Abstract
Sierra Leone in West Africa is in a Lassa fever-hyperendemic region that also includes Guinea and Liberia. Each year, suspected Lassa fever cases result in submission of ≈500-700 samples to the Kenema Government Hospital Lassa Diagnostic Laboratory in eastern Sierra Leone. Generally only 30%-40% of samples tested are positive for Lassa virus (LASV) antigen and/or LASV-specific IgM; thus, 60%-70% of these patients have acute diseases of unknown origin. To investigate what other arthropod-borne and hemorrhagic fever viral diseases might cause serious illness in this region and mimic Lassa fever, we tested patient serum samples that were negative for malaria parasites and LASV. Using IgM-capture ELISAs, we evaluated samples for antibodies to arthropod-borne and other hemorrhagic fever viruses. Approximately 25% of LASV-negative patients had IgM to dengue, West Nile, yellow fever, Rift Valley fever, chikungunya, Ebola, and Marburg viruses but not to Crimean-Congo hemorrhagic fever virus.
Highlights
Sierra Leone in West Africa is in a Lassa fever– hyperendemic region that includes Guinea and Liberia
We tested for IgM to dengue virus (DENV), West Nile virus (WNV), yellow fever virus (YFV), Rift Valley fever virus (RVFV), chikungunya virus (CHIKV), Ebola virus (EBOV), Marburg virus (MBGV), and Crimean-Congo hemorrhagic fever virus (CCHFV)
LASVnegative samples were tested for IgM to DENV, WNV, YFV, RVFV, and CHIKV before being transferred to the US Army Medical Research Institute of Infectious Diseases for additional testing for IgM to EBOV, MBGV, and CCHFV
Summary
Each year, suspected Lassa fever cases result in submission of ≈500–700 samples to the Kenema Government Hospital Lassa Diagnostic Laboratory in eastern Sierra Leone. Only 30%–40% of samples tested are positive for Lassa virus (LASV) antigen and/or LASVspecific IgM; 60%–70% of these patients have acute diseases of unknown origin. To investigate what other arthropod-borne and hemorrhagic fever viral diseases might cause serious illness in this region and mimic Lassa fever, we tested patient serum samples that were negative for malaria parasites and LASV. 25% of LASV-negative patients had IgM to dengue, West Nile, yellow fever, Rift Valley fever, chikungunya, Ebola, and Marburg viruses but not to Crimean-Congo hemorrhagic fever virus. We tested samples from these patients using IgM-capture ELISAs to virus pathogens that could occur in the region and mimic Lassa fever. Inset image: Lassa Diagnostic Laboratory, Kenema Government Hospital, Kenema, Sierra Leone
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