Lassa hemorrhagic fever in a late term pregnancy from northern sierra leone with a positive maternal outcome: case report

Abstract

Lassa fever (LF) is a devastating viral disease prevalent in West Africa. Efforts to take on this public health crisis have been hindered by lack of infrastructure and rapid field deployable diagnosis in areas where the disease is prevalent. Recent capacity building at the Kenema Government Hospital Lassa Fever Ward (KGH LFW) in Sierra Leone has lead to a major turning point in the diagnosis, treatment and study of LF. Herein we present the first comprehensive rapid diagnosis and real time characterization of an acute hemorrhagic LF case at KGH LFW. This case report focuses on a third trimester pregnant Sierra Leonean woman from the historically non-endemic Northern district of Tonkolili who survived the illness despite fetal demise.Employed in this study were newly developed recombinant LASV Antigen Rapid Test cassettes and dipstick lateral flow immunoassays (LFI) that enabled the diagnosis of LF within twenty minutes of sample collection. Deregulation of overall homeostasis, significant hepatic and renal system involvement, and immunity profiles were extensively characterized during the course of hospitalization. Rapid diagnosis, prompt treatment with a full course of intravenous (IV) ribavirin, IV fluids management, and real time monitoring of clinical parameters resulted in a positive maternal outcome despite admission to the LFW seven days post onset of symptoms, fetal demise, and a natural still birth delivery. These studies solidify the growing rapid diagnostic, treatment, and surveillance capabilities at the KGH LF Laboratory, and the potential to significantly improve the current high mortality rate caused by LF. As a result of the growing capacity, we were also able to isolate Lassa virus (LASV) RNA from the patient and perform Sanger sequencing where we found significant genetic divergence from commonly circulating Sierra Leonean strains, showing potential for the discovery of a newly emerged LASV strain with expanded geographic distribution. Furthermore, recent emergence of LF cases in Northern Sierra Leone highlights the need for superior diagnostics to aid in the monitoring of LASV strain divergence with potentially increased geographic expansion.

Lassa Fever in Post-Conflict Sierra Leone

“…It is unlikely that infection with LASV would inform the subject regarding her pregnancy status, and first trimester pregnancies are likely underreported. We did not find a statistically significant increase in CFR related to pregnancy, as has been noted in previous studies [22], [29]. Nevertheless, the CFR for Ag+/IgM− pregnant women in our study was 93%, compared with 66% of non-pregnant women in this serogroup (Fig.…”

The sensitivity and specificity of Lassa virus IgM by ELISA as screening tool at early phase of Lassa fever infection

“…An early immunosuppression resulting from the disease appears responsible for the depressed production of IgM at the early phase of the infection and, as a result, some patients failed to elaborate IgM at the time of presentation. Current reports by Branco et al .,21 show that the detection of significant level of IgM response to Glycoprotein1 (GP1) and GP2 only become apparent between 11 th and 20 th day of infection whereas Bausch et al .,12 had earlier reported that acute phase antibodies to LAV only start appearing from 4 th -14 th day of infection.…”

Multiple Circulating Infections Can Mimic the Early Stages of Viral Hemorrhagic Fevers and Possible Human Exposure to Filoviruses in Sierra Leone Prior to the 2014 Outbreak

“…Currently, the LF program at the KGH provides diagnostic services and clinical care for more than 500 suspected LF cases per year (41) with routine laboratory testing for LF using recombinant antigen immunoassays that were implemented in 2008. Since 2008, there have been continuous improvements in LF laboratory (LFL) testing at the KGH, including developing and refining recombinant antigen enzyme-linked immunosorbent assays (ELISAs) for the detection of LASV antigens (viremia) and for LASV-specific immunoglobulin M (IgM) and immunoglobulin G (IgG) (11)(12)(13)24). A lateral flow immunoassay (LFI) was implemented in 2010 (11,12,24,41; Boisen et al Improved Diagnosis of Lassa Fever Using ReLASV LF Immunoassays [in preparation]) for its simplicity, low cost, and widespread use in a variety of clinical and field settings, particularly in regions where electricity and other resources are not routinely available.…”