Clinical Manifestations Morbidity and Mortality

High fever associated with malaise, muscle and joint pains, sore throat, retrosternal pain, nausea, manifestation of liver involvement, bleeding tendency of variable severity, proteinuria, and erythematous maculopapular rash with petechiae are features of the illness, but not of themselves particularly diagnostic. The presence of an enanthem in the oropharynx has been considered by some to have specific diagnostic importance.

In early stages, the disease can simulate many illnesses occurring in Central Africa, prominent among them malaria (Downs 1975), although typhoid fever, rickettsial diseases, brucellosis, hepatitis (before appearance of jaundice), and even yellow fever can also be mimicked. Sporadically occurring Lassa cases are certainly not often diagnosed. When epidemics arise, the clumping of cases of mysterious illness can and has attracted attention, leading to diagnosis. It has become recognized from studies, such as one in Sierra Leone, that there are many mild Lassa cases (McCormick et al. 1987a). This study of several years' duration was conducted by personnel from the Centers for Disease Control, U.S. Public Health Service, in two hospitals in central Sierra Leone. It determined that Lassa was the causative agent (determined by virus isolation) in 10 to 16 percent of all adult medical hospital admissions and in about 30 percent of adult hospital deaths. The fatality rate for 441 hospitalized patients was 16.5 percent.

Karl M. Johnson and colleagues (1987) have shown that mortality is directly associated with level of viremia, although it must be noted that by the time figures for viremia have been received from the overseas laboratory, the patient is either recovered or dead. Joseph B. McCormick and colleagues (1987b) estimate the ratio of fatalities in infections in general to be 1 to 2 percent, a rate lower than estimates based on hospitalized patients. How widely the findings on rates and outcome can be extrapolated to other hospitals and other settings in West Africa is not yet known. Studies simply have not been done to determine this. However, it is clear that when seriously ill patients are seen, the prognosis is highly unfavorable, even when the best of currently recognized therapeutic regimes are applied.

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