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. 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. 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). Treatment of arenavirus hemorrhagic fevers with convalescent plasma therapy reduces mortality significantly and anectodal evidence from the only surviving Lujo patient.
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. Due to the risk of secondary transmission, viral hemorrhagic fever precautions should be implemented for all cases of Lujo virus infection, with specialized precautions to protect against aerosols when performing enhanced-risk procedures such as endotracheal intubation.