Ogbaini-Emovon Ephraim, Akpede George, Okogbenin Sylvanus, Osagiede Emmanuel, Tobin Ekaete, Asogun Danny, Okokhere Peter, Okonofua Martha, Akpede Nosa, Akhideno Peter, Erameh Cyril, Rafiu Mojeed, Azubuike Chukwuemeka, Iraoya Kelly, Iruolagbe Chris, Erohubie Christian, Ahmed Dazumi, Ediawe Osahogie, Okoguale Joseph, Eifediyi Reuben, Odia Ikponmwonsa, Agbukor Jacqueline, Adomeh Donatus, Odike Maxy A C, Ovienria Wilson, Elkanem Anieno, Muoebenam Ekene B, Ojide Kingsley C, Pallasch Elisa, Müller Jonas, Hinzmann Julia, Günther Stephan, Pahlmann Meike, Thielebein Anke, Duraffour Sophie, Oestereich Lisa, Krumkamp Ralf
Institute of Viral Haemorrhagic Fever and Emergent Pathogens, Irrua Specialist Teaching Hospital, Irrua, Nigeria.
Department of Pediatrics, Irrua Specialist Teaching Hospital, Irrua, Nigeria.
Open Forum Infect Dis. 2024 Oct 15;11(10):ofae575. doi: 10.1093/ofid/ofae575. eCollection 2024 Oct.
The standard of care for Lassa fever is the use of ribavirin with supportive therapy. There is little information on the course of viremia and its relationship with clinical outcomes in patients treated with ribavirin.
We conducted a retrospective analysis of virologic and clinical parameters of 152 reverse transcription polymerase chain reaction-confirmed Lassa fever cases admitted and treated with ribavirin therapy. We describe the Lassa virus RNA kinetics in blood in relation to the clinical course of the patients.
The overall mortality was 9%. The median duration (interquartile range [IQR]) of illness before admission was 8 (5-12) days. Median (IQR) Ct values on admission ( ) were lower among patients who died (21 [20-27]) than in those who survived (34 [30-37]; < .01). The receiver operating characteristics curve of the association between outcome and Ct value at had a high classification performance, with an AUC of 0.92 (95% CI, 0.86-0.98). The median time to viral clearance (IQR) was 10 (5-15) days. The viral load decreased steadily with the duration of treatment, and all survivors achieved viral clearance within 25 days of hospitalization.
Our study demonstrates that the Ct value on admission has prognostic value and Lassa fever patients treated with ribavirin typically clear the virus within 3-4 weeks of hospitalization. This kinetics has implications for the design of clinical case management and future clinical trial protocols.
拉沙热的标准治疗方法是使用利巴韦林并辅以支持性治疗。关于接受利巴韦林治疗的患者病毒血症病程及其与临床结局的关系，相关信息较少。
我们对152例经逆转录聚合酶链反应确诊并接受利巴韦林治疗的拉沙热病例的病毒学和临床参数进行了回顾性分析。我们描述了血液中拉沙病毒RNA动力学与患者临床病程的关系。
总死亡率为9%。入院前疾病的中位持续时间（四分位间距[IQR]）为8（5 - 12）天。死亡患者入院时的中位（IQR）Ct值（ ）低于存活患者（分别为21[20 - 27]和34[30 - 37]； <.01）。结局与入院时Ct值之间关联的受试者工作特征曲线具有较高的分类性能，曲线下面积（AUC）为0.92（95%CI，0.86 - 0.98）。病毒清除的中位时间（IQR）为10（5 - 15）天。病毒载量随治疗持续时间稳步下降，所有存活患者在住院25天内实现病毒清除。
我们的研究表明，入院时的Ct值具有预后价值，接受利巴韦林治疗的拉沙热患者通常在住院3 - 4周内清除病毒。这种动力学对临床病例管理设计和未来临床试验方案具有重要意义。
