Lujo hemorrhagic fever (LUHF) is caused by Lujo virus, a single-stranded virus of the Arenaviridae family. The limited clinical information about LUHF comes from a small, nosocomial cluster of hemorrhagic disease in September-October 2008 involving 5 patients in South Africa. The case fatality rate was 80% (4/5 cases). The first patient, whose source of infection was unknown, was the source of infection of 3 health care workers.
The distribution of this newly described arenavirus is uncertain. A tertiary infection occurred in a fourth healthcare worker who received ribavirin treatment and was the only survivor. Lujo virus is the second African hemorrhagic fever virus described. (Lassa virus was identified in 1969). We describe the clinical features of five cases of Lujo hemorrhagic fever and summarize their clinical management, as well as providing additional epidemiologic detail regarding the 2008 outbreak.
Supportive therapy is important in Lujo hemorrhagic fever. This includes: 1)maintenance of hydration, 2) management of shock, 3) sedation, 4) pain relief, 5) usual precautions for patients with bleeding disorders, 6) transfusions (when necessary). Treatment of arenavirus hemorrhagic fevers with convalescent plasma therapy reduces mortality significantly and anectodal evidence from the only surviving Lujo patient shows that the antiviral drug ribavirin may hold promise in the treatment of LUHF.
Illness typically began with the abrupt onset of fever, malaise, headache, and myalgias followed successively by sore throat, chest pain, gastrointestinal symptoms, rash, minor hemorrhage, subconjunctival injection, and neck and facial swelling over the first week of illness. No major hemorrhage was noted. Neurological signs were sometimes seen in the late stages. Lujo virus causes a clinical syndrome remarkably similar to Lassa fever.