Lujo hemorrhagic fever (LUHF) is caused by Lujo virus, a single-stranded virus of the Arenaviridae family. The first patient, whose source of infection was unknown, was the source of infection of 3 health care workers. 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.)
The distribution of this newly described arenavirus is uncertain. 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. Ribavirin has been considered for preventing development of disease in people exposed to other arenaviruses.
Distinguishing characteristics of her care which could have played a role in her survival include rapid commencement of ribavirin (oral ribavirin was begun on ID-1 with conversion to IV on ID-8), and the administration of recombinant factor VIIa, N-acetylcysteine, and atorvastatin on ID 2. Supportive therapy is important in Lujo hemorrhagic fever. This includes: 1)maintenance of hydration, 2) management of shock, 3) sedation, 4) pain relief.
Shock and multi-organ system failure, often with evidence of disseminated intravascular coagulopathy, ensued in the second week, with death in four of the five cases. Distinctive treatment components of the one surviving patient included rapid commencement of the antiviral drug ribavirin and administration of HMG-CoA reductase inhibitors (statins), N-acetylcysteine, and recombinant factor VIIa. Lujo virus causes a clinical syndrome remarkably similar to Lassa fever.