title: Monitoring of clinical and laboratory data in two cases of imported Lassa fever.
abstract: During 2000, four cases of fatal Lassa fever were imported from Africa to Europe. In two patients, consecutive serum samples were available for monitoring of virus load and cytokine levels in addition to standard laboratory data. Both patients had non-specific early clinical symptoms including high fever. Patient 1 developed multi-organ failure and died of hemorrhagic shock on day 15 of illness, while patient 2 died of respiratory failure due to aspiration without hemorrhage on day 16. Ribavirin was administered to both patients beginning only on day 11. High serum aspartate aminotransferase and lactate dehydrogenase (LDH) levels were remarkable in both patients. Patient 1 had an initial virus load of 10(6) S RNA copies/ml as measured by real-time RT-PCR. Viremia increased steadily and reached a plateau of approximately 10(8)-10(9) copies/ml 4 days before death, while IFN-gamma and TNF-alpha rose to extremely high levels only shortly before death. In contrast, in patient 2 the virus load decreased from 10(7) to 10(6) copies/ml during the late stage of illness which was paralleled by a decrease in the IFN-gamma and TNF-alpha levels. The IL-10 level increased when specific IgM and IgG appeared. These data suggest that a high virus load and high levels of pro-inflammatory cytokines in the late stage of Lassa fever play an important role in the pathogenesis of hemorrhage, multi-organ failure, and shock in Lassa fever.
authors.affiliation: Department of Virology, Bernhard-Nocht-Institute for Tropical Medicine, Bernhard-Nocht-Str.74, 20359 Hamburg, Germany. schmitz@bni.uni-hamburg.de
authors.forename: Herbert
authors.initials: H
authors.lastname: Schmitz
authors.forename: Bernhard
authors.initials: B
authors.lastname: Köhler
authors.forename: Thomas
authors.initials: T
authors.lastname: Laue
authors.forename: Christian
authors.initials: C
authors.lastname: Drosten
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Veldkamp
authors.forename: Stephan
authors.initials: S
authors.lastname: Günther
authors.forename: Petra
authors.initials: P
authors.lastname: Emmerich
authors.forename: Hans P
authors.initials: HP
authors.lastname: Geisen
authors.forename: Klaus
authors.initials: K
authors.lastname: Fleischer
authors.forename: Matthias F C
authors.initials: MF
authors.lastname: Beersma
authors.forename: Achim
authors.initials: A
authors.lastname: Hoerauf
mesh_terms: D000328:Adult; D000349:Africa; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D016207:Cytokines / Q000378:metabolism; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007835:Lassa Fever / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology* / Q000821:virology*; D007836:Lassa virus / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012254:Ribavirin / Q000627:therapeutic use; D014195:Travel; D019562:Viral Load; D014766:Viremia
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D016207:Cytokines; D012367:RNA, Viral; D012254:Ribavirin