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Another form of Lassa fever? Early neurological symptoms and high mortality reveal differences in two outbreaks in Ebonyi State, Nigeria 2017–2019Chika-Igwenyi, N; Harrison, RE; Unigwe, U; Psarra, C; Onwe Ogah, E; Ajayi, N; Onoh, R; Ugwu, C; Reid, A (International Society for Infectious Diseases, 2020-12-01)Background: Lassa fever (LF) is an acute viral haemorrhagic illness with various clinical manifestations. Neurological symptoms are not commonly present at the early stage of the disease; however, early manifestation of central nervous system features depicts poor prognostication. In Ebonyi state, an unusual pattern was observed between two outbreaks with patients presenting early neurological symptoms and a high mortality rate in the second outbreak. The study described the epidemiological evolution, socio-demographic profiles, clinical characteristics and patients’ outcomes. Methods and materials: A retrospective analytic analysis of routinely collected clinical data was conducted of all confirmed and probable LF patients admitted to the Virology Centre of the AEFUTHA in Ebonyi State, December 2017 to January 2019. Results: In a total of 83 cases, 70 were RT-PCR confirmed and 13 probable cases. In outbreak 1, 69 were seen with 53.6% being urban residents, 19% farmers, 15% students, and 10% health workers. Fourteen cases were seen in outbreak 2 with 92.9% rural residents, 58.3% being farmers and 49.9% students. There were differences in clinical and laboratory signs and symptoms between the two outbreaks with neurological symptoms present 43% of the time in outbreak 1 and 93% in outbreak 2 (p = 0.001), with a shorter time of onset for these symptoms in outbreak 2. The mortality rate was 85.7% in outbreak 2 versus 29.9% in outbreak 1 (p < 0.001). Patients with neurological symptoms, who were more common in outbreak 2 had a RR of dying of 8.5 compared to those without. Conclusion: This study revealed a different form of LF that is of great concern due to its high mortality rate. Further studies are needed to better define its characteristics.
Early onset of neurological features differentiates two outbreaks of Lassa fever in Ebonyi state, Nigeria during 2017-2018.Chika-Igwenyi, NM; Harrison, RE; Psarra, C; Gil Cuesta, J; Gulamhusein, M; Onwe, EO; Onoh, RC; Unigwe, US; Ajayi, NA; Nndadozie, UU; et al. (Public Library of Science, 2021-03-08)Lassa fever (LF) is an acute viral haemorrhagic illness with various non-specific clinical manifestations. Neurological symptoms are rare at the early stage of the disease, but may be seen in late stages, in severely ill patients.The aim of this study was to describe the epidemiological evolution, socio-demographic profiles, clinical characteristics, and outcomes of patients seen during two Lassa fever outbreaks in Ebonyi State, between December 2017 and December 2018. Routinely collected clinical data from all patients admitted to the Virology Centre of the hospital during the period were analysed retrospectively. Out of a total of 83 cases, 70(84.3%) were RT-PCR confirmed while 13 (15.7%) were probable cases. Sixty-nine (83.1%) patients were seen in outbreak 1 of whom 53.6% were urban residents, while 19%, 15%, and 10% were farmers, students and health workers respectively. There were 14 (16.8%) patients, seen in second outbreak with 92.9% rural residents. There were differences in clinical symptoms, signs and laboratory findings between the two outbreaks. The case fatality rates were 29.9% in outbreak 1 and 85.7% for outbreak 2. Neurological features and abnormal laboratory test results were associated with higher mortality rate, seen in outbreak 2. This study revealed significant differences between the two outbreaks. Of particular concern was the higher case fatality during the outbreak 2 which may be from a more virulent strain of the Lassa virus. This has important public health implications and further molecular studies are needed to better define its characteristics.