Capacity building permitting comprehensive monitoring of a severe case of Lassa hemorrhagic fever in Sierra Leone with a positive outcome: Case Report

Abstract

Lassa fever is a neglected tropical disease with a significant impact on the health care system of endemic West African nations. To date, case reports of Lassa fever have focused on laboratory characterisation of serological, biochemical and molecular aspects of the disease imported by infected individuals from Western Africa to the United States, Canada, Europe, Japan and Israel. Our report presents the first comprehensive real time diagnosis and characterization of a severe, hemorrhagic Lassa fever case in a Sierra Leonean individual admitted to the Kenema Government Hospital Lassa Fever Ward. Fever, malaise, unresponsiveness to anti-malarial and antibiotic drugs, followed by worsening symptoms and onset of haemorrhaging prompted medical officials to suspect Lassa fever. A recombinant Lassa virus protein based diagnostic was employed in diagnosing Lassa fever upon admission. This patient experienced a severe case of Lassa hemorrhagic fever with dysregulation of overall homeostasis, significant liver and renal system involvement, the interplay of pro- and anti-inflammatory cytokines during the course of hospitalization and an eventual successful outcome. These studies provide new insights into the pathophysiology and management of this viral illness and outline the improved infrastructure, research and real-time diagnostic capabilities within LASV endemic areas.

Infecciones por arenavirus

“…Existen algunas observaciones que indican que los pacientes infectados por los virus Junín, Manchupo y Sabiá, que están gravemente enfermos y presentan una viremia elevada, pueden transmitir el virus de persona a persona a través de vía aérea. Por lo que es aconsejable un aislamiento que evite el contacto con sangre, fluidos corporales y secreciones respiratorias, en este tipo de pacientes (5,38,39).…”

“…Como en el caso del Dengue, las infecciones por arenavirus pueden producir un cuadro de choque aún en ausencia de hemorragias (37)(38)(39). La gestión precoz de este cuadro con el suministro de corticoides puede ayudar en la reducción de la mortalidad.…”

An Outbreak of Ebola Virus Disease in the Lassa Fever Zone

“…Corgenix (Broomfield, Colorado) assembled and validated the ReLASV diagnostic assays, which are capable of identifying 95% of active Lassa fever cases, as confirmed by PCR. A lateral flow immunoassay (a rapid diagnostic test [RDT]) requiring only a drop of blood (30 µL) obtained with a safety lancet and capable of detecting LASV antigenemia within 15 minutes was implemented in 2010 [11]. Since 2007, every diagnosis of Lassa fever at KGH has been performed by MoHS personnel by using recombinant immunoassays provided by the VHFC.…”

Laboratory Diagnosis of Lassa Fever

“…A lateral flow assay for Lassa virus nucleoprotein (ReLASV) is one type of rapid diagnostic test that could be used for point-of-care testing. Following initial development and testing efforts (50,57), this assay received the CE mark in 2013, although the assay has not been approved by the U.S. Federal Drug Administration. According to the product insert, the test yields results in 15 to 25 min and has 85% sensitivity and 99% specificity using confirmed Lassa virus-positive blood samples (Lassa virus positive by RT-PCR and IgM negative by ELISA) (58).…”