Constraints in the diagnosis and treatment of Lassa Fever and the effect on mortality in hospitalized children and women with obstetric conditions in a rural district hospital in Sierra Leone
Constraints in the diagnosis and treatment of Lassa Fever and the effect on mortality in hospitalized children and women with obstetric conditions in a rural district hospital in Sierra Leone
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DOI：
10.1093/trstmh/tru009
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发表时间：
2014-03-01
影响因子：
2.2
通讯作者：
Zachariah, R.
中科院分区：
文献类型：
--
作者：
Dahmane, A.;van Griensven, J.;Zachariah, R.
背景：拉沙热（LF）是一种急性病毒性出血性感染，在西非流行。肺炎的诊断和治疗（利巴韦林）是困难的，昂贵的，并限于专科医院。在确诊和疑似LF病例中，我们报告了临床和实验室特征、利巴韦林的使用时间和给药以及与病死率的关系。方法：我们对塞拉利昂农村一家儿科和产科转诊医院收治的疑似LF病例的病历进行了审核结果：共有84例疑似LF病例; 36例（43%）为实验室确诊病例，其中只有20例（56%）在入院后中位8天（IQR 314天）接受利巴韦林治疗。在16例未接受利巴韦林治疗的患者中，14例（87%）在开始利巴韦林治疗前死亡。入院后6天内开始利巴韦林治疗的病死率为29%（2/7），而6天后开始利巴韦林治疗的病死率为50%（6/12）。在48例疑似LF病例没有实验室确认，有21（44%）deaths.Conclusions：这些研究结果突出了LF管理的缺点，包括诊断和治疗延误。应该对这种“被忽视的疾病”进行更多的研究和开发。
Background: Lassa fever (LF) is an acute viral haemorrhagic infection, endemic in West Africa. Confirmatory diagnosis and treatment (ribavirin) is difficult, expensive, and restricted to specialised hospitals. Among confirmed and suspected LF cases, we report on clinical and laboratory features, timing and administration of ribavirin and the relationship with case fatality.Methods: We conducted an audit of patient files of suspected LF cases admitted to a pediatric and obstetric referral hospital in rural Sierra Leone (April 2011 to February 2012).Results: There were 84 suspected LF cases; 36 (43%) were laboratory-confirmed cases, of whom only 20 (56%) received ribavirin after a median duration of eight days (IQR 314 days) of hospital admission. Of 16 patients who did not receive ribavirin, 14 (87%) died before ribavirin treatment could be commenced. Starting ribavirin within six days of admission was associated with a case fatality of 29% (2/7), while starting ribavirin later than six days was associated with a case fatality of 50% (6/12). Among the 48 suspected LF cases without laboratory confirmation, there were 21 (44%) deaths.Conclusions: These findings highlight shortcomings in LF management, including diagnostic and treatment delays. More research and development efforts should be devoted to this 'neglected disease'.