Lujo hemorrhagic fever (LUHF) is caused by Lujo virus, a single-stranded virus of the Arenaviridae family. 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. 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.
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.
There was little opportunity for uniformity of clinical approach. Management of the non-survivors included IV fluids (4/4); broad spectrum antibiotics (4/4); transfusion of packed red blood cells, platelets, and fresh frozen plasma (2/4); hemodialysis (2/4); mechanical ventilation (2/4); plasmapheresis (1/4); and oral ribavirin (1/4, but the patient received only three doses before death). The surviving patient received many of these same treatments.
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.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.