title: Molecular diagnostics for lassa fever at Irrua specialist teaching hospital, Nigeria: lessons learnt from two years of laboratory operation.
abstract: BACKGROUND
  Lassa fever is a viral hemorrhagic fever endemic in West Africa. However, none of the hospitals in the endemic areas of Nigeria has the capacity to perform Lassa virus diagnostics. Case identification and management solely relies on non-specific clinical criteria. The Irrua Specialist Teaching Hospital (ISTH) in the central senatorial district of Edo State struggled with this challenge for many years.
  
  
  RESULTS
  A laboratory for molecular diagnosis of Lassa fever, complying with basic standards of diagnostic PCR facilities, was established at ISTH in 2008. During 2009 through 2010, samples of 1,650 suspected cases were processed, of which 198 (12%) tested positive by Lassa virus RT-PCR. No remarkable demographic differences were observed between PCR-positive and negative patients. The case fatality rate for Lassa fever was 31%. Nearly two thirds of confirmed cases attended the emergency departments of ISTH. The time window for therapeutic intervention was extremely short, as 50% of the fatal cases died within 2 days of hospitalization--often before ribavirin treatment could be commenced. Fatal Lassa fever cases were older (p = 0.005), had lower body temperature (p<0.0001), and had higher creatinine (p<0.0001) and blood urea levels (p<0.0001) than survivors. Lassa fever incidence in the hospital followed a seasonal pattern with a peak between November and March. Lassa virus sequences obtained from the patients originating from Edo State formed--within lineage II--a separate clade that could be further subdivided into three clusters.
  
  
  CONCLUSIONS
  Lassa fever case management was improved at a tertiary health institution in Nigeria through establishment of a laboratory for routine diagnostics of Lassa virus. Data collected in two years of operation demonstrate that Lassa fever is a serious public health problem in Edo State and reveal new insights into the disease in hospitalized patients.
authors.affiliation: Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Edo State, Nigeria.
authors.forename: Danny A
authors.initials: DA
authors.lastname: Asogun
authors.forename: Donatus I
authors.initials: DI
authors.lastname: Adomeh
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Ehimuan
authors.forename: Ikponmwonsa
authors.initials: I
authors.lastname: Odia
authors.forename: Meike
authors.initials: M
authors.lastname: Hass
authors.forename: Martin
authors.initials: M
authors.lastname: Gabriel
authors.forename: Stephan
authors.initials: S
authors.lastname: Olschläger
authors.forename: Beate
authors.initials: B
authors.lastname: Becker-Ziaja
authors.forename: Onikepe
authors.initials: O
authors.lastname: Folarin
authors.forename: Eric
authors.initials: E
authors.lastname: Phelan
authors.forename: Philomena E
authors.initials: PE
authors.lastname: Ehiane
authors.forename: Veritas E
authors.initials: VE
authors.lastname: Ifeh
authors.forename: Eghosasere A
authors.initials: EA
authors.lastname: Uyigue
authors.forename: Yemisi T
authors.initials: YT
authors.lastname: Oladapo
authors.forename: Ekene B
authors.initials: EB
authors.lastname: Muoebonam
authors.forename: Osagie
authors.initials: O
authors.lastname: Osunde
authors.forename: Andrew
authors.initials: A
authors.lastname: Dongo
authors.forename: Peter O
authors.initials: PO
authors.lastname: Okokhere
authors.forename: Sylvanus A
authors.initials: SA
authors.lastname: Okogbenin
authors.forename: Mojeed
authors.initials: M
authors.lastname: Momoh
authors.forename: Sylvester O
authors.initials: SO
authors.lastname: Alikah
authors.forename: Odigie C
authors.initials: OC
authors.lastname: Akhuemokhan
authors.forename: Peter
authors.initials: P
authors.lastname: Imomeh
authors.forename: Maxy A C
authors.initials: MA
authors.lastname: Odike
authors.forename: Stephen
authors.initials: S
authors.lastname: Gire
authors.forename: Kristian
authors.initials: K
authors.lastname: Andersen
authors.forename: Pardis C
authors.initials: PC
authors.lastname: Sabeti
authors.forename: Christian T
authors.initials: CT
authors.lastname: Happi
authors.forename: George O
authors.initials: GO
authors.lastname: Akpede
authors.forename: Stephan
authors.initials: S
authors.lastname: Günther
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007835:Lassa Fever / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D007836:Lassa virus / Q000235:genetics / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D008969:Molecular Sequence Data; D009549:Nigeria; D016133:Polymerase Chain Reaction / Q000379:methods*; D012367:RNA, Viral / Q000235:genetics; D012254:Ribavirin / Q000627:therapeutic use; D017422:Sequence Analysis, DNA; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D012367:RNA, Viral; D012254:Ribavirin