Russian Journal of Infection and ImmunityRussian Journal of Infection and ImmunityИнфекция и иммунитет2220-76192313-7398SPb RAACI181410.15789/2220-7619-EEA-1814REVIEWSОБЗОРЫReview ArticleLassa fever. Part 1. Etiology, epidemiology and clinical manifestationsЛихорадка Ласса. Часть 1. Этиология, эпидемиология, клиническая картинаhttps://orcid.org/0000-0002-1856-61472874-5102KazachinskaiaElena I.КазачинскаяЕлена Ивановна
Russian Federation

PhD, MD (Biology), Leading Researcher, Department of Experimental Modeling of Pathogenesis of Infectious Diseases; Leading Researcher, Department of Bioengineering

д.б.н., ведущий научный сотрудник отдела экспериментального моделирования патогенеза инфекционных заболеваний; ведущий научный сотрудник отдела биоинженерии

lena.kazachinskaia@mail.ruAripovV. S.АриповВ. С.
Russian Federation

PhD Candidate, Junior Researcher, Department of Bioengineering

аспирант, младший научный сотрудник отдела биоинженерии

aripov_vs@vector.nsc.ruIvanovaA. V.ИвановаА. В.
Russian Federation

PhD (Biology), Senior Researcher, Department of Bioengineering

к.б.н., старший научный сотрудник отдела биоинженерии

Ivanova_av@vector.nsc.ruShestopalovA. M.ШестопаловА. М.
Russian Federation

PhD, MD (Biology), Professor, Head of the Department of Experimental Modeling of Pathogenesis of Infectious Diseases

д.б.н., профессор, зав. отделом экспериментального моделирования патогенеза инфекционных заболеваний

shestopalov2@mail.ruFederal Research Center for Fundamental and Translational Medicine of Ministry of Science and higher Education Russian FederationФГБНУ Федеральный исследовательский центр фундаментальной и трансляционной медицины Министерства науки и высшего образования Российской ФедерацииState Research Centre of Virology and Biotechnology “Vector”, Federal Service for the Oversight of Consumer Protection and Welfare (Rospotrebnadzor)Государственный научный центр вирусологии и биотехнологии «Вектор» Роспотребнадзора12042022040720221234274380411202119022022Copyright ©; 2022, Kazachinskaia E.I., Aripov V.S., Ivanova A.V., Shestopalov A.M.Copyright ©; 2022, Казачинская Е.И., Арипов В.С., Иванова А.В., Шестопалов А.М.2022Kazachinskaia E.I., Aripov V.S., Ivanova A.V., Shestopalov A.M.Казачинская Е.И., Арипов В.С., Иванова А.В., Шестопалов А.М.https://creativecommons.org/licenses/by/4.0https://iimmun.ru/iimm/article/view/1814

Lassa fever is a natural focal disease dangerous for humans. In the larger part of sub-Saharan West Africa 37.7 million people in 14 countries live in areas where living conditions are suitable for zoonotic transmission of the virus from secretions of infected rodents of the species Mastomys natalensis. Routes of transmission can be via alimentary, airborne dust or airborne droplet pathways in case of accidental human contact with secretions of infected rodents. Mastomys natalensis penetrates into residence and place of storage of food and drinking water. In addition, the residents use such animals for food, so infection is also possible upon butchering carcasses. The etiological agent of this disease is the Lassa virus being one of the members of the Arenaviridae family. Unlike other arenavirus infections (e.g., Argentine and Bolivian fevers caused by Junin viruses and Machupo, respectively), human infection with Lassa virus can also occur from person to person. Cases of nosocomial infection among patients in conditions of poor hygiene and through contaminated medical equipment are described. Medical workers become infected during surgical operations or through contact with patients, because the pathogen can be transmitted via blood, saliva, vomiting, stool or urine. In endemic territories, Lassa fever is associated with significant morbidity, because 500 thousand clinical cases and due to 5 to 10 thousand fatal outcomes of this disease are registered annually (i.e. 1–2% mortality). The likelihood that this disease will become a more widespread threat worldwide may be associated with increased globalization as well as climate change leading to the expansion of the Lassa fever endemic zone into regions suitable for the settlement of M. natalensis and other rodent species capable of lifelong pathogen carriage. Among hospitalized persons with severe hemorrhagic symptoms, the mortality rate can be very high — ranging from 14 to 89.5%. But in the majority of cases, the disease proceeds asymptomatically, and due to its long-term incubation period all ill subjects may be a source of infection, especially travelling at long distance by plane or train. Clinically evident disease occurs in the form of various nonspecific symptoms — from malaise, fever, sore throat and chest, cough, myalgia and gastrointestinal disorders to signs of central nervous system disorders. The diagnosis of Lassa fever is often difficult due to the similarity of its course with other viral diseases common in Africa or malaria or typhoid fever. More specific symptoms for Lassa fever are revealed as conjunctivitis, hepatitis, pharyngitis, tonsillitis as well as developing oropharyngeal ulcers. Severe disease is complicated by abnormal bleeding, generalized edema, respiratory failure, hypotension, proteinuria, transaminitis, encephalopathy. Deafness develops in about 20% of cases. Multiple organ failure and open bleeding lead to death. The review is devoted to analyzing publications on the etiology, epidemiology and clinical picture of Lassa fever due to a threat of its importation with sick subjects to the territory of the Russian Federation.

