Questions

Lujo virus — Questions

Study questions about Lujo virus — exam-style, clinical-scenario and FAQ.

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11 questions: 11 MCQ, 0 written.

Every Lujo case after the index patient was acquired in hospital, by person-to-person spread to those providing care.

No vector, water or rodent-exposure route was involved in the secondary cases, which is why infection prevention and control is the central lesson of the outbreak.

Lujo virus binds neuropilin-2 at the cell surface and depends on the tetraspanin CD63 in the late endosome to trigger fusion, a pathway independent of the usual arenavirus receptors.

Alpha-dystroglycan and transferrin receptor 1 serve the other arenaviruses; CD4 and LAMP1 are not its surface receptor.

Lujo virus was discovered by unbiased metagenomic deep sequencing within days of the outbreak, when conventional tests had failed, making it one of the first human pathogens found this way.

Culture, antigen ELISA, microscopy and antibody tests did not identify the novel agent; today diagnosis uses RT-PCR under maximum containment.

Treatment is supportive, with ribavirin used by analogy with Lassa fever; the single survivor of the 2008 cluster received it early.

No Lujo-specific antiviral or proven plasma therapy exists, and corticosteroids and aciclovir have no role.

Lujo fever closely resembled severe Lassa fever, beginning with nonspecific fever, headache, myalgia, sore throat and diarrhoea and progressing to facial oedema, bleeding, respiratory and renal failure and circulatory collapse.

It was neither mild, rash-limited nor a pure encephalitis, and it did not differ fundamentally from Lassa.

Lujo virus is known from a single event, the 2008 cluster of five cases, and its reservoir has never been identified.

Unlike Lassa it has no defined endemic zone or reservoir, and no recurrent or widespread infection has been documented.

The incubation period of Lujo fever is estimated at about 7 to 13 days, based on the 2008 cluster.

The other intervals are too short or too long for the observed course.

Lujo is a contraction of Lusaka and Johannesburg, the two cities between which the 2008 outbreak unfolded after the index patient was evacuated from Zambia to South Africa.

The other derivations are invented.

Lujo virus is the arenavirus that emerged within southern Africa, in the 2008 Johannesburg nosocomial cluster, and like the other haemorrhagic arenaviruses it is handled at biosafety level 4.

Junin, Guanarito and Machupo are New World agents of the Americas, and Tacaribe is a non-pathogenic bat-associated virus.

Lujo is the only arenaviral haemorrhagic fever to have emerged within southern Africa, in the 2008 Johannesburg outbreak, which places arenaviral haemorrhagic fever in the local differential and biosafety planning.

It is not endemic, tick-borne, vaccine-preventable or a routine cause of fever.

Lujo virus is broadly an Old World arenavirus but a marked phylogenetic outlier, its glycoprotein so divergent that it clusters with neither the Old World nor the New World complex.

It is not a New World, reptile or Tacaribe-complex virus, and despite an almost identical syndrome it is genetically distant from Lassa.

MCQ
In the 2008 Lujo outbreak, transmission after the index case occurred mainly by:
- A. The bite of an infected mosquito
- B. Ingestion of contaminated water
- C. Direct exposure to infected rodent urine and droppings
- D. Unprotected sexual contact
- E. Person-to-person spread in healthcare settings
Show answer
Correct answer: E
Every Lujo case after the index patient was acquired in hospital, by person-to-person spread to those providing care.

No vector, water or rodent-exposure route was involved in the secondary cases, which is why infection prevention and control is the central lesson of the outbreak.
MCQ
Lujo virus is unusual among arenaviruses because it enters cells using:
- A. Alpha-dystroglycan, as the other Old World arenaviruses do
- B. Transferrin receptor 1, like New World viruses
- C. Neuropilin-2, with CD63 as an intracellular factor
- D. The CD4 receptor
- E. LAMP1 as its primary surface receptor
Show answer
Correct answer: C
Lujo virus binds neuropilin-2 at the cell surface and depends on the tetraspanin CD63 in the late endosome to trigger fusion, a pathway independent of the usual arenavirus receptors.

Alpha-dystroglycan and transferrin receptor 1 serve the other arenaviruses; CD4 and LAMP1 are not its surface receptor.
MCQ
Lujo virus was originally identified by:
- A. Conventional virus culture on Vero cell monolayers
- B. A routine antigen-detection ELISA
- C. Unbiased metagenomic deep sequencing
- D. Electron microscopy of serum alone
- E. A commercial rapid antibody test
Show answer
Correct answer: C
Lujo virus was discovered by unbiased metagenomic deep sequencing within days of the outbreak, when conventional tests had failed, making it one of the first human pathogens found this way.

