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J. ter Meulen



Viruses—new arenaviruses of uncertain pathogenicity isolated from animals and human.

Treatment—new pyrazine derivative antiviral agent showed preclinical activity against Junin, Machupo, and Guanarito viruses.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 29 April 2017

Arenaviruses are zoonotic RNA viruses that are distributed worldwide and are adapted to various rodent genera. Some are highly pathogenic and cause haemorrhagic fevers that are endemic in restricted regions of a few countries. Humans are thought to become infected mainly through inhalation of aerosolized rodent urine or dust particles to which infectious urine has dried, or by ingestion of contaminated foodstuff: prevention therefore depends on rodent control and avoidance of contact with rodents, their excreta, and nesting materials.

Clinical approach—because arenaviruses cause diseases that start insidiously and therapy is life-saving, they should be considered in all patients with fever of unknown origin and a history of possible exposure in the well-known endemic areas.

Specific infections

Lassa fever—reservoir is a small rodent (Mastomys natalensis); occurs regularly in rural areas of Nigeria, Liberia, Sierra Leone and the Republic of Guinea, but may occur also in other West African countries. Clinical picture is highly variable and can be difficult to distinguish from other febrile infections, but may include chest pain, nausea/vomiting/diarrhoea/abdominal pain, facial swelling, pulmonary oedema, and bleeding. Case-fatality is 15 to 30%, but may be reduced by up to 90% through prompt administration of ribavirin. Irreversible sensorineural deafness is a frequent complication. Body fluids of patients are highly infectious and Lassa virus has been transmitted directly from person-to-person, hence strict ‘barrier nursing’ measures are required and (if possible) patients with severe disease and bleeding should be managed in a negative-pressure room by personnel wearing appropriate protective gear, including respiratory filters; postexposure prophylaxis with ribavirin should be considered. No vaccine is available.

Lymphocytic choriomeningitis virus infection—reservoir is the house mouse. Most commonly causes an influenza-like illness, sometimes with subsequent aseptic meningitis or encephalomyelitis. Intrauterine infection has resulted in nonobstructive hydrocephalus with periventricular calcifications, chorioretinitis, and psychomotor retardation. Use of ribavirin has not been systematically evaluated.

South American haemorrhagic fevers—the reservoir(s) for Argentinian haemorrhagic fever is the vesper mouse, for Bolivian haemorrhagic fever Calomys callosus, and for Venezuelan haemorrhagic fever the cotton rat and the cane mouse. These cause an influenza-like illness with marked skin erythema and (in almost half of cases) haemorrhagic manifestations; a late neurological cerebellar syndrome occurs in about 10%. Treatment with convalescent-phase plasma is very effective in Argentinian haemorrhagic fever, and ribavirin may be effective. A live attenuated vaccine for Argentinian haemorrhagic fever is licensed in Argentina.

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