Лихорадка Ласса (ЛЛ) — природно-очаговое заболевание, опасное для человека. На большей части Западной Африки к югу от Сахары 37,7 млн человек в 14 странах проживают в районах, где условия жизни способствуют для зоонозной передачи инфекции. Способами передачи могут быть алиментарный, воздушно-пылевой или воздушно-капельный пути при случайном контакте человека с выделениями инфицированных грызунов вида Mastomys natalensis, проникающих в жилища и места хранения продуктов и питьевой воды. Кроме того, местные жители употребляют этих животных в пищу, поэтому заражение возможно также при разделывании тушек. Этиологический агент этой болезни — вирус Ласса, один из представителей семейства Arenaviridae. В отличие от других аренавирусных инфекций (например, аргентинской и боливийской лихорадок, вызываемых вирусами Хунин и Мачупо соответственно), заражение людей вирусом Ласса может происходить также и от человека к человеку. Описаны случаи внутрибольничных вспышек ЛЛ среди пациентов в условиях плохой гигиены и через контаминированное медицинское оборудование. Медицинские работники инфицируются во время проведения хирургических операций или при контакте с пациентами, так как патоген может передаваться через кровь, слюну, рвоту, стул или мочу. На эндемичных территориях ЛЛ ассоциируется со значительной заболеваемостью, так как ежегодно регистрируется 500 тыс. клинических cлучаев и от 5 до 10 тыс. летальных исходов этой болезни (то есть 1–2%-ная летальность). Вероятность того, что эта болезнь станет более распространенной угрозой в мире, может быть связана с усилением глобализации, а также изменением климата, приводящим к расширению зоны эндемичности ЛЛ на регионы, пригодные для расселения M. natalensis и других видов грызунов, способных пожизненно переносить патоген. Среди госпитализированных лиц с тяжелыми геморрагическими симптомами летальность может быть очень высокой — от 14 до 89,5%. Но в большинстве случаев болезнь протекает бессимптомно, и в связи с ее длительным инкубационным периодом заболевшие могут быть источником инфекции, особенно при перемещении на большие расстояния авиа- и железнодорожным транспортом. Клинически выраженное заболевание протекает в виде разных неспецифических симптомов — от недомогания, повышения температуры тела, болей в горле и груди, кашля, миалгии и желудочно-кишечных расстройств до признаков нарушения ЦНС. Постановка диагноза ЛЛ зачастую вызывает затруднения из-за сходства протекания болезни с другими распространенными в Африке вирусными заболеваниями или, например, с малярией или брюшным тифом. Более специфические симптомы при ЛЛ выражаются в виде конъюктивита, гепатита, фарингита, тонзиллита, а также появлением язв в ротоглотке. Тяжелое заболевание осложняется аномальным кровотечением, генерализованным отеком, дыхательной недостаточностью, гипотонией, протеинурией, повышением уровня печеночных трансамининаз, энцефалопатией. Глухота развивается примерно в 20% случаев от общего числа заболевших. Полиорганная недостаточность и открытое кровотечение приводит к смерти. Обзор посвящен анализу литературы по этиологии, эпидемиологии и клинической картине ЛЛ, так как существует опасность ее завоза с заболевшими людьми на территорию РФ.

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