Lassa Fever

Epidemiology
Definition Causes an acute viral hemorrhagic fever caused by the Lassa virus Lassa virus 1) A member of the Arenaviridae family 2) It is an enveloped, single-stranded, bisegmented RNA virus 3) It is zoonotic / air borne 1) Endemic in areas of West Africa, including Nigeria, Liberia, Sierra Leone, and Guinea 2) Estimated 300,000-500,000 infections/year, with 5000 deaths 3) Rodent-to-human transmission (the multimammate rat, Mastomys species-complex) 4) Secondary human-to-human transmission with the potential for nosocomial outbreaks with high case-fatality 1) All age groups 2) In both men and women 3) Those living in rural areas Mastomys are usually found Especially in areas of poor sanitation / crowded living conditions 4) Health care workers If proper barrier nursing and infection control practices are not maintained 1) Rodent to human Inhalation of aerosolized virus Ingestion of food or materials contaminated by infected rodent excreta Catching and preparing Mastomys as a food source 2) Human to human Direct contact with blood, tissues, secretions or excretions of infected humans Needle stick or cut Inhalation of aerosolized virus Multimammate rat (Mastomys species complex) 1) Taxonomy still unclear M. huberti (more common in peridomestic habitat) M. erytholeucus (more common in brush habitat) 6 21 days

Geographical Distribution

High Risk Groups

Mode of Transmission

Rodent Reservoir Incubation Period

~Firdaus Fariq Che Ahmad~

Lassa Fever
Clinical Presentations & Complications
Clinical Presentations 1) During the onset Usually gradual Starting with fever (insipidous) General weakness Malaise 2) After a few days Headache Sore throat Muscle pain Chest pain Nausea & vomiting Diarrhoea Cough & abdominal disturbances 3) Severe cases Facial swelling Fluid in the lung cavity Bleeding from mouth, nose, vagina or gastrointestinal tract Low blood pressure 4) Late Shock Seizures Tremor Disorientation Coma 5) Recovery Transient hair loss Gait disturbance Complications 6) Deafness Most common Various degrees of deafness occur in approximately one-third of cases In many cases hearing loss is permanent Severity of the disease does not affect this complication: deafness may develop in mild as well as in severe cases 2) Spontaneous abortion 3) Swollen baby syndrome 4) Shock 5) Hypotension 6) Peripheral vasoconstriction 7) Hypovolemia 8) Anuria 9) Death

~Firdaus Fariq Che Ahmad~

Lassa Fever
Laboratory Diagnosis
Main Others

1) Enzyme-linked immunosorbent serologic assays (ELISA) To detect IgM and IgG antibodies as well as Lassa antigen 2) Immunohistochemistry Performed on tissue specimens To make a post-mortem diagnosis 3) Reverse transcription-polymerase chain reaction (RTPCR) To detect the virus However, this method is primarily a research tool 4) The virus itself may be cultured in 7 to 10 days

1) Leukocyte count can be low, normal, or moderately elevated 2) Platelet counts are usually normal, but might be slightly low 3) AST (SGOT) and ALT (SGPT) are usually elevated (10x normal) 4) Chest x-rays are usually normal, but may show pleural effusions or basilar pneumonitis 5) Albuminaturia (excessive amounts of albumin proteins in the urine) is common 6) ECGs are usually abnormal

3 ways to diagnose the Lassa virus 1) Isolating the virus from blood, urine, or throat washings 2) Demonstrating the presence of immunoglobuline M (IgM) antibody to Lassa virus 3) Showing a fourfold rise in titer of IgG antibody between acute- and convalescent-phase serum The virus can be isolated from the blood or serum during the febrile phase of the disease, up to 2 weeks post onset Antibody can be detected by CF, IFA, or ELISA In severe cases, patients can die before the appearance of antibodies

~Firdaus Fariq Che Ahmad~

Lassa Fever
Virology of Lassa virus
Family Genus Arenaviridae Arenavirus 1) RNA virus single stranded negative sense two nucleic acid segments L & S segments one segment being slightly larger in the overall 5000-7400 base pair genome 2) Virions enveloped inner side of the envelope is lined by matrix protein (MP) pleomorphic sperical structures with distinct club-shaped surface projections (glycoprotein spikes) 3) Host ribosomes within the viral envelope give the virus its characteristic sandy appearance 4) Nucleocapsid structure helical

Morphology

~Firdaus Fariq Che Ahmad~

Lassa Fever
Treatment
Supportive Care
1) Maintenance of appropriate fluid and electrolyte balance

Antiviral Drug

Ribavirin 2) Oxygenation and blood pressure 1) A prodrug which appears to interfere with viral 3) Teatment of any other complicating infections replication 4) Antibiotics (secondary and/or opportunistic bacterial Inhibits RNA-dependent nucleic acid synthesis infection) 2) Almost twice as effective when given intravenously as when taken by mouth 3) Dose 2-gm loading dose Followed by 1 gm every 6 hours for 4 days Followed by 0.5 gm every 8 hours for 6 days

Pregnant Women (Late Third Trimester) It is necessary to induce delivery for the mother to have a good chance of survival The virus has an affinity for the placenta and other highly vascular tissues The fetus has only a one in ten chance of survival no matter what course of action is taken, hence focus is always on saving the life of the mother Following delivery, women should receive the same treatment as other Lassa fever patients

~Firdaus Fariq Che Ahmad~

Lassa Fever
Other Viral Hemorrhagic Fevers
VHF Cause Vector Yellow Fever Flaviviruses Mosquitoes 1) 17D strain (LAV) 2) French Dakar Vaccine Hanta Fever Hantavirus Deer mouse (Peromyscus maniculatus) Crimean Congo Tick-borne virus (Nairovirus) Ixodid (hard) ticks 1) Inactivated, mouse-brain derived vaccine Ebola Fever Ebola virus (Filoviridae) Cynomolgous monkeys Rift Valley Fever RVF virus of genus Phlebovirus (family Bunyaviridae) Aedes or Culex mosquitoes 1) Animals Killed RVFV vaccines live-attenuated RVFV vaccines 2) Humans live attenuated vaccine, MP-12 Formalin-inactivated vaccines viral glycoprotein

Vaccines

Prevention of Lassa Fever

Isolating infected patients from contact with unprotected persons until the disease has run its course Putting food away in rodent-proof containers and keeping the home clean help to discourage rodents from entering homes Transmission of the Lassa virus from rodent to humans can be prevented by avoiding contact with Mastomys rodents Trapping in and around homes can help reduce rodent populations Using infection control measures, such as complete equipment sterilization Wearing protective clothing, such as Masks, gloves, gowns, and goggles When caring for patients with Lassa fever, further transmission of the disease through person-toperson contact can be avoided by taking preventive precautions against contact with patient secretions

~Firdaus Fariq Che Ahmad~