Background: Lassa fever cases outside Africa are seen as imported cases of Lassa fever. Timely diagnosis of imported Lassa fever is important for timely intervention necessary to reduce the morbidity and mortality associated with Lassa fever, and this requires the knowledge of the clinical manifestations of Lassa fever. Purpose: This review was done to see how clinical diagnosis of imported Lassa fever can be facilitated based on the clinical presentations of i mported cases of Lassa fever in Lassa fever non-endemic region. Methods: The relevant articles for the review were obtained from the databases of PubMed and Google Scholar. Results: The clinical presentations of the imported Lassa fever cases consisted of multisystem involvement and were similar to those of Lassa fever patients who were treated in the Lassa fever endemic region. Conclusions: History of recent travel to, or residence in, Lassa fever endemic region is an important clue for clinical diagnosis of Lassa fever. The 2011 CDC surveillance case definition and the modified Khan case definition for Lassa fever may aid clinical diagnosis of Lassa fever. Any clinically suspected case of Lassa fever should have a laboratory confirmation.
KeywordsImported Lassa FeverClinical Features of Lassa FeverClinical Diagnosis of Lassa Fever
Kofman, A., Choi, M.J. and Rollin, P.E. (2019) Lassa Fever in Travelers from West Africa, 1969-2016. Emerging Infectious Diseases, 25, 236-239. https://doi.org/10.3201/eid2502.180836
Frame, J.D., Baldwin Jr., J.M., Gocke, D.J. and Troup, J.M. (1970) Lassa Fever, a New Virus Disease of Man from West Africa. I. Clinical Description and Pathological Findings. The American Journal of Tropical Medicine and Hygiene, 19, 670-676. https://doi.org/10.4269/ajtmh.1970.19.670
Gilles, H.M. and Kent, J.C. (1976) Lassa Fever: Retrospective Diagnosis of Two Patients Seen in Great Britain in 1971. The BMJ, 2, 1173. https://doi.org/10.1136/bmj.2.6045.1173
Woodruff, A.W., Monath, T.P., Mahmoud, A.A., Pain, A.K. and Morris, C.A. (1973) Lassa Fever in Britain: An Imported Case. The BMJ, 3, 616-617. https://doi.org/10.1136/bmj.3.5881.616
Bowen, G.S., Tomori, O., Wulff, H., Casals, J., Noonan, A. and Downs, W.G. (1975) Lassa fever in Onitsha, East Central State, Nigeria in 1974. Bulletin of the World Health Organization, 52, 599-604. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2366632/
Macher, A.M. and Wolfe, M.S. (2006) Historical Lassa Fever Reports and 30-Year Clinical Update. Emerging Infectious Diseases, 12, 835-837. https://doi.org/10.3201/eid1205.050052
Lassa Fever Surveillance (1981). The Weekly Epidemiological Record, 6, 48.
Cooper, C.B., Gransden, W.R., Webster, M., King, M., O’Mahony, M., Young, S., et al. (1982) A Case of Lassa Fever: Experience at St Thomas’s Hospital. British Medical Journal, 285, 1003-1005. https://doi.org/10.1136/bmj.285.6347.1003
Emond, R.T., Bannister, B., Lloyd, G., Southee, T.J. and Bowen E.T.W. (1982) A Case of Lassa Fever: Clinical and Virological Findings. British Medical Journal, 285, 1001-1002. https://doi.org/10.1136/bmj.285.6347.1001
Public Health Laboratory Service Communicable Disease Centre (1983) Communicable Diseases. Lassa Fever 1982. British Medical Journal, 287, 48. https://doi.org/10.1136/bmj.287.6384.48
Schlaeffer, F., Bar-Lavie, Y., Sikuler, E., Alkan, M. and Keynan, A. (1988) Evidence against High Contagiousness of Lassa Fever. Transactions of The Royal Society of Tropical Medicine and Hygiene, 82, 311. https://doi.org/10.1016/0035-9203(88)90458-0
Hirabayashi, Y., Oka, S., Goto, H., Shimada, K., Kurata, T., Fisher-Hoch, S.P., et al. (1988) An Imported Case of Lassa Fever with Late Appearance of Polyserositis. The Journal of Infectious Diseases, 158, 872-875. https://doi.org/10.1093/infdis/158.4.872
Mahdy, M.S., Chiang, W., McLaughlin, B., Derksen, K., Truxton, B.H. and Neg, K. (1989) Lassa Fever: The First Confirmed Case Imported into Canada. Canada Communicable Disease Report, 15, 193-198.
