Aseptic Meningitis Caused by Lassa Virus: Case Series Report

Abstract

The Lassa virus is known to cause disease in different organ systems of the human body, with varying clinical manifestations. The features of severe clinical disease may include bleeding and/or central nervous system manifestations. Whereas Lassa fever encephalopathy and encephalitis are well described in the literature, there is paucity of data on Lassa virus meningitis. We present the clinical description, laboratory diagnosis, and management of 4 consecutive cases of aseptic meningitis associated with Lassa virus infection without bleeding seen in a region of Nigeria known to be endemic for both the reservoir rodent and Lassa fever. The 4 patients recovered fully following intravenous ribavirin treatment and suffered no neurologic complications.

Clinical and laboratory predictors of Lassa fever outcome in a dedicated treatment facility in Nigeria: a retrospective, observational cohort study

“…Severe central nervous system (CNS) symptoms (coma, seizure; irrational talk/behavior, altered sensorium, tremors, and disorientation/confusion: which suggest encephalitis, meningitis, or encephalopathy), face and neck (F/N) swelling, jaundice, bleeding, hematuria, proteinuria, and non-severe CNS symptoms (dizziness, lethargy, drowsiness) are the clinical features associated with outcome at P<0.05. These designations of severe and non-severe CNS features were based on known symptoms and signs of viral encephalitis, meningitis, and encephalopathy, and our previous observations 18,19 at ISTH that certain CNS features were associated with excess mortality while others were not. Overall incidence of severe and non-severe CNS manifestations at presentation was 30% (84/284).…”

Delayed-onset paraparesis in Lassa fever: A case report

“…Neurological manifestations in patients with LF were reported in several works (Okokhere and Akpede, 2013;Okokhere et al, 2016Okokhere et al, , 2018b. However, to our knowledge, we report here the first case of LF-associated paraparesis.…”

“…In conclusion, if CNS manifestations are known complications of LF, their causative mechanisms are still poorly understood and their spectrum remains incompletely known. The case described here suggests that besides hemispheric encephalitis (Günther et al, 2001;Okokhere and Akpede, 2013;Okokhere et al, 2018b) and meningitis (Okokhere et al, 2016), delayed myelitis and brainstem encephalitis could be possible features of CNS involvement in patients with LF and might be immunologically driven. Further investigations are necessary to substantiate these hypotheses, to better understand their pathophysiology and to refine the syndromic categorization of LF related CNS disorders.…”

“…Humanto-human transmission is mainly reported in a nosocomial context (Houlihan and Behrens, 2017). Central nervous system (CNS) disorders associated with LF, including encephalitis and meningitis, have been described previously (Günther et al, 2001;Okokhere and Akpede, 2013;Okokhere et al, 2016Okokhere et al, , 2018b and are associated with an increased number of deaths (Okokhere and Akpede, 2013;Okokhere et al, 2018a). Here we report a case of delayed-onset paraparesis in an LF survivor.…”

Sequelae of Lassa Fever: Postviral Cerebellar Ataxia

“…Multiorgan involvement is reported in LF, leading to complications including gastrointestinal symptoms, pleuritic chest pain, bleeding, acute kidney injury, convulsion, shock, and coma [10, 16–18]. In addition, central nervous system (CNS) involvement is well documented in LF, with complications including seizures, labile hypotension, encephalitis, encephalopathy, aseptic meningitis, vertigo, unilateral or bilateral sensorineural hearing loss, and ataxia (less frequently) [10, 16, 17, 19–21]. Furthermore, LASV was isolated from CSF in a patient whose serum had no circulating detectable LASV [10].…”