Dermatology MCQ - Viral Infections - Lujo Virus Haemorrhagic Fever

A 45-year-old Zambian healthcare worker presents with fever, headache, myalgia, and a maculopapular rash. Over the next few days, she develops rapid clinical deterioration with hemorrhagic manifestations, including mucosal bleeding and petechiae. She had recently treated a patient with similar symptoms who died. Travel history is limited to within southern Africa. Which of the following is the most likely causative agent and its mode of transmission?

A) Lassa virus; inhalation of aerosolized rodent excreta
B) Lujo virus; human-to-human transmission via bodily fluids
C) Ebola virus; contact with infected fruit bats
D) Crimean-Congo hemorrhagic fever virus; tick bite
E) Marburg virus; exposure to bat caves

Correct Answer: B) Lujo virus; human-to-human transmission via bodily fluids

Explanation

This presentation describes Lujo viral hemorrhagic fever, a rare and highly fatal disease caused by the Lujo virus, first identified in 2008 during an outbreak in Zambia and South Africa.

Key Clinical Features of Lujo Hemorrhagic Fever:

• Initial Phase: Nonspecific symptoms like fever, headache, myalgia, and a maculopapular rash.

• Hemorrhagic Phase: Rapid progression to mucosal bleeding, petechiae, ecchymoses, and shock.

• High Case Fatality Rate: ~80% in documented cases.

• Epidemiology: Nosocomial and human-to-human transmission is prominent; the index case often sparks outbreaks among healthcare workers and contacts.

Virologic Features:

• Causative Agent: Lujo virus, an arenavirus (like Lassa virus but distinct).

• Transmission:

  • Primary transmission reservoir is unknown but likely involves rodents (like other arenaviruses).

  • Human-to-human transmission occurs via direct contact with infected bodily fluids (blood, secretions), making it a significant nosocomial threat.

• Geographic Distribution: Southern Africa (Zambia, South Africa).

Why Not the Other Options?

• (A) Lassa virus: Causes similar hemorrhagic fever but is endemic to West Africa (not Southern Africa). Transmission is primarily from rodents, with less efficient human-to-human spread.

• (C) Ebola virus: Causes hemorrhagic fever with high human-to-human transmission, but it is associated with Central and West Africa (not Southern Africa). Reservoir is fruit bats.

• (D) Crimean-Congo hemorrhagic fever virus: Tick-borne, with geographic distribution including Africa, but also Europe and Asia. Often associated with livestock exposure.

• (E) Marburg virus: Causes hemorrhagic fever similar to Ebola, with bat reservoirs and human-to-human transmission. Outbreaks have occurred in East and Central Africa (e.g., Uganda, DR Congo), not typically Southern Africa.

Management:

• Strict isolation: Infection control measures (e.g., PPE, barrier nursing) to prevent nosocomial spread.

• Supportive care: Fluid management, hemodynamic support.

• Ribavirin: May be considered (as for Lassa fever), though efficacy for Lujo virus is not well-established.

Prognosis:
Extremely poor; rapid progression to multiorgan failure and death in most cases.

Note: Lujo virus is a novel arenavirus highlighting the ongoing risk of emerging zoonotic pathogens. Healthcare workers in endemic areas must maintain high suspicion and strict precautions.