Holmes, G.P., McCormick, J.B., Trock, S.C., Chase, R.A., Lewis, S.M., Mason, C.A., et al. (1990) Lassa Fever in the United States. Investigation of a Case and New Guidelines for Management. The New England Journal of Medicine, 323, 1120-1123. https://doi.org/10.1056/NEJM199010183231607
Haas, W.H., Breuer, T., Pfaff, G., Schmitz, H., Köhler, P., Asper, M., et al. (2003) Imported Lassa Fever in Germany: Surveillance and Management of Contact Persons. Clinical Infectious Diseases, 36, 1254-1258. https://doi.org/10.1086/374853
Günther, S., Weisner, B., Roth, A., Grewing, T., Asper, M., Drosten, C., et al. (2001) Lassa Fever Encephalopathy: Lassa Virus in Cerebrospinal Fluid but Not in Serum. The Journal of Infectious Diseases, 184, 345-349. https://doi.org/10.1086/322033
Kiehl, W. and Haas, W. (2000) A Case of Lassa Fever Imported into Wiesbaden, Germany. Euro Surveill, 4, 1615. https://doi.org/10.2807/esw.04.17.01615-en
Swaan, C.M., van den Broek, P.J., Wijnands, S. and van Steenbergen, J.E. (2002) Management of Viral Haemorrhagic Fever in the Netherlands. Euro Surveill, 7, 338. https://doi.org/10.2807/esm.07.03.00338-en
Wijnands, S. and van Steenbergen, J. (2000) Public Health Management of Fatal Case of Lassa Fever in the Netherlands. Euro Surveill, 4, 1552. https://doi.org/10.2807/esw.04.31.01552-en
WHO Collective (2000) Imported Case of Lassa Fever in the Netherlands. Euro Surveill, 4, 1557. https://doi.org/10.2807/esw.04.30.01557-en
Amorosa, V., MacNeil, A., McConnell, R., Patel, A., Dillon, K.E., Hamilton, K., et al. (2010) Imported Lassa Fever, Pennsylvania, USA, 2010. Emerging Infectious Diseases, 16, 1598-1600. https://doi.org/10.3201/eid1610.100774
Centers for Disease Control and Prevention (2014) Traveler Returning from West Africa. Contact Investigation under Way; Risk to Other Travelers Considered Extremely Low. https://www.cdc.gov/media/releases/2014/p0404-lassa-fever.html
Choi, M.J., Worku, S., Knust, B., Vang, A., Lynfield, R., Mount, M.R., et al. (2018) A case of Lassa Fever Diagnosed at a Community Hospital—Minnesota 2014. Open Forum Infectious Diseases, 5, Article No. ofy131. https://doi.org/10.1093/ofid/ofy131
Kulkarni, P.A., Chew, D., Youssef-Bessler, M., Hamdi, H.A., Montoya, L.A., Cervantes, K.B., et al. (2018) Case Report: Imported Case of Lassa Fever—New Jersey, May 2015. The American Journal of Tropical Medicine and Hygiene, 99, 1062-1065. https://doi.org/10.4269/ajtmh.17-0316
Raabe, V.N., Kann, G., Ribner, B.S., Morales, A., Varkey, J.B., Mehta, A.K., et al. (2017) Emory Serious Communicable Diseases Unit. Favipiravir and Ribavirin Treatment of Epidemiologically Linked Cases of Lassa Fever. Clinical Infectious Diseases, 65, 855-859. https://doi.org/10.1093/cid/cix406
Grahn, A., Bråve, A., Lagging, M., Dotevall, L., Ekqvist, D., Hammarström, H., et al. (2016) Imported Case of Lassa Fever in Sweden with Encephalopathy and Sensorineural Hearing Deficit. Open Forum Infectious Diseases, 3, ofw198. https://doi.org/10.1093/ofid/ofw198 https://academic.oup.com/ofid/article/3/4/ofw198/2343991
