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. 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).
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.
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.