Lassa fever diagnosis and management

Lassa fever diagnosis and management

Lassa fever diagnosis and management

This acute febrile illness was first described in patients whocame from the village of Lassa in eastern Nigeria near theborder with Cameroon. It is an arenavirus (RNA) infectioncharacterized by high sustained fever, ulcerativepharyngitis and swelling of the neck in typical cases.

Transmission and epidemiology Mastomys nataliensis, the multimammate rat, is the reservoirof infection and persistently excretes virus in its urine,which contaminates food eaten by humans. Person-topersonspread occurs through contact with body fluids.Infection can occur through cuts and needle-stick injury, orcontact of body fluids with mucosal surfaces. In endemicareas, which include Nigeria, Sierra Leone, Liberia andother west African countries, there is a range in severityof disease with appreciable numbers of mild infections;severe infection occurs in 5-10% of cases with a hospitalmortality of 15%. Children develop less severe diseasethan adults.

Clinical features After an incubation period of up to 17 days there is agradual onset of fever with anorexia, lethargy andheadache. In the second week of illness ulcerative pharyngitisand swelling of the neck and face may occur. Vomiting,diarrhoea, cough and abdominal and chest pain alsooccur. A maculopapular rash may appear on the face, trunkand upper limbs in the second week. Bleeding occurs in thethird week and affects gums, nasal mucosae, gut and othersites. Fatal cases show declining renal function and oliguria,declining conscious level and secondary bacterial infections.Leukopenia, low albumin, raised urea and elevatedtransaminases with normal platelet counts are also evident.Neutrophil leukocytosis can be a feature later in thecourse. Platelet function is abnormal. An aspartatetransaminase of greater than twice normal is associatedwith rising mortality.

Diagnosis This may have to depend on clinical features in endemicareas, but virus can be identified in body fluids by electronmicroscopy, in cell culture and by PCR. Serological testingis also used.

Management Supportive measures are used, with maintenance of fluidbalance, analgesia and antipyretics, avoiding aspirinbecause of impaired platelet function. Ribavirin givenintravenously reduces mortality if given in the first weekof the illness: 30mg/kg as a loading dose, followed by15mg/kg 6-hourly for 4 days, then 7.5mg/kg 8-hourly for afurther 6 days. Close contacts should be treated immediatelythey develop a fever. Diagnosed cases in Europe andNorth America are managed in secure isolation facilitiesto give maximum protection to staff caring for the patient,but in endemic areas standard barrier nursing precautionsare adequate. Oral ribavirin treatment may be given tostaff and others exposed to the virus by needle-stick orother injury.Marburg and

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