Abstract
Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff.We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin.Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission.
Highlights
Exploratory laparotomies are carried out for patients in emergency situations when there is little time left for any exhaustive investigations in the face of deterioration in a patient’s clinical condition
Case 6 A 40 year old man presented to a private hospital in Port Harcourt, Rivers State, Nigeria in March 2012 with a 3 day history of abdominal pain which shifted from the epigastrium to the right iliac fossa
The presence of localized right iliac fossa pain and tenderness led to a diagnosis of acute appendicitis and subsequent surgical intervention
Summary
Exploratory laparotomies are carried out for patients in emergency situations when there is little time left for any exhaustive investigations in the face of deterioration in a patient’s clinical condition. Platelet count was 229,000/mm; AST was 35 IU/L, ALT was 25 IU/L; urinalysis showed protein (3+) and blood (2+) She made an uneventful recovery after a 10 day course of ribavirin treatment which was started 8 days after surgery, but the 2nd day after presentation to Irrua Specialist Teaching Hospital. Case 6 A 40 year old man presented to a private hospital in Port Harcourt, Rivers State, Nigeria in March 2012 with a 3 day history of abdominal pain which shifted from the epigastrium to the right iliac fossa. Case 7 A 24 year old undergraduate was referred from the University Health Centre Ekpoma to Irrua Specialist Teaching Hospital with a diagnosis of acute appendicitis in March 2012 She had been ill for 5 days with fever, chills and rigors. Histology of the appendix specimen revealed evidence of tissue edema and neutrophil infiltration in the muscularis propria
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