Clinical Chemistry
On presentation to KGH LFW, his sodium (Na+), chloride (Cl-), total carbon dioxide (TCO2), albumin (Alb) and total protein (TP) were all below the normal values for a male his age. The liver function panel revealed an aspartate aminotransferase (AST), alanine transaminase (ALT) and alkaline phosphatase (ALP) drastically above the normal range. Additionally, the blood urea nitrogen (BUN) and BUN: creatinine (Cre) levels were elevated. His potassium (K+), total bilirubin (TBil), corrected calcium (Ca2+) and Cre levels, on the other hand, all were within the upper normal range. His hemoglobin (Hb) levels were low throughout hospitalization.
At the time of admission to KGH LFW, a cytokine profile indicated that interleukin (IL) -12p70, IL-6 and IL-10 levels were elevated compared to the healthy controls.
Diagnosis
A blood specimen collected on the day of admission was positive for Lassa NP antigen (Ag) by LFI, and positive by quantitative NP antigen-capture ELISA, with a level of 13 μg/mL NP. Additionally, IgM levels to recombinant Lassa proteins (NP alone and NP, GP1, GPC combination) were determined by ELISA, with low but detectable levels of immunoglobulin to NP and GPC. IgG levels were not above background detection upon initial diagnosis.
Treatment and hospital course
Intravenous (IV) ribavirin was administered upon LFI Ag positive diagnosis: a loading dose of 30mg per kilogram followed by 15mg/kg every 6 hours for 4 days and 7.5mg/kg every 8 hours for an additional 6 days. Broad spectrum antibiotics (ceftriaxone, ciprofloxacin and metronidazole) and anti-malarials (artemether and quinine) were also started. A single dose of dexamethasone was given. Five percent and 50% glucose boluses were given as needed. Upon slight recovery, the patient requested energy drinks, which were provided (Lucozade, a sports-like drink similar to Gatorade in composition). Despite therapy, G-1180 continued to experience bleeding abnormalities for the next two weeks including hematochezia and hemoptysis. Ciprofloxacin was restarted on the eighth day post onset of illness to treat a catheter-related infection of his penis, which was resolved shortly thereafter. The patient required a blood transfusion on day 8 of illness due to severe anaemia. The donor was a Caucasian American female of the same blood type (A+). A second blood transfusion was administered on day 21 of illness from a type O+ Caucasian American male donor. On this day the patient was alert, responsive, able to walk on his own and had stopped bleeding altogether.
Blood samples were collected daily, except for day 12 of illness. Day 14 post onset of illness was the last day that diagnostic, metabolic and inflammatory tests were conducted on patient G-1180. The LFI tests detected LASV NP in G-1180 through day 8 of illness and NP Ag capture ELISA detected LASV NP through day 11. LASV NP antigen dropped rapidly over 3 days following the onset of ribavirin treatment.