World Health Organization (2016) Lassa Fever—Sweden. https://www.who.int/emergencies/disease-outbreak-news/item/8-april-2016-lassa-fever-sweden-en
Wolf, T., Ellwanger, R., Goetsch, U., Wetzstein, N., Gottschalk, R. (2020) Fifty Years of Imported Lassa Fever: A Systematic Review of Primary and Secondary Cases. Journal of Travel Medicine, 27, Article No. taaa035. https://doi.org/10.1093/jtm/taaa035
European Centre for Disease Prevention and Control (2020, April 30) Lassa Fever. https://www.ecdc.europa.eu/en/lassa-fever
Lehmann, C., Kochanek, M., Abdulla, D., Becker, S., Böll, B., Bunte, A., et al. (2017) Control Measures Following a Case of Imported Lassa Fever from Togo, North Rhine Westphalia, Germany, 2016. Euro Surveillance, 22, 17-00088. https://doi.org/10.2807/1560-7917.ES.2017.22.39.17-00088
Ajayi, N.A., Nwigwe, C.G., Azuogu, B.N., Onyire, B.N., Nwonwu, E.U., Ogbonnaya, L.U., et al. (2013) Containing a Lassa Fever Epidemic in a Resource-Limited Setting: Outbreak Description and Lessons Learned from Abakaliki, Nigeria (January-March 2012). International Journal of Infectious Diseases, 17, e1011-e1016. https://doi.org/10.1016/j.ijid.2013.05.015
Woyessa, A.B., Maximore, L., Keller, D., Dogba, J., Pajibo, M., Johnson, K., et al. (2019) Lesson Learned from the Investigation and Response of Lassa Fever Outbreak, Margibi County, Liberia, 2018: Case Report. BMC Infectious Diseases, 19, Article No. 610. https://doi.org/10.1186/s12879-019-4257-z
Abdulkarim, M.A., Babale, S.M., Umeokonkwo, C.D., Bamgboye, E.A., Bashorun, A.T., et al. (2020) Epidemiology of Lassa Fever and Factors Associated with Deaths, Bauchi State, Nigeria, 2015-2018. Emerging Infectious Diseases, 26, 799-801. https://doi.org/10.3201/eid2604.190678
Mateer, E.J., Huang, C., Shehu, N.Y. and Paessler, S. (2018) Lassa Fever-Induced Sensorineural Hearing Loss: A Neglected Public Health and Social Burden. PLOS Neglected Tropical Diseases, 12, Article ID: e0006187. https://doi.org/10.1371/journal.pntd.0006187
World Health Organization (2017) Lassa Fever Fact Sheet 2017. http://www.who.int/mediacentre/factsheets/fs179/en/
Centers for Disease Control and Prevention (2014) Lassa Fever. https://www.cdc.gov/vhf/lassa/transmission/index.html
Ehichioya, D.U., Asogun, D.A., Ehimuan, J., Okokhere, P.O., Pahlmann, M., Olschläger, S., Becker-Ziaja, B., Günther, S. and Omilabu, S.A. (2012) Hospital-Based Surveillance for Lassa Fever in Edo State, Nigeria, 2005-2008. Tropical Medicine & International Health, 17, 1001-1004. https://doi.org/10.1111/j.1365-3156.2012.03010.x
Maigari, I.M., Jibrin, Y.B., Umar, M.S., Lawal, S.M. and Gandi, A.Y. (2018) Descriptive Features of Lassa Fever in Bauchi, Northeastern Nigeria—A Retrospective Review. Research Journal of Health Sciences, 6, 149-156. https://doi.org/10.4314/rejhs.v6i3.7
