Lassa fever — DTM&H MCQ

Correct answer: B — Supportive care, isolation and early ribavirin after specialist advice

The correct answer is B, supportive care, isolation and early ribavirin after specialist advice. Lassa fever is a viral haemorrhagic fever transmitted from contact with infected body fluids or rodent excreta, exactly the exposure described in a healthcare worker caring for a patient with unexplained bleeding, and fever, sore throat, facial swelling and proteinuria are classic early features before frank haemorrhage appears. Management centres on strict isolation to prevent nosocomial spread, aggressive supportive care (fluid and electrolyte correction, treatment of shock and organ support), and consideration of ribavirin, which has reported benefit when started early in the illness, given only under specialist infectious disease or UKHSA Imported Fever Service guidance because evidence and dosing protocols are evolving. Waiting for confirmatory bleeding or definitive virological results before acting would delay life-saving supportive measures and increase transmission risk to other staff. Why the other options are wrong: D. Yellow fever vaccine as post-exposure treatment: yellow fever vaccine is a live vaccine for prevention of a different flavivirus infection and has no role in treating or post-exposure prophylaxis for Lassa fever, an arenavirus. C. No treatment until haemorrhage develops: haemorrhage is a late and inconsistent feature; delaying treatment until it appears misses the window for early ribavirin and supportive intervention and risks fatal deterioration and onward transmission. E. Oral aciclovir as definitive therapy: aciclovir targets herpesviruses via viral thymidine kinase dependent mechanisms and has no activity against arenaviruses such as Lassa virus. A. Albendazole and ivermectin: these are anthelmintic agents used for helminth infections and have no antiviral activity relevant to Lassa fever. Key point: In a healthcare worker with fever, facial swelling and proteinuria after viral haemorrhagic fever exposure, immediate isolation, supportive care and specialist-guided early ribavirin are the priority, not waiting for haemorrhage or reaching for unrelated antimicrobials.

Reference: GOV.UK / UK Health Security Agency, Lassa fever: origins, reservoirs, transmission and guidelines, https://www.gov.uk/guidance/lassa-fever-origins-reservoirs-transmission-and-guidelines