A Case-Control Study of the Clinical Diagnosis and Course of Lassa Fever

McCormick, Joseph B.; King, Isabel J.; Webb, P. A.; Johnson, Karl M.; O'Sullivan, R.; Smith, Ethleen S.; Trippel, Sally; Tong, Tony C.

doi:10.1093/infdis/155.3.445

Cited by 365 publications

(313 citation statements)

References 13 publications

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“…[12] In this study records that have to do with the most useful clinical predictors of LF are fever, pharyngitis, retrosternal pain, and proteinuria for diagnosis; and fever, sore throat, and vomiting for outcome were not recorded as part of routine data of patients. [6] A case fatality rate of 52.2% was observed in this study as against a declining rate observed in a previous study conducted in health facilities from 70% -18.5% in 2012-2014. [12] It appears to be higher than the values suggested by CDC that approximately 15%-20% of patients hospitalized for Lassa fever die from the illness.…”

Section: Discussionsupporting

confidence: 44%

“…Although LF presents like malaria, the most useful clinical predictors are fever, pharyngitis, retrosternal pain, and proteinuria for diagnosis; and fever, sore throat, and vomiting for outcome. [6] By June 2017, a total of 501 cases including 104 deaths have been reported since the onset of the current LF outbreaks season in December 2016 in Nigeria. Of the reported cases, 189 have been further classified, 175 laboratory-confirmed including 59 deaths and 14 probable cases (all dead).…”

Section: Introductionmentioning

confidence: 99%

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Lassa fever: A recurring decimal in Plateau state, Nigeria

Dauda¹,

Olutomi²,

Luret³

2018

Int Jour of Biomed Res

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Background: Since the first reported case of Lassa fever (LF) in Jos, Plateau state Nigeria in the early 70's, the state has been plagued with increasing number of cases. This could be due to poor environmental practices, food and personal hygiene. By the end of August 2017 there were 42 reported cases with 15 confirmed cases. Sadly, over the years there have been challenges with reporting and investigation of cases. This could be due to weak health systems commonly seen in developing countries. Methods and Materials:We reviewed 2012-2016 surveillance data from the State Ministry of Health (SMoH) using Microsoft Excel. Descriptive analysis was conducted on the reported LF cases in the state. Results: Between the years 2012 -2016 there were 109 reported LF cases, with 57 (52.3%) males and 52 (47.7%) females. The mean age of the reported cases was 27.9± 13.6 years. Out of these, 23 (21.1%) were confirmed cases: 1 (4.5%) in 2012, none in 2013, 2014 and 2015, and 21 (91.3%) in 2016.The male: female ratio was10 (43.5%): 13 (56.5%). Six (26.1%) of the confirmed cases were health workers. The case fatality rate of the confirmed cases was 52.2%. Even though there is significant association between LF and death (P-value = 0.003) the odds ratio, 0.215 (95% CI) is low. The reporting years show consistent increasing trend from 2012 to 2016, except for 2015 where there was a decline in the number of reported cases. In 2016 there were 74 (67.9%) cases, 5 (4.6%) in 2015, 15 (13.7%) in 2014, 12 (11.0%) in 2013 and 3 (2.6%) in 2012. Conclusion: Even though reported cases are increasing, there are still gaps observed in the surveillance system of the SMoH. The annual recurrence of LF outbreak in the state without reciprocal preventive efforts on ground to combating it has exposed the populace and health workers to ill-health and death.

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Section: Discussionsupporting

confidence: 44%

Section: Introductionmentioning

confidence: 99%

Lassa fever: A recurring decimal in Plateau state, Nigeria

Dauda¹,

Olutomi²,

Luret³

2018

Int Jour of Biomed Res

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“…2 Guinea pigs infected with this adapted PIC virus develop fever, leukopenia, thrombocytopenia, platelet dysfunction, 3 and terminal vascular collapse 4 in the absence of significant hemorrhagic manifestations, resembling Lassa fever. 5 Like Lassa virus in humans, adapted PIC virus replicates in all extraneural tissues of guinea pigs, and induces minimal histopathologic changes in liver, spleen and other reticuloendothelial organs of the infected host. [6][7][8] In contrast, the parental, unpassaged virus is naturally attenuated, and causes a self-limited febrile illness with low mortality in inbred guinea pigs.…”

mentioning

confidence: 99%

Sequence analysis of the small RNA segment of guinea pig-passaged Pichinde virus variants.

