LASSA FEVER MASQUERADING AS PEUERPERAL SEPSIS
Formerly published in Vol. 6 No. 1 Jan. - Mar., 2022
Keywords:
Lassa fever, puerperal sepsisAbstract
Introduction
Lassa fever is an animal-borne, or zoonotic, acute viral illness. It is endemic in parts of West Africa including Sierra Leone, Liberia, Guinea and Nigeria. Neighboring countries are also at risk, as the animal vector for Lassa virus, the “multimammate rat” (Mastomys natalensis) is distributed throughout the region. The signs and symptoms of Lassa fever are initially indistinguishable from other febrile illnesses common in the tropics like; malaria, typhoid, dengue, yellow fever, and other viral hemorrhagic fevers which can complicates pregnancy and puerperium.
Clinical Presentation
Mrs. R A was a 19-year-old married woman who presented via the Gynaecological emergency clinic with complaints of high grade continuous fever of 5 days’ duration, which as well started 9 days’ post-delivery. The pregnancy was booked and she attended antenatal clinic (ANC) at a General Hospital where she had vaginal delivery of fresh stillborn. There was no history of contact with any person with febrile illness in the 3 weeks prior to presentation, though she had history of eating uncovered foods/left overs and had contact with rats in her house. She was acutely ill, febrile (T -38.5⁰c), not pale, but dehydrated. Pulse rate of 120b/m and hypotensive (blood pressure of 90/50 mmHg).
Initial diagnosis was that of Puerperal sepsis (septic shock). She was resuscitated with intravenous fluid had intravenous antibiotics. However, 72 hours after patient was still febrile, Temperature ranged between 38.8⁰C and 40.1⁰C. A diagnosis of Lassa fever was entertained and she was reviewed further by physicians, nursed in an isolated facility and samples were taken and sent for RT-PCR which confirmed diagnosis of Lassa fever.
Patient was commenced on intravenous Ribavirin and by the 6th day she was clinically stable, afebrile; however, had a reduction in PCV to 22% and she was transfused with 3 units of packed cells.
Conclusion
A case of Lassa fever initially thought to be puerperium sepsis was managed successfully. The infection is highly contagious with high morbidity and mortality. The clinicians should have high index of suspicion in patients with high grade fever who does not response to conventional treatment with antibiotics.
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References
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