Presence of Lassa Virus RNA in Cerebrospinal Fluid Indicating Neuroinvasive Lassa Fever in Pediatric Patients From Edo State, Nigeria - Report - MDSpire
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Presence of Lassa Virus RNA in Cerebrospinal Fluid Indicating Neuroinvasive Lassa Fever in Pediatric Patients From Edo State, Nigeria
Detection of Lassa Virus RNA in CSF Indicates Neuroinvasive Lassa Fever in Nigerian Children
Overview
This study demonstrates frequent detection of Lassa virus RNA in cerebrospinal fluid (CSF) of pediatric patients with neurological symptoms in Edo State, Nigeria. Viral loads were generally higher in CSF than plasma, supporting active Lassa virus replication within the central nervous system (CNS).
Background
Lassa fever (LF) is an endemic viral hemorrhagic fever in West Africa with high morbidity and mortality, especially in hospitalized cases. Neurological complications such as meningitis and seizures are associated with poor outcomes, but direct CNS infection by Lassa virus (LASV) has been unclear. Previous isolated reports detected LASV RNA in CSF, suggesting possible neuroinvasion. Understanding CNS involvement is critical for improving clinical management and therapeutic development.
Data Highlights
Parameter
Value
Total pediatric patients with CSF LASV RT-PCR results
153
Confirmed LF cases
49 (32%)
LF patients LASV RNA positive in CSF
42 (86% of confirmed)
Patients positive in both CSF and plasma
33 (79% of CSF positives)
Patients positive in CSF only
9 (21% of CSF positives)
Median age of CSF-positive patients
10.5 years
Sample pairs (CSF and plasma) analyzed
26
Patients with higher LASV RNA concentration in CSF vs plasma
23 (88%)
Median Ct value CSF
28.2
Median Ct value plasma
36.7
Key Findings
Lassa virus RNA was detected in the CSF of 86% of pediatric patients with confirmed LF and neurological symptoms.
21% of patients had LASV RNA detectable only in CSF but not in plasma, indicating possible compartmentalized CNS infection.
In paired samples, 88% showed higher viral loads in CSF compared to plasma, with significantly lower cycle threshold values in CSF (median Ct 28.2 vs 36.7; P < .00001).
The median age of CSF-positive patients was 10.5 years, highlighting pediatric vulnerability.
Findings support active replication of LASV within the CNS rather than passive viral presence.
Clinical Implications
Detection of LASV RNA in CSF with higher viral loads than plasma suggests that neurological symptoms in LF patients may result from direct CNS infection. This highlights the importance of considering neuroinvasive disease in pediatric LF cases presenting with neurological signs. Clinicians should be aware of potential CNS involvement when managing LF and consider lumbar puncture for diagnosis. These findings also underscore the need for antiviral therapies that effectively penetrate the CNS.
Conclusion
This study provides strong evidence that Lassa virus can directly infect the central nervous system in pediatric patients, contributing to neurological complications. Recognition of neuroinvasive Lassa fever has important implications for diagnosis, treatment, and future drug development.
References
Ehichioya et al. 2024 -- Detection of Lassa Virus RNA in Cerebrospinal Fluid Suggesting Neuroinvasive Lassa Fever in Pediatric Patients from Edo State, Nigeria
by Hannah Caroline Sophie Müller, Cyril Oshomah Erameh, Joseph Okoeguale, Sheila Ojor Ileli, Imonifome Frank Onyeke, Adewale Elijah Adetunji, Lilian Omoyemen Akerele, Rita Esumeh, Ebo Benevolence Ohomoime, Mette Hinrichs, Jonas Müller, Ujiagbe Moses Aiterebhe, Christiana Ngozi Ekuma, Chukwuemeka Ogbuinya Ugadu, Ifeanyi Henry Onyerikam, Juliet Oemhenze Idialu-Eigbobo, Matthew Apeleokha, Ehisuan Ehiaghe, Osahogie Isaac Edeawe, Kelly Ohis Iraoyah, Chris Hoffmann, Donatus Adomeh, Thomas Olokor, Ikponmwosa Odia, Danny Asogun, Sylvanus Okogbenin, Ephraim Ogbaini-Emovon, Reuben Eifediyi, Stephan Günther, Meike Pahlmann, Michael Ramharter, Lisa Oestereich, Till Omansen, George Akpede