Zhang

Marriott

Aronson³

1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. The established animal model for Lassa fever is based on the new world arenavirus Pichinde (PIC). Natural isolates of PIC virus are attenuated in guinea pigs, but serial guinea pig passage renders them extremely virulent in that host. We have compared the nucleotide sequences of the small RNA segments of two attenuated, lowpassage variants of the PIC virus Munchique strain (CoAn 4763) and two virulent, high-passage derivatives. Missense mutations in the glycoprotein precursor (GPC) gene at codons GPC-119, GPC-140, and GPC-164 and the nucleoprotein gene (NP) codons NP-35 and NP-374 were most closely associated with virulence. Codon GPC-140 is predicted to represent a region of peak hydrophilicity of the glycoprotein 1 (GP1); it is conceivable that mutations at this site could influence virulence by altering B cell epitopes or virus attachment protein conformation.Of all the viral hemorrhagic fevers of humans, Lassa fever (caused by the arenavirus Lassa) is most amenable to pathogenesis studies because of the availability of a wellcharacterized, safe, and accurate animal model. This model uses the new world arenavirus Pichinde (PIC), 1 a member of the Tacaribe serogroup, which is non-pathogenic for humans. Serial passage of the Munchique isolate of PIC virus (CoAn 4763) in inbred guinea pigs dramatically increases the pathogenicity of the virus. 2 Guinea pigs infected with this adapted PIC virus develop fever, leukopenia, thrombocytopenia, platelet dysfunction, 3 and terminal vascular collapse 4 in the absence of significant hemorrhagic manifestations, resembling Lassa fever. 5 Like Lassa virus in humans, adapted PIC virus replicates in all extraneural tissues of guinea pigs, and induces minimal histopathologic changes in liver, spleen and other reticuloendothelial organs of the infected host. [6][7][8] In contrast, the parental, unpassaged virus is naturally attenuated, and causes a self-limited febrile illness with low mortality in inbred guinea pigs. 2 This system offers the opportunity to delineate molecular genetic determinants of virulence. The relatively short passage history of parent (attenuated) and passaged (virulent) PIC virus suggests that sequence analysis would uncover a relatively small number of mutations between the two; the disparate virulence phenotypes favors the correlation of pathogenicity with specific viral genetic alterations.Arenaviruses have bipartite, ambisense, single-stranded RNA genomes. The small (S) segment encodes the viral envelope glycoproteins and nucleoprotein. 9 The glycoprotein precursor (GPC) protein is translated from a virus sense mRNA derived from the 5Ј half of the S segment. The GPC polypeptide is post-translationally processed by host cell signal peptidase and furin-like proteases to yield GP1 and GP2. Biochemical studies suggest that tetramers of GP2, which have a transmembrane domain, form a coiled-coil stalk, atop which tetramers of the globular GP1 protein are bound by non-covalent interactions.9,10 The cytoplasmic tails of the GP2 molecules are believe...

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“…We did not model outbreaks due to the Lassa arenavirus, because few epidemiologic data are available and a different model, which addresses zoonotic transmission of this agent, would be essential, but the benefits of early diagnosis could be greater for Lassa fever-endemic areas in West Africa. There, Lassa fever infects many more people than all filoviruses combined and accounts for a considerable number of hospitalizations -up to 15% in highly endemic areas [46,47] -and early treatment with the antiviral ribavarin significantly improves prognosis [48]. As ribavarin is costly, any diagnostic protocol that delineates presumptive Lassa fever cases from malaria will help to target its use.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic schemes for reducing epidemic size of african viral hemorrhagic fever outbreaks

Okeke

Manning

2014

J Infect Dev Ctries

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Introduction: Viral hemorrhagic fever (VHF) outbreaks, with high mortality rates, have often been amplified in African health institutions due to person-to-person transmission via infected body fluids. By collating and analyzing epidemiological data from documented outbreaks, we observed that diagnostic delay contributes to epidemic size for Ebola and Marburg hemorrhagic fever outbreaks. Methodology: We used a susceptible-exposed-infectious-removed (SEIR) model and data from the 1995 outbreak in Kikwit, Democratic Republic of Congo, to simulate Ebola hemorrhagic fever epidemics. Our model allows us to describe the dynamics for hospital staff separately from that for the general population, and to implement health worker-specific interventions. Results: The model illustrates that implementing World Health Organization/US Centers for Disease Control and Prevention guidelines of isolating patients who do not respond to antimalarial and antibacterial chemotherapy reduces total outbreak size, from a median of 236, by 90% or more. Routinely employing diagnostic testing in post-mortems of patients that died of refractory fevers reduces the median outbreak size by a further 60%. Even greater reductions in outbreak size were seen when all febrile patients were tested for endemic infections or when febrile health-care workers were tested. The effect of testing strategies was not impaired by the 1-3 day delay that would occur if testing were performed by a reference laboratory. Conclusion: In addition to improving the quality of care for common causes of febrile infections, increased and strategic use of laboratory diagnostics for fever could reduce the chance of hospital amplification of VHFs in resource-limited African health systems.

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A Case-Control Study of the Clinical Diagnosis and Course of Lassa Fever

Cited by 365 publications

References 13 publications

Lassa fever: A recurring decimal in Plateau state, Nigeria

Lassa fever: A recurring decimal in Plateau state, Nigeria

Sequence analysis of the small RNA segment of guinea pig-passaged Pichinde virus variants.

Diagnostic schemes for reducing epidemic size of african viral hemorrhagic fever outbreaks

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