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 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.
The distribution of this newly described arenavirus is uncertain. 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).
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. Ribavirin has been considered for preventing development of disease in people exposed to other arenaviruses.
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. 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.