What Is the Lujo Virus?

How Is Lujo Similar to Other Viral Syndromes Like Ebola?

Female scientist about to view a human sample under a microscope
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Most diseases are unique in their reach and effects, and we don't always hear about them. While we've heard about Ebola outbreaks, for example, there are infections that take more lives than Ebola. TB took about 1.5 million lives in 2015. HIV took about 1.2 million lives in 2015. Malaria took about 400,000 lives in 2015.

There are other viruses that can spread farther and faster than Ebola. These can spread in hospitals and in the air, like the flu does, or through food, like salmonella, or livestock, like Rift Valley Fever.

There are others which also cause viral hemorrhagic fevers (VHFs).

VHFs, although described as hemorrhagic, usually do not cause a lot of bleeding. The bleeding that does happen can be from an IV, from the nose or mouth, or through vomiting and easy bruising. These viruses include Crimean Congo Hemorrhagic Fever, Lassa, Nipah, and Marburg, as well as a highly fatal virus with only one of five known survivors: Lujo.

What Is Lujo?

Lujo may mean luxury in Spanish, but this virus is named for the first two letters of the first two cities where it was seen—Lusaka and Johannesburg.

As mentioned, Lujo is a viral hemorrhagic fever, which is a group of viral syndromes leading to fevers and bleeding. Lujo is related to Lassa Fever—it's an Arenavirus like Lassa.

Lujo starts off causing a mild illness with fever, headache, and muscle aches. It can then cause a rash (sometimes red like measles) on the face, chest, and stomach.

It can lead to the face and neck swelling, along with a sore throat. Some will develop diarrhea. A patient may seem like they're getting better, but then experience symptoms like difficulty breathing, confusion, lethargy, and low blood pressure.

Like many VHF's, there usually isn't that much bleeding.

After being exposed to the virus, it usually takes one to two weeks to get sick. The illness starts off mild. Unfortunately, however, the virus doesn't have a favorable outcome. Most people who contracted the virus passed away within 10 days to two weeks.

Where Has Lujo Spread?

Despite the unfavorable outcome, the majority of the world's population is not currently at risk. The virus has only been seen in Southern Africa. The first case occurred in Zambia; the critically ill patient was then transferred to South Africa where the virus spread in the hospital to caregivers.

How Does Lujo Spread?

The virus, abbreviated as LUJV, spread from person-to-person in the hospital, likely through contact with body fluids. Since there have been so few cases, we don't know all the details on how likely it is to spread between people.

The first case led to an infection in the paramedic who assisted her; later three involved in cleaning and/or nursing in the hospital were infected as well.

Outside of hospitals, we don't really know.

It is thought to spread by contact with rodents, like with Lassa. It may be that someone has to touch the rodent, or their droppings or urine. It may also be that someone can breathe in the virus, especially when someone has been sweeping or cleaning up a rodent nest or droppings.

How Do You Treat Lujo?

The mainstay of treatment is "supportive care." This means making sure that the patient:

  • is hydrated, either by drinking or through IV fluids
  • has medications to keep their blood pressure high enough if fluids aren't enough
  • has help breathing, with oxygen through their nose or mouth, through machines that help them breathe, or through intubation with a machine that can 'breathe for them'
  • is comfortable—with medications for pain, anxiety, or sedation as needed
  • has risks from bleeding minimized (with careful choice of medications and reduction of risk of injury)
  • has blood transfusions, potentially, if needed

There may be a role for other medications. The drug ribavirin is used in Lassa. It was also used in the only patient who survived from Lujo.

Treatment of arenavirus hemorrhagic fevers with convalescent plasma therapy reduces mortality significantly and anecdotal evidence from the only surviving Lujo patient shows that the antiviral drug ribavirin may hold promise in the treatment of LUHF. Ribavirin has been considered for preventing the development of disease in people exposed to other arenaviruses.

What's the Chance of Surviving Lujo?

We don't know exactly. What we do know is that 4 out of 5 infected died, despite medical care. The fifth patient—the first and only to survive—was treated with ribavirin early on.

Could Someone Spread the Virus After They Get Better?

As we've seen with other viruses, like Zika and Ebola, body fluids can remain infectious after the symptoms have abated. Those infected with related viruses can shed virus in urine or semen. It's possible that Lujo could as well, possibly posing a risk for sexual partners of recovered patients.

What Else Do We Know About How The Virus Affects Us?

Low blood platelets, low white blood cell count (at the onset, rising later on) and elevated liver function values were present in all patients.

Since arenaviruses may enter the fetus through infection of the mother, and anecdotal evidence suggests that infected pregnant women may suffer miscarriages, it is reasonable to assume that both infection of the fetus and miscarriage may be associated with Lujo infection in the mother.

    How Is Lujo Diagnosed?

    Because so few have been diagnosed, Lujo is often not thought of.

    During the acute febrile phase, Lujo virus was isolated from blood from days 2 to 13 after onset. Virus was also isolated from liver tissue obtained post-mortem. A subsequent complete genomic analysis of Lujo virus facilitated the development of specific molecular detection (RT-PCR) assays.

    Serologic diagnosis of Lujo hemorrhagic fever can be made by indirect immunofluorescent assay and ELISA. However, individuals from endemic areas displaying fever, rash, pharyngitis, accompanied by laboratory findings of low platelet counts and elevated liver enzymes, should be suspected of having a hemorrhagic fever virus infection. Clinical specimens should be tested using specific assays.

    Sources:

    CDC. Lujo Hemorrhagic Fever (LUHF). http://www.cdc.gov/vhf/lujo/ 

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