Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, USA.
Virol J. 2011 Aug 15;8:404. doi: 10.1186/1743-422X-8-404.
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.
拉沙热（LF）是一种在西非流行的严重病毒性疾病。由于缺乏基础设施和在疾病流行地区快速部署的现场诊断能力，应对这一公共卫生危机的努力受到了阻碍。塞拉利昂凯内马政府医院拉沙热病房（KGH LFW）最近的能力建设为 LF 的诊断、治疗和研究带来了重大转折点。本文介绍了在 KGH LFW 首次对急性出血性 LF 病例进行的综合快速诊断和实时特征描述。本病例报告重点介绍了一位来自历史上非疫区通科利利北部地区的塞拉利昂第三孕期孕妇，尽管胎儿死亡，但她仍幸存下来。本研究采用了新开发的重组 LASV 抗原快速检测试剂盒和试纸侧向流动免疫分析（LFI），可在样本采集后二十分钟内诊断 LF。在住院期间，广泛研究了整体内环境平衡失调、肝肾功能系统显著受累和免疫特征。快速诊断、及时用完整疗程的静脉内（IV）利巴韦林治疗、IV 液管理以及实时监测临床参数，尽管在症状出现后七天、胎儿死亡和自然分娩时入院到 LFW，但仍使产妇获得了积极的结果。这些研究巩固了 KGH LF 实验室日益增长的快速诊断、治疗和监测能力，并有潜力显著降低 LF 目前的高死亡率。由于能力的提高，我们还能够从患者中分离出拉沙病毒（LASV）RNA，并进行 Sanger 测序，发现与塞拉利昂常见流行株存在显著的遗传差异，显示出发现具有扩展地理分布的新出现 LASV 株的潜力。此外，最近在塞拉利昂北部出现 LF 病例突显了需要更好的诊断方法来帮助监测 LASV 株的遗传分化，这可能会导致地理范围的潜在扩大。
