Acute Viral Diseases: Lassa Fever

Acute Viral Diseases: Lassa Fever

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Lassa Fever is an acute viral disease found in a family of viruses called Arenaviridae. All Arenaviridae are spread through human contact with a rodent host and their viral particles are contained in a fat membrane and acquire ribosomes from their host cells (The Centers for Disease Control and Prevention, 2014). Lassa Fever was first described in Sierra Leone in the 1950's, however, the virus responsible for the illness was not identified as Lassa Fever until two nurses from Nigeria died of it in 1969 (Ogbu, O., Ajuluchukwa, E., & Uneke, C. J., 2007).
Lassa Fever is spread by the multimammate rat, Mastomys natalensis, a very common rodent in central, east and West Africa and tends to live near humans due to easy access of food (The Centers for Disease Control and Prevention, 2014). The virus can be spread from rat-to-human, most often fecal-oral, or by inhaling contaminated air into the respiratory system or from person-to-person through body fluids (Ogbu, O., et al, 2007). The disease is asymptomatic or mild in 80% of cases, however, the remaining 20% develop the disease in systems throughout the body after an incubation period of 6-21 days (Heymann, D. L., 2008). The illness begins gradually with generic systems such as fever, sore throat, headache, cough, nausea, vomiting, headache, chest pain, abdominal pair and body aches and progresses through several systems in the body (Heymann, D. L., 2008). The disease attacks the circulatory system by multiplying viral particles in the blood vessels causing capillary lesions leading to hemorrhaging in other parts of the body including the brain, digestive system, heart and lungs. (Ogbu, O., et al, 2007). The cardiovascular system can be affected as well with most cases showing an abnormal EKG reading with changes in the T-wave and ST-segment, pericarditis, tachycardia or bradycardia, hypertension or hypotension (Magill, A. J., Ryan, E. T., Hill, D., 2013 & Soloman, T., 2013; Ogbu, O., et al, 2007). The respiratory symptoms include cough, shortness of breath and bronchitis (Ogbu, O., et al, 2007). The neurological symptoms can vary from fine tremors and confusion to much more serious symptoms such as seizures and encephalopathy (Magill, A. J., et al, 2013).
Lassa Fever found in several West African countries and is considered endemic in Nigeria, Guinea, Liberia and Sierra Leone with cases also found in Mali, Ghana, Côte d’Ivoire and Burkina Faso with blood work showing evidence of infection in Togo and Benin (The Centers for Disease Control and Prevention, 2014).

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The number of individuals infected each year is a rough estimate and falls between 100,000-300,000 cases with 5,000 deaths (The Centers for Disease Control and Prevention, 2014). This disease affects men and women equally with those at most risk being individuals living in rural areas with increased direct contact with Mastomys natalensis and exacerbated by crowded living conditions or very poor sanitation (Ogbu, O., et al, 2007). The overall death rate for individuals infected with the disease is 1% and 15-20% in those hospitalized for the illness (Heymann, D. L., 2008 & Ogbu, O., et al, 2007). The disease is more deadly in pregnant women and fetuses and increases the maternal fatality rate to 40% with individuals becoming infected in the third trimester at the greatest risk (Magill, A. J., et al, 2013). In Sierra Leone the disease is the cause of 25% of total maternal deaths. Research has shown individuals throughout the region have antibodies to the disease with 7% in Guinea, 15-20% in Sierra Leone and Liberia and over 20% in Nigeria (Ogbu, O., et al, 2007).
The current treatment includes the antiviral Ribavirin, typically used intravenously, along with supportive therapy including fluid replacement, blood transfusions, antibiotics and pain relievers/fever reducers (Ogbu, O., et al, 2007). One study showed patients at a high-risk for fatality that were treated within the first 6 days with Ribavirin for 10 days had a death rate of 5%, but those treated on the 7th day and after jumped to 26% (Ogbu, O., et al, 2007).
With an overall fatality rate of 1% the prognosis for individuals contracting Lassa Fever is good. Only 20% of patients show symptoms beyond general mild flu-like symptoms. The acute virus typically lasts for 1-4 weeks, is excreted through urine for 3-9 weeks and excreted through semen for up to 3 months (Heymann, D. L., 2008). The most common symptom to occur during the recovery period is eighth cranial nerve deafness in one or both ears, with up to 25% of patients showing this symptom. Of this 25% around ½ regain some of the hearing after several months (Heymann, D. L, 2008). Other symptoms include pericarditis or inflammation of the pericardium (more common in males), ataxia or lack of voluntary coordination of muscle motions, alopecia or hair loss, seizures and global encephalopathy (Ogbu, O., et al, 2007).

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