Imported Case of Lassa Fever in Sweden With Encephalopathy and Sensorineural Hearing Deficit

Abstract

We describe an imported case of Lassa fever with both encephalopathy and bilateral sensorineural hearing deficit. Absence of fever during hospitalization, initially nonspecific symptoms, and onset of hearing deficit in a late stage of disease probably contributed to delayed diagnosis (14 days after admittance to hospital). The pathogenesis of neurological manifestations of Lassa fever is poorly understood and no specific treatment was given. A total of 118 personnel had close contact with the patient, but no secondary cases occurred. This case highlights the importance of considering Lassa fever as a differential diagnosis in patients with recent travel to endemic areas.

Absence of Nosocomial Transmission of Imported Lassa Fever during Use of Standard Barrier Nursing Methods

“…The highest concentration of LASV RNA detected was 1.2 × 10 5 copies/mL. For other characteristics of this patient, see the Figure and Grahn et al ( 16 ). …”

“…A patient with severe symptoms, including profuse vomiting, diarrhea, and bleeding, implies a high risk for virus transmission, and one could also presume that the degree of illness reflects the viremia ( 23 ), although data on the association between degree of illness and amount of infectious virus in different body fluids are scarce ( 5 , 16 , 24 ). However, despite the absence of fever 7 days before admission, the index patient in the present study had moderately high concentrations of LASV RNA in serum at admission and traces of viral RNA (<300 copies/mL) up to 32 days after admission.…”

“…A 72-year-old woman was admitted to Sahlgrenska University Hospital in Gothenburg, Sweden, in March 2016, ten days after onset of fever, nausea, arthralgia, loose stools, and headache, and 2 days after onset of personality changes ( 16 ). The initial fever had resolved after 3 days and 7 days before hospitalization.…”

The challenges of detecting and responding to a Lassa fever outbreak in an Ebola-affected setting

“…The case exported to Sweden (Grahn et al, 2016) highlights the ease of international importation of infectious disease and demonstrates the importance of reporting such events under the IHR (WHO, 2013). There are a number of reports of cases of Lassa fever exported from West Africa to other countries where this diagnosis is a very rare event (Kyei et al, 2015;Amorosa et al, 2010;Kitching et al, 2009).…”

“…The patient was isolated and recovered. Contact tracing in Sweden identified 118 healthcare workers and family members with low-level exposure and no secondary cases were identified (WHO, 2016;Grahn et al, 2016).…”