Journal Article

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

Bangura, James J, Raabe, Vanessa N, Branco, Luis M, Garry, Robert F, Andersen, Kristian G, Muncy, Ivana J, Henderson, Lee A, Schieffellin, John S, Grant, Donald S, Boisen, Matt L, Robinson, James E, Fonnie, Mbalu, Grove, Jessica N, Moses, Lina M, Sabeti, Pardis C

2011

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Antibodies, Viral - analysis / Antibodies, Viral - immunology / antigens / Antigens, Viral - analysis / Antigens, Viral - immunology / Biomedical and Life Sciences / Biomedicine / Case Report / case studies / Case-Control Studies / Cytokines - analysis / Cytokines - biosynthesis / Data collection / Diagnosis / diagnostic techniques / Evolutionary biology / Female / Fetal Death / Fetuses / Fever / Genetic aspects / Genetic Variation / geographical distribution / Health aspects / Hemorrhagic fever / homeostasis / Hospitalization / hospitals / Human subjects / Humans / immunity / Immunoassay / Injections, Intravenous / intravenous injection / Lassa Fever - diagnosis / Lassa Fever - drug therapy / Lassa Fever - epidemiology / Lassa Fever - immunology / Lassa Fever - virology / Lassa mammarenavirus / Lassa virus - genetics / Lassa virus - immunology / Lassa virus - isolation & purification / Lassa virus fever / monitoring / Mortality / patients / Physiological aspects / Polymerase Chain Reaction / Pregnancy / Pregnancy Complications, Infectious - diagnosis / Pregnancy Complications, Infectious - drug therapy / Pregnancy Complications, Infectious - immunology / Pregnancy Complications, Infectious - mortality / Pregnancy Complications, Infectious - virology / Pregnancy Trimester, Third / Pregnant women / Public Health / rapid methods / Real time / Ribavirin - administration & dosage / Ribavirin - therapeutic use / Risk factors / RNA / RNA, Viral - analysis / Sierra Leone / Sierra Leone - epidemiology / Virology / women / Young Adult