Open Access Case Report

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

Luis M Branco12, Matt L Boisen3, Kristian G Andersen4, Jessica N Grove1, Lina M Moses1, Ivana J Muncy3, Lee A Henderson5, John S Schieffellin6, James E Robinson6, James J Bangura78, Donald S Grant79, Vanessa N Raabe10, Mbalu Fonnie9, Pardis C Sabeti114 and Robert F Garry1*

Author Affiliations

1 Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, USA

2 Autoimmune Technologies, LLC, New Orleans, Louisiana, USA

3 Corgenix Medical Corporation, Broomfield, Colorado, USA

4 Department of Organismic and Evolutionary Biology, Center for Systems Biology, Harvard University, Cambridge, Massachusetts, USA

5 Vybion, Inc., Ithaca, New York, USA

6 Department of Paediatrics, Section of Infectious Disease, Tulane University, New Orleans, Louisiana, USA

7 Ministry of Health and Sanitation Workplace Health, Republic of Sierra Leone, Freetwon, Sierra Leone

8 The Global Viral Forecasting Initiative, San Francisco, California, USA

9 Kenema Government Hospital Lassa Fever Ward, Kenema, Republic of Sierra Leone

10 University of Minnesota School of Medicine, Minneapolis, Minnesota, USA

11 Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, USA

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Virology Journal 2011, 8:404  doi:10.1186/1743-422X-8-404

Published: 15 August 2011

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.