29 October 2008

5 Patients with Novel Arenavirus in South Africa

The latest update from South Africa’s renowned National Institute for Communicable Diseases (NCID) describes five (5) lab-confirmed cases of infection with a novel arenavirus. The initial four patients have died. The 5th patient, a nurse who cared for patient 2, became ill October 9 and is in critical but stable condition while receiving the antiviral drug ribavirin. The full report and timeline graph of the 5 cases can be found at: www.nicd.ac.za/pubs/communique/communique.htm

Figure 1: Epidemic curve of cases of infection with an arenavirus, South Africa, September - October 2008

Source: Special Pathogens Unit and Epidemiology Division, NICD; Gauteng Provincial Outbreak Response Team and partners;

SA-FELTP residents;

Department of Anatomical Pathology, University of the Witwatersrand and the National Health Laboratory Service

The source of infection is still uncertain. The four workers in health care settings (cases 2-5) all had potential exposure to blood and/or body fluids of other lab-confirmed cases. The incubation period appears to range from 7-13 days.

The clinical manifestations can include an influenza-like illness of fever and myalgia, diarrhea, facial swelling, and a morbilliform rash on the face and trunk between day 6 and day 8 of illness. Some of the patients improved initially then rapidly deteriorated with respiratory failure, neurological signs and shock. Treatment with ribavirin is based on extrapolating from its efficacy against another arenavirus in Africa, Lassa Fever virus.

This update from South Africa is much appreciated in terms of the remarkable speed and detail provided in describing a new virus and its clinical manifestations.

Daniel R. Lucey, MD, MPH

EROne Institutes, Department of Emergency Medicine

Washington Hospital Center

Washington, D.C.

Website for this posting: www.BePast.org

Email:Daniel.R.Lucey@Medstar.net