An unsuspected yellow fever and lassa fever in a tertiary healthcare facility in Jos, North Central, Nigeria: a case report

Abstract

Background: Yellow Fever and Lassa Fever are both zoonotic diseases (Mosquito borne flavirus and Rodent borne arenavirus, respectively) and classified as viral haemorrhagic fevers (VHF) because of their common clinical presentations – especially fevers and bleeding during the terminal stages of the diseases. After an incubation period of 3 – 6 days in Yellow fever, and 2 – 21 days in Lassa fever: they present with fevers, rigors, headache, myalgia, nausea, and vomiting. Jaundice is noticed in Yellow fever, while Lassa in addition to other symptoms also present with sore throat (with patchy tonsillar exudate), dysphagia, dry cough, chest pain, and cramping abdominal pain, diarrhoea or epigastric pains. Gradual deterioration is associated with oedema of the face and neck, respiratory distress, pleural and pericardial effusions, encephalopathy, and haemorrhage from various sites (including hypotension and shock, nonrelated to blood loss). The laboratory confirmation from a specialized virology laboratory was conducted for both disease conditions using reverse transcriptase polymerase chain reaction (PCR) testing, with containment facilities (biosafety level 4).

The management of each of these conditions is mainly supportive, although Ribavirin has significantly reduced mortality associated with Lassa fever; with best results obtained when drug is started early in the course of the illness. Reports of Yellow fever and Lassa fever co-infection are particularly scarce. The objective of this study was to report a successfully managed Case report in an Adolescent Child.

Case Report: A 10 – year old boy with a positive history of contact with and adult (grandmother) who died from a febrile illness, bleeding from body orifices and jaundice; presented with high grade fever, sore throat abdominal pain and passage of loose watery stool. All these symptoms were persistent for more than twelve days despite antibiotics and antimalarial medications. He was ill looking, febrile, anicteric and had right upper quadrant tenderness/hepatomegaly. A diagnosis of viral haemorrhagic fever was made, he was admitted and nursed in the isolation ward, infection prevention and control measures were observed, he had baseline investigations, supportive care and Ribavirin. PCR results was positive for Yellow fever and Lassa fever. He responded to treatment, was discharged home, and recuperated well during his follow up visits.

Conclusion: This case clearly illustrates the importance of having high index of suspicion following the significant history of contact with a probable case of viral haemorrhagic fever (absence of laboratory confirmation at the time of her death) by the index case, especially when there was non-response to routine treatment for common causes of fever in the community.

Keywords: Yellow Fever, Lassa Fever, Viral Haemorrhagic Fever, Polymerase Chain Reaction