Alex-Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria.
Alex-Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria.
Int J Infect Dis. 2019 Dec;89:84-86. doi: 10.1016/j.ijid.2019.08.023. Epub 2019 Aug 26.
The signs and symptoms of Lassa fever are initially indistinguishable from other febrile illnesses common in the tropics and complications of pregnancy. Surviving Lassa fever during pregnancy is rare. Only few cases have been documented. The antiviral drug of choice is ribavirin.
A 25-year-old multigravida farmer with fever who was initially thought to have malaria in pregnancy at 29 weeks gestation. Further changes in her clinical state and laboratory tests led to a confirmation of Lassa fever. The Liver enzymes were markedly deranged and the packed cell volume was 27%. She commenced on ribavirin and subsequently was delivered of a live male neonate who was RT PCR negative for Lassa fever virus. Her clinical state improved, repeat RT PCR on day 15 was negative and she made full recovery.
The case reported had similar clinical features of fever and abdominal pain and resulted in the initial diagnoses of Malaria in pregnancy. When she failed to respond to antimalarial and antibiotics treatments, a strong suspicion of viral hemorrhagic fever was made. At this time the patient was in advanced stage of the disease with bleeding from vagina and puncture sites. On the third day of admission she was delivered of a live male neonate who remained negative after 2 consecutive RT PCR tests for Lassa fever virus. Lassa fever carries a high risk of death to the fetus throughout pregnancy and to the mother in the third trimester. Mothers with Lassa fever improved rapidly after evacuation of the uterus by spontaneous abortion, or normal delivery. She was clinically stable following delivery. Her laboratory investigations were essentially normal. Throughout her management transmission based precautions were observed. None of the six close contacts developed symptoms after been followed up for 21 days.
This report adds to the body of literature that individuals can survive Lassa fever during pregnancy with good maternal and fetal outcome.
拉沙热的症状最初与热带地区常见的其他发热疾病无法区分，且妊娠会使拉沙热复杂化。孕妇感染拉沙热后能幸存下来的情况非常罕见。仅有少数病例有记录。利巴韦林是抗病毒的首选药物。
一名 25 岁的多产妇农民，怀孕 29 周时最初被认为患有疟疾发热。她的临床状态和实验室检查结果进一步变化，确诊为拉沙热。肝酶显著异常，红细胞压积为 27%。她开始接受利巴韦林治疗，随后生下一名男性活产儿，其拉沙热病毒实时逆转录聚合酶链反应（RT-PCR）检测结果为阴性。她的临床状态有所改善，第 15 天的重复 RT-PCR 结果为阴性，完全康复。
报告的病例具有类似的发热和腹痛的临床特征，最初被诊断为妊娠疟疾。当她对抗疟和抗生素治疗没有反应时，强烈怀疑为病毒性出血热。此时，患者处于疾病晚期，阴道和穿刺部位出血。入院第三天，她生下一名男性活产儿，连续两次 RT-PCR 检测拉沙热病毒均为阴性。拉沙热病毒在整个妊娠期间对胎儿和妊娠晚期的母亲都有很高的死亡风险。患有拉沙热的母亲通过自然流产或正常分娩排出子宫后，病情迅速改善。她在分娩后临床稳定。她的实验室检查基本正常。在整个管理过程中，均采取了基于传播途径的预防措施。在随访 21 天后，六名密切接触者均未出现症状。
本报告增加了文献记录，表明孕妇可在感染拉沙热后幸存下来，母婴结局良好。
