Manifestations and outcomes of lassa fever in Nigerian children: a case series
Background Lassa fever is a viral haemorrhagic fever due to infection by the lassa virus (LV). it is acquired by man through contaminated food or close contact with infected persons or rats. The reservoir is Mastomys Natalensis, a peri-domestic multi-mammate rat.
The LV is hepatotopic, lymphoreticulotropic, pneumotropic and myocardiotropic. The effects are therefore pansystemic.
The Lassa fever is endemic in some parts of Nigeria and outbreaks have been reported in some other countries in the West African sub-region. Both the spectrum of infection, clinical manifestations and course are diverse.
Manifestations vary from subclinical infection through moderate illness to fulminant Lassa Fever. The early stage of the disease can easily be mistaken for malaria, tonsillopharyngitis or gastroenteritis. Prompt diagnosis, though life-saving can be very challenging in the absence of a high index of suspicion. We present five cases with different manifestations.
Aim To describe the various clinical features and highlight the unusual manifestations of Lassa Fever in children.
Method Data was obtained from case notes of children with confirmed Lassa Fever in our institution in 2011.
Case summaries CASE 1: A 1 year old boy seen with fever, bloody diarrhoea, vomiting, hepatosplenomegaly who developed haemorrhage (with normal platelet count), convulsion, coma and features of intestinal obstruction.
CASE 2: A 7 old boy seen with fever, haematemesis, tonsilitis, hepatomegaly and thrombocytopenia.
CASE 3: A 6 year old girl with fever, vomiting, gastritis and tonsilitis.
CASE 4: A 15 year old boy with fever, headache, vomiting, gastritis, thrombocytopenia, and haematuria who subsequently developed haemorrhage, haematemesis, acute renal failure, convulsion and coma.
CASE 5: A 13 year old boy with fever, headache, vomiting, gastritis, nuchal rigidity, tonsilitis, haematuria, azotemia and thrombocytosis.
Two of the cases were fatalities, while three recovered fully.
Conclusion The clinical features of Lassa fever are myriad and in the early stages mimic other common infectious diseases. Fever is a constant feature, while haemorrhage, acute renal failure, convulsion and coma are indicators of poor outcome.