Acute abdominal pain in patients with lassa fever: Radiological assessment and diagnostic challenges

Abstract

Background:To highlight the problems of diagnosis and management of acute abdomen in patients with lassa fever. And to also highlight the need for high index of suspicion of lassa fever in patients presenting with acute abdominal pain in order to avoid surgical intervention with unfavourable prognosis and nosocomial transmission of infections, especially in Lassa fever-endemic regions.Materials and Methods:A review of experiences of the authors in the management of lassa fever over a 4-year period (2004-2008). Literature on lassa fever, available in the internet and other local sources, was studied in November 2010 and reviewed.Results:Normal plain chest radiographic picture can change rapidly due to pulmonary oedema, pulmonary haemorrhage and acute respiratory distress syndrome. Plain abdominal radiograph may show dilated bowels with signs of paralytic ileus or dynamic intestinal obstruction due to bowel wall haemorrhage or inflamed and enlarged Peyer's patches. Ultrasound may show free intra-peritoneal fluid due to peritonitis and intra-peritoneal haemorrhage. Bleeding into the gall bladder wall may erroneously suggest infective cholecystitis. Pericardial effusion with or without pericarditis causing abdominal pain may be seen using echocardiography. High index of suspicion, antibody testing for lassa fever and viral isolation in a reference laboratory are critical for accurate diagnosis.Conclusion:Patients from lassa fever-endemic regions may present with features that suggest acute abdomen. Radiological studies may show findings that suggest acute abdomen but these should be interpreted in the light of the general clinical condition of the patient. It is necessary to know that acute abdominal pain and vomiting in lassa fever-endemic areas could be caused by lassa fever, which is a medical condition. Surgical option should be undertaken with restraint as it increases the morbidity, may worsen the prognosis and increase the risk of nosocomial transmission.

Baseline mapping of Lassa fever virology, epidemiology and vaccine research and development

“…Shock, seizures, tremor, disorientation, and coma have also been reported during this stage of the disease. 7 , 23 , 24 Approximately 15–20% of hospitalized LF patients (roughly estimated at 1–3% of all cases) die from the illness, 7 generally within 2 weeks after the onset of symptoms due to multi-organ complication and/or failure involving the liver, spleen or kidneys. Signs of acute kidney failure have been associated with fatal outcomes and hepatitis is frequent and moderately severe in patients diagnosed with LF.…”

“…Infection in infants can result in “swollen baby syndrome” with edema, abdominal distension, bleeding and often death whereas symptoms in children (2 years of age and older) are similar to those seen in adults. 23 , 25 Neurological problems have also been described in LF patients including hearing loss and encephalopathy. Various degrees of deafness, which may develop during both mild or severe cases, 24 have been shown to occur in patients who survive the disease.…”

Case series of outcome of newborn babies exposed to Lassa fever virus infection

“…There have been instances of persistent false-negative tests of Lassa fever in patients presenting with classic symptoms of the disease and many of these patients have been managed as Lassa fever and they recovered. 11 It is also known that with highly diverse pathogens such as Lassa virus, genetic diversity can be problematic for nucleic acid-based assays, as even a single nucleotide variant in one of the primers can have a significant negative impact on assay sensitivity depending on the location of the nucleotide variant. 9 This may affect the demonstration of positivity of a particular symptomatic case.…”

Lassa Fever: Current Treatment and Prospects of an Effective Vaccine

“…Other clinical features are generalized oedema, deafness, respiratory distress and hypotension. Symptoms referable to the neuronal system include: tremors, deafness, and encephalitis [3,25]. In fatal cases, cardiovascular shock and multi-organ failure may precede death.…”