Lassa fever natural history, complications and prognosis: Difference between revisions
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* 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> | * 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'''}} | ||
| align="center" style="background:#4479BA; width: 400px;"|{{fontcolor|#FFF|'''Symptoms'''}} | | align="center" style="background:#4479BA; width: 400px;" |{{fontcolor|#FFF|'''Symptoms'''}} | ||
| 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-grade [[fever]] (39-41 °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]], [[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 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 | ||
|} | |} | ||
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==Prognosis== | ==Prognosis== | ||
* Approximately 15 | * Approximately 5-15% of patients hospitalized for Lassa fever die from the [[illness]]. The following factors are associated with poorer prognosis of Lassa fever:<ref name="CDC">{{cite web | title = The Centers for Disease Control and Prevention | url =http://www.cdc.gov/NCIDOD/dvrd/spb/mnpages/lassaslides.htm }}</ref> | ||
** Infection during the t[[Third trimester of pregnancy|hird trimester of pregnancy]] or during [[infancy]] | |||
** Increased [[viremia]] concentration | |||
** Serum [[AST]] level > 150 IU/L | |||
** [[Bleeding]], [[hypotension]], and [[shock]] | |||
** Development of [[Encephalitis]], [[confusion]], or [[coma]] | |||
** [[Edema]] ([[facial edema]], [[Pleural effusion|pleural]]/[[pericardial effusion]], [[ascites]] | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 19:33, 9 June 2015
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Lassa fever Microchapters |
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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]
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 3 to 21 days following exposure.[1]
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 persistent 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 and hemorrhage, 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[2])
| 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 |
Complications
Complications of Lassa fever include the following:
- Sensorineural Deafness
- The most common complication of Lassa fever is deafness (1/3 of patients)
- Deafness may be either temporary or permanent and may either by unilateral or bilateral.
- Deafness does not seem to be associated with the severity of disease and may develop equally among patients with mild or severe infections.
- Spontaneous abortion among pregnant women
- Hepatitis and hepatic necrosis
- Splenic necrosis
- Adrenocortical necrosis
- Pulmonary alveolar edema
- Interstitial pneumonitis
- Lymph node histiocytosis
- Mucosal (e.g. GI) bleeding
- Renal tubular injury and interstitial nephritis
- Swollen baby syndrome (edema and bleeding among fetuses)
Prognosis
- Approximately 5-15% of patients hospitalized for Lassa fever die from the illness. The following factors are associated with poorer prognosis of Lassa fever:[3]
- Infection during the third trimester of pregnancy or during infancy
- Increased viremia concentration
- Serum AST level > 150 IU/L
- Bleeding, hypotension, and shock
- Development of Encephalitis, confusion, or coma
- Edema (facial edema, pleural/pericardial effusion, ascites
References
- ↑ Günther S, Lenz O (2004). "Lassa virus". Crit Rev Clin Lab Sci. 41 (4): 339–90. doi:10.1080/10408360490497456. PMID 15487592.
- ↑ McCarthy M (2002). "USA moves quickly to push biodefence research". Lancet. 360 (9335): 732. doi:10.1016/S0140-6736(02)09938-5. PMID 12296302.
- ↑ "The Centers for Disease Control and Prevention".