBEB;"|[[Mucosal bleeding]], internal [[bleeding]], [[facial edema]], [[confusion]], [[disorientation]] and [[convulsion]]||style="padding: 5px 5px; background: #F2F2F2;"|> 7 days
|-
|-
| style="padding: 5px 5px; background: #EBEBEB;"| Stage 4||style="padding: 5px 5px; background: #EBEBEB;"|[[Coma]], [[death]] ||style="padding: 5px 5px; background: #F2F2F2;"|>14 days
| style="padding: 5px 5px; background: #EBEBEB;"| Stage 4||style="padding: 5px 5px; background: #EBEBEB;"|[[Coma]], [[death]] ||style="padding: 5px 5px; background: #F2F2F2;"|> 14 days
|}
|}
[[File:Signs and symptoms Lassa.png|thumb|center|800 px|Clinical signs and symptoms Lassa Fever CDC<SMALL><SMALL>''[http://www.cdc.gov/NCIDOD/dvrd/spb/mnpages/lassaslides.htm]''</SMALL></SMALL>]]
[[File:Signs and symptoms Lassa.png|thumb|center|800 px|Clinical signs and symptoms Lassa Fever CDC<SMALL><SMALL>''[http://www.cdc.gov/NCIDOD/dvrd/spb/mnpages/lassaslides.htm]''</SMALL></SMALL>]]

Revision as of 19:05, 9 June 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [3]

Synonyms and keywords: Lassa hemorrhagic fever; LHF

Overview

Signs and symptoms of Lassa fever typically occur 1-3 weeks after the patient comes into contact with the virus. 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.

Natural History

Incubation Period

  • Infected patients remain asymptomatic for 1 to 3 weeks following exposure.

Development of Clinical Manifestations

  • The majority of patients experience no or mild symptoms. Only a minority (approximately 15-20%) of patients experience multiorgan dysfunction, and typically 5-15% of infected patients die of Lassa fever.
  • Patients typically first develop high-grade fever (39 °C to 41 °C) and other non-specific symptoms, such as muscle aches, conjunctival injection, headache, sore throat, nausea, and vomiting.
  • If left untreated, the majority of patients self-resolve without any intervention.
  • In a minority of cases, patients may develop worsening abdominal/chest pain, temporary/permanent deafness, facial edema, mucosal bleeding, pulmonary edema, pleural/pericardial effusions or ascites, multi-organ failure, and shock.
  • Prolonged and worsening symptoms are usually associated with worsening prognosis, typically resulting in convulsions, encephalitis, seizures, coma and finally death.


  • The following table demonstrates the 4 clinical stages of Lassa fever (adapted from McCarthy et al. 2002[1])
Stage Symptoms Days
Stage 1 High-grade fever (39-41 °C), malaise, weakness Day1 -day 3
Stage 2 Headache, backache, chest pain, sore throat with exudation, abdominal pain, diarrhea, nausea, vomiting, hypotension, anemia, proteinuria, conjunctivitis Day4 -day 7
Stage 3 Mucosal bleeding, internal bleeding, facial edema, confusion, disorientation and convulsion > 7 days
Stage 4 Coma, death > 14 days
Clinical signs and symptoms Lassa Fever CDC[1]

Complications

  • Complications of Lassa fever include the following.

Sensorineural Deafness

  • The most common complication of Lassa fever is deafness.
  • Occurs in 1/3rd of the cases.
  • 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.
  • It could be unilateral or bilateral.

Lassa Fever in Pregnancy

  • Increased mortality in 3rd trimester of more than 30% to the mother.
  • Increased viremia in pregnant woman.
  • Evacuation of the uterus improves mother's chance of survival.
  • Placental infection of the fetus.
  • Spontaneous abortion is a serious complication of infection with an estimated 95% mortality in fetuses of infected pregnant mothers.
  • Increased fetal and neonatal mortality of more than 85%.

Lassa Fever in Children

Swollen Baby Syndrome

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. Prognosis of Lassa fever is poor if its associated with following features[2].

References

  1. ↑ McCarthy M (2002). "USA moves quickly to push biodefence research". Lancet. 360 (9335): 732. doi:10.1016/S0140-6736(02)09938-5. PMID 12296302.
  2. ↑ "The Centers for Disease Control and Prevention".


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