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

Additional files

Additional File 1:

Map of Sierra Leone and expanded view of relevant localities and routes travelled by patient G-1442. Maps of Sierra Leone outlining Districts (A) and Provinces (B) [http://commons.wikimedia.org/wiki/Atlas_of_Sierra_Leone webcite], with an inset map (C) [http://maps.google.com webcite] displaying the location of Mabineh 1 [red star], where the suspected LF case in the current report originated, and the four localities where the patient travelled to and from, with known dates noted: Waterloo (late Dec 2010), Masingbi (early Jan 2011), Tongo (Jan 10, 2011), and Kenema (Jan 19, 2011). The inbound routes travelled by the patient are indicated in dotted lines, and outbound ones in solid lines. The bar represents 20 miles.

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Additional File 2:

Patient G-1442 at time of admission presenting with haemoptysis, facial edema, gingivorrhagia. Patient G-1442 presented with significant haemoptysis, facial edema, and gingivorrhagia, at the time of admission and medical assessment at the KGH LFW. These symptoms persisted for several days after admission but resolved with ribavirin treatment.

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Additional Figure 3:

Vital signs for G-1442 during hospitalization at KGH LFW. Core temperature (°C) [green triangle], pulse [red circle], respiratory rate [blue diamond], and blood pressure purple [square = systolic, yellow square = diastolic] were measured at regular intervals, usually every 4 hours at the onset, and every 12 hours at later times, throughout the hospitalization period.

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Additional Figure 4:

Additional Piccolo metabolites analyzed in G-1442. Patient G-1442 presented with low serum Cl- and albumin, normal K+, Na+, Ca2+ (corrected for albumin levels), TCO2, and total protein levels. Over the course of disease management the patient developed hyponatremia, hypochloremia, and slight hypokalemia. Total protein and albumin levels remained low throughout. Between days 9 and 13 G-1442 developed hypercalcaemia, but then normalized. Metabolic indicators in the two healthy Sierra Leonean donors all were within or near normal ranges.

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Additional Figure 5:

Table 1. Urinalysis profile for patient G-1442 during the course of admission at the KGH LFW. Urine samples were collected from patient G-1442 daily (days 7-18) and tested for 10 metabolites as outlined in Methods. The first day of ribavirin administration (7) and still birth delivery (13) are noted. Abbreviations and codes: moderate (mod.); negative (-); positive (+); specific gravity (spec. gravity); 30 mg/dL protein in urine (30+); 300 mg/dL protein in urine (300+).

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Additional Figure 6:

Table 2. Metabolic, cytokine, LASV Ag, IgG, and IgM profiles for five patients who succumbed to LF at the KGH LFW in recent months, and in two healthy controls. Thirteen metabolic indicators, 11 cytokines, LASV NP Ag, IgM, and IgG status were compared between 5 representative recent fatal cases of LF (G-1209, G-1220, G-1380, G-1401), including one previously characterized fatal late term pregnancy (G-1177), and two healthy volunteers (LS004, LS022). Reported normal ranges for metabolic indicators (Abaxis, Inc.) and serum cytokine levels (Cambridge Biomedical [IL-1b, IL-10], BD Biosciences [IL-2, IL-4, IL-8, IL-12p70], R&D Systems [IL-5, IL-6], Thermo Scientific [TNF-α], BioVendor [TNF-β, IFN-γ]) are shown in the rightmost corresponding columns. Metabolic panel values are in SI units, and cytokine levels are in pg/mL. ELISA data was scored as positive (+), negative (-), or indeterminate (+/-), based on statistical comparison to positive and negative sera, and using a positive control serum dilution series.

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