Clinical features and patient management of Lujo hemorrhagic fever

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dc.contributor.author Sewlall, Nivesh H.
dc.contributor.author Richards, Guy A.
dc.contributor.author Duse, Adriano
dc.contributor.author Swanepoel, Robert
dc.contributor.author Paweska, Janusz Tadeusz
dc.contributor.author Blumberg, Lucille H.
dc.contributor.author Dinh, Thu-Ha
dc.contributor.author Bausch, Daniel
dc.date.accessioned 2015-07-16T08:07:32Z
dc.date.available 2015-07-16T08:07:32Z
dc.date.issued 2014-11-13
dc.description.abstract BACKGROUND : In 2008 a nosocomial outbreak of five cases of viral hemorrhagic fever due to a novel arenavirus, Lujo virus, occurred in Johannesburg, South Africa. Lujo virus is only the second pathogenic arenavirus, after Lassa virus, to be recognized in Africa and the first in over 40 years. Because of the remote, resource-poor, and often politically unstable regions where Lassa fever and other viral hemorrhagic fevers typically occur, there have been few opportunities to undertake in-depth study of their clinical manifestations, transmission dynamics, pathogenesis, or response to treatment options typically available in industrialized countries. METHODS AND FINDINGS : We describe the clinical features of five cases of Lujo hemorrhagic fever and summarize their clinical management, as well as providing additional epidemiologic detail regarding the 2008 outbreak. Illness typically began with the abrupt onset of fever, malaise, headache, and myalgias followed successively by sore throat, chest pain, gastrointestinal symptoms, rash, minor hemorrhage, subconjunctival injection, and neck and facial swelling over the first week of illness. No major hemorrhage was noted. Neurological signs were sometimes seen in the late stages. Shock and multi-organ system failure, often with evidence of disseminated intravascular coagulopathy, ensued in the second week, with death in four of the five cases. Distinctive treatment components of the one surviving patient included rapid commencement of the antiviral drug ribavirin and administration of HMG-CoA reductase inhibitors (statins), N-acetylcysteine, and recombinant factor VIIa. CONCLUSIONS : Lujo virus causes a clinical syndrome remarkably similar to Lassa fever. Considering the high case-fatality and significant logistical impediments to controlled treatment efficacy trials for viral hemorrhagic fever, it is both logical and ethical to explore the use of the various compounds used in the treatment of the surviving case reported here in future outbreaks. Clinical observations should be systematically recorded to facilitate objective evaluation of treatment efficacy. Due to the risk of secondary transmission, viral hemorrhagic fever precautions should be implemented for all cases of Lujo virus infection, with specialized precautions to protect against aerosols when performing enhanced-risk procedures such as endotracheal intubation. en_ZA
dc.description.librarian am2015 en_ZA
dc.description.uri http://www.plosntds.org en_ZA
dc.identifier.citation Sewlall NH, Richards G, Duse A, Swanepoel R, Paweska J, Blumberg, L, Dinh, TH & Bausch, D (2014) Clinical Features and Patient Management of Lujo Hemorrhagic Fever. Plos Neglected Tropical Diseases 8(11): e3233. DOI: 10.1371/journal.pntd.0003233 en_ZA
dc.identifier.issn 1932-6203
dc.identifier.other 10.1371/journal.pntd.0003233
dc.identifier.uri http://hdl.handle.net/2263/49001
dc.language.iso en en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights The work is made available under the Creative Commons CC0 en_ZA
dc.subject Hemorrhagic fever en_ZA
dc.subject Lujo virus en_ZA
dc.subject Lujo hemorrhagic fever en_ZA
dc.title Clinical features and patient management of Lujo hemorrhagic fever en_ZA
dc.type Article en_ZA


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