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. 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.)

Signs and Symptoms

The symptoms of Lujo hemorrhagic fever, as described in the five patients in the original cluster outbreak, resemble those of severe Lassa Fever. After an incubation period of 7 to 13 days, the clinical course started by a non-specific febrile illness accompanied by headache and muscle pain.

The disease increases in severity, with:

• a morbilliform rash of the face and trunk
• face and neck swelling
• pharyngitis (sore throat)
• diarrhea

Bleeding was not a prominent feature during the illness.

In the fatal cases (4/5 patients), a transient improvement was followed by:

• rapid deterioration with respiratory distress
• neurological signs and circulatory collapse

Death occurred 10 to 13 days after onset.

Diagnosis

During the acute febrile phase, Lujo virus was isolated from blood from days 2 to 13 after onset. Virus was also isolated from liver tissue obtained post-mortem. A subsequent complete genomic analysis of Lujo virus facilitated the development of specific molecular detection (RT-PCR) assays.

Treatment

Supportive therapy is important in Lujo hemorrhagic fever. This includes:

• maintenance of hydration
• management of shock
• sedation
• pain relief
• usual precautions for patients with bleeding disorders
• 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. Ribavirin has been considered for preventing development of disease in people exposed to other arenaviruses.