Lassa Fever

Department of Medicine, Mainland Hospital Yaba.

Dr ANIMASHAUN
29/11/2023.
OUTLINE
• Introduction
• Epidemiology
• Clinical Manifestation
• Investigation
• Treatment
• Prognosis
• Prevention
• Recommendation
• References
Introduction
• Lassa fever is an acute viral haemorrhagic illness caused by
Arenaviridae, Lassa Virus.

• Lassa fever is known to be endemic in West Africa; Benin, Ghana,

Guinea, Liberia, Mali, Sierra Leone, and Nigeria.

• Estimated 300,000-500,000 infection/year, with 5,000 deaths

• Discovered in Nigeria in 1969

• Seasonal Clustering; Early dry season and Late rainy season.

Epidemiology 1
Epidemiology 2
An Electron Microscope view of Lassa Virus
 Epidemiology 3

• Lassa fever is a zoonotic disease, meaning that

humans become infected from contact with
infected animals.

• The animal reservoir, or host, of Lassa virus is a

rodent of the genus Mastomys, commonly known
as the “multimammate rat.”

• Mastomys rats infected with Lassa virus do not

become ill, but they can shed the virus in their
urine and faeces.
A pictoral illustration of multimammate rats
 Epidemiology 4

• Rodent to Human transmission – Ingestion of food contaminated with

urine or faeces of infected Mastomys rats.
• Human to Human transmission - Direct contact with the blood, urine,
faeces, or other bodily secretions of a person infected with Lassa
fever, needle stick or cut.

• There is no epidemiological evidence supporting airborne spread

between humans.
Epidemiology 5

In the Healthcare setting the virus may be

spread by contaminated medical equipment,

Lassa fever occurs in all age groups and

both sexes.
Epidemiology
Epidemiology (Local)
Epidemiology
Pathogenesis

• My dogs are Lhasas.

• They have a fever.

Pathogenesis: Host Cell Entry
• Following transmission, Lassa virus primarily infects the
endothelial cells.

• Unlike most enveloped virus, Lassa virus undergoes cellular entry

via endocytosis using alpha-dystroglycan receptor

• Once within the cell, the viruses are rapidly delivered to endosomes
via vesicular trafficking.

• Lassa virus evades endosomal degradation using envelope

glycoproteins
Pathogenesis: Host – Cell Entry
 Pathogenesis: Genetics
• Replication for Lassa virus is very rapid and demonstrates a temporal
control

• This temporal control allows the spike proteins to be produced last, and
therefore, delay recognition by the host immune system
 Pathogenesis : Host Immune Response

• Lassa fever evades the host immune system by production of

protein, which has an exonuclease activity and causes the inhibition
of host type I IFN signaling

• Endothelial dysfunction- release of pro-inflammatory cytokines/cell

mediator - platelet dysfunction, hepatic necrosis, suppression of
cardiac function, pleural and pericardial effusions, and hypovolemic
shock.
Pathogenesis: Host Immune Response

• Prompt host immune response is critical for host survival, and may be
fatal. Lassa fever is often characterized by impaired or delayed
cellular immunity.

• Failure of the host to mount an adequate cellular immune response to

control viral dissemination + replication in tissues and absence of
neutralizing antibodies, results in host death.
Pathogenesis - Gross Pathology
• Lassa virus commonly involves the liver and results in hepatocellular necrosis
and apoptosis
• Splenic necrosis
• Adrenocortical necrosis
• Mononuclear interstitial myocarditis
• Pulmonary alveolar edema with capillary congestion and mild
interstitial pneumonitis
• Lymph nodal sinus histiocytosis
• Gastrointestinal mucosal petechiae
• Renal tubular injury
• Interstitial nephritis
CLINICAL PRESENTATION
A diagram depicting Clinical Features
Clinical Features 1

• Incubation period of 5 -21 days

• Case fatality of 15-20% in hospitalised cases

• Particularly severe in pregnant women (Placenta infection-30%

mortality in 3rd trimester) and 85% mortality in fetus and neonates.

• Deafness is a common sequelae (1/3rd of cases, SNHL, persists in 1/3rd

of those affected)
Clinical Stages
of Lassa Fever
Symptoms and
their recorded
percentages in
confirmed
Lassa Virus
cases
 Clinical Features 2

• Death usually occurs within 14 days of onset in fatal cases.

 Investigation 1
• Lassa fever is difficult to distinguish from other viral haemorrhagic
fevers such as Ebola virus disease

• As well as other diseases that cause fever, including malaria,

shigellosis, typhoid fever and yellow fever.

• Definitive diagnosis requires testing that is available only in reference

laboratories
Investigation 2
• Reverse transcriptase polymerase chain reaction (RT-PCR) assay

• Antibody enzyme-linked immunosorbent assay (ELISA)

• Antigen detection tests

•
Virus isolation by cell culture.
Treatment
• Early supportive care with rehydration and symptomatic treatment
improves survival

• The antiviral drug ribavirin seems to be an effective treatment for

Lassa fever if given early on in the course of clinical illness.

• There is no evidence to support the role of ribavirin as post-exposure

prophylactic treatment for Lassa fever.
Prognosis
• Associated with poor prognosis
• High Viraemia
• Bleeding
• Encephalitis
• Edema
• Third Trimester Pregnancy
• Serun AST > 150 IU/L
Prevention 1
Community Hygiene
• Effective measures include storing grain and other foodstuffs in
rodent-proof containers

• Disposing of garbage far from the home, clean households

• Keeping cats.
Dear Comrade,
The cops are here.
Hide your mammary glands.
 Prevention 2
HEALTH CARE SETTING

• Staffs should always apply standard infection prevention and control precautions
when caring for patients, regardless of their presumed diagnosis, barrier nursing

• Basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block
splashes)

• Safe burial practices

• Diagnostic technology
Prevention 3
When in close contact (within 1 metre) of patients with Lassa fever,
health-care workers should

• Wear face protection (a face shield or a medical mask and goggles)

• Provision of clean, sterile or non-sterile long-sleeved gown
• Provision of gloves, sanitizers, functional non contact taps, amongst
other basic amenities
Recommendation
When presence of the disease is confirmed in a community,

• Prompt isolation of affected patients,

• Good infection prevention and control practices,

• Rigorous contact tracing can stop outbreaks.

• Incentive package for health care providers.
 References
• Akpede G.O. Asogun D.A.Okogbenin S.A.et al.Lassa fever outbreaks in Nigeria.Expert Rev Anti Infect
Ther. 2018; 16: 663-666
• Baseline mapping of Lassa fever virology, epidemiology and vaccine research and development.
• NPJ Vaccin. 2018; 3: 11. 1-8
• CDC 2019. Lassa fever https://www.cdc.gov/vhf/lassa/index.html
• Owolabi J.B. Mamah C.M. Okoro C.C. et al. Re-emerging human viral hemorrhagic fevers: a
review.Am J Infect Dis Microbiol. 2016; 4: 79-90
• Price ME, Fisher-Hoch SP, Craven RB, McCormick JB. A prospective study of maternal and fetal
outcome in acute Lassa fever infection during pregnancy. BMJ 1988;297: 584-7.
• NCDC Lassa fever Situation Report Epi Week 2:10 – 16 January, 2022
https://reliefweb.int/report/nigeria/ncdc-lassa-fever-situation-report-epi-week-210-16-january-2022
• WHO 2019. Lassa feverhttps://www.who.int/emergencies/diseases/lassa-fever/en/