Bausch, D.G., Rollin, P.E., Demby, A.H., Coulibaly, M., Kanu, J., Conteh, A.S., et al. (2000) Diagnosis and Clinical Virology of Lassa Fever as Evaluated by Enzyme-Linked Immunosorbent Assay, Indirect Fluorescent-Antibody Test, and Virus Isolation. Journal of Clinical Microbiology, 38, 2670-2677. https://doi.org/10.1128/JCM.38.7.2670-2677.2000
Dahmane, A., van Griensven, J., Van Herp, M., Van den Bergh, R., Nzomukunda, Y., Prior, J., et al. (2014) Constraints in the Diagnosis and Treatment of Lassa Fever and the Effect on Mortality in Hospitalized Children and Women with Obstetric Conditions in a Rural District Hospital in Sierra Leone. Transactions of the Royal Society of Tropical Medicine and Hygiene, 108, 126-132. https://doi.org/10.1093/trstmh/tru009
Buba, M.I., Dalhat, M.M., Nguku, P.M., Waziri, N., Mohammad, J.O., Bomoi, I.M., et al. (2018) Mortality among Confirmed Lassa Fever Cases during the 2015-2016 Outbreak in Nigeria. American Journal of Public Health, 108, 262-264. https://doi.org/10.2105/AJPH.2017.304186
Omeh, D.J., Achinge, G.I. and Echekwube, P.O. (2017) Lassa Fever in West Africa: A Clinical and Epidemiological Review. Journal of Advances in Medicine and Medical Research, 24, 1-12. https://doi.org/10.9734/JAMMR/2017/37171
Ficenec, S.C., Percak, J., Arguello, S., Bays, A., Goba, A., Gbakie, M., Shaffer, J.G., Emmett, S.D., Schieffelin, J.S. and Bausch, D. (2020) Lassa Fever Induced Hearing Loss: The Neglected Disability of Hemorrhagic Fever. International Journal of Infectious Diseases, 100, 82-87. https://doi.org/10.1016/j.ijid.2020.08.021
Dzotsi, E.K., Ohene, S.A., Asiedu-Bekoe, F., Amankwa, J., Sarkodie, B., Adjabeng, M., et al. (2012) The First Cases of Lassa Fever in Ghana. Ghana Medical Journal, 46, 166-170.
Gary, J.M., Welch, S.R. and Ritter, J.M. (2019) Lassa Virus Targeting of Anterior Uvea and Endothelium of Cornea and Conjunctiva in Eye of Guinea Pig Model. Emerging Infectious Diseases, 25, 865-874. https://doi.org/10.3201/eid2505.181254
Mock, C.N., Amaral, J. and Visser, L.E. (1992) Improvement in Survival from Typhoid Ileal Perforation. Results of 221 Operative Cases. Annals of Surgery, 215, 244-249. https://doi.org/10.1097/00000658-199203000-00008
Okokhere, P., Colubri, A., Azubike, C., Iruolagbe, C., Osazuwa, O., Tabrizi, S., et al. (2018) Clinical and Laboratory Predictors of Lassa Fever Outcome in a Dedicated Treatment Facility in Nigeria: A Retrospective, Observational Cohort Study. The Lancet Infectious Diseases, 18, 684-695. https://doi.org/10.1016/S1473-3099(18)30121-X
Shaffer, J.G., Grant, D.S., Schieffelin, J.S., Boisen, M.L., Goba, A., Hartnett, J.N., Levy, D.C., et al. (2014) Lassa Fever in Post-Conflict Sierra Leone. Viral Hemorrhagic Fever Consortium. PLOS Neglected Tropical Diseases, 8, Article No. e2748. https://doi.org/10.1371/journal.pntd.0002748
Centers for Disease Control and Prevention (2011) National Notifiable Diseases Surveillance System (NNDSS), Viral Hemorrhagic Fever. https://ndc.services.cdc.gov/case-definitions/viral-hemorrhagic-fever-2011/