Culture, antigen ELISA, microscopy and antibody tests did not identify the novel agent; today diagnosis uses RT-PCR under maximum containment.
MCQ
Specific treatment of Lujo fever rests on:
- A. High-dose systemic corticosteroid therapy
- B. Ribavirin, used by analogy with Lassa fever
- C. Intravenous aciclovir
- D. A specifically licensed anti-Lujo antiviral drug
- E. Convalescent plasma of proven benefit
Show answer
Correct answer: B
Treatment is supportive, with ribavirin used by analogy with Lassa fever; the single survivor of the 2008 cluster received it early.

No Lujo-specific antiviral or proven plasma therapy exists, and corticosteroids and aciclovir have no role.
MCQ
The clinical illness of Lujo fever, as seen in 2008:
- A. Was mild and self-limiting in every patient
- B. Was limited to a transient skin rash without systemic upset
- C. Was clinically quite distinct from Lassa fever in most respects
- D. Resembled severe Lassa fever, ending in multiorgan failure
- E. Presented purely as a viral encephalitis
Show answer
Correct answer: D
Lujo fever closely resembled severe Lassa fever, beginning with nonspecific fever, headache, myalgia, sore throat and diarrhoea and progressing to facial oedema, bleeding, respiratory and renal failure and circulatory collapse.

It was neither mild, rash-limited nor a pure encephalitis, and it did not differ fundamentally from Lassa.
MCQ
The epidemiology of Lujo virus is characterised by:
- A. Recurrent annual outbreaks reported widely across southern Africa
- B. A large endemic zone throughout West Africa
- C. A well-defined rodent reservoir
- D. A single known outbreak, with the reservoir still unidentified
- E. Widespread asymptomatic human infection in the region
Show answer
Correct answer: D
Lujo virus is known from a single event, the 2008 cluster of five cases, and its reservoir has never been identified.

Unlike Lassa it has no defined endemic zone or reservoir, and no recurrent or widespread infection has been documented.
MCQ
The estimated incubation period of Lujo fever is approximately:
- A. A few hours
- B. 1 to 2 days
- C. 6 to 12 weeks
- D. 2 to 4 months
- E. 7 to 13 days
Show answer
Correct answer: E
The incubation period of Lujo fever is estimated at about 7 to 13 days, based on the 2008 cluster.

The other intervals are too short or too long for the observed course.
MCQ
The name 'Lujo' derives from:
- A. Lusaka and Johannesburg, its 2008 outbreak cities
- B. The Luo people of the East African lake region and beyond
- C. A Latin word for jaundice
- D. Its discoverer, the virologist J. Lujo
- E. A river said to run through western Zambia
Show answer
Correct answer: A
Lujo is a contraction of Lusaka and Johannesburg, the two cities between which the 2008 outbreak unfolded after the index patient was evacuated from Zambia to South Africa.

The other derivations are invented.
MCQ
Which arenavirus emerged within southern Africa and is handled at biosafety level 4?
- A. Junin virus
- B. Guanarito virus
- C. Machupo virus
- D. Tacaribe virus
- E. Lujo virus
Show answer
Correct answer: E
Lujo virus is the arenavirus that emerged within southern Africa, in the 2008 Johannesburg nosocomial cluster, and like the other haemorrhagic arenaviruses it is handled at biosafety level 4.

Junin, Guanarito and Machupo are New World agents of the Americas, and Tacaribe is a non-pathogenic bat-associated virus.
MCQ
Why does Lujo virus hold particular significance for South African virology?
- A. It is the only arenaviral haemorrhagic fever to emerge in the region
- B. It is endemic across the Western Cape province
- C. It is a common routine cause of undifferentiated febrile illness locally
- D. It is transmitted by ticks widely found across South Africa
- E. It is prevented by a locally licensed vaccine
Show answer
Correct answer: A
Lujo is the only arenaviral haemorrhagic fever to have emerged within southern Africa, in the 2008 Johannesburg outbreak, which places arenaviral haemorrhagic fever in the local differential and biosafety planning.

It is not endemic, tick-borne, vaccine-preventable or a routine cause of fever.
MCQ
Within the arenaviruses, Lujo virus is best classified as:
- A. A New World clade B haemorrhagic fever virus
- B. An Old World virus, but a phylogenetic outlier
- C. A reptarenavirus of snakes
- D. Genetically almost identical to Lassa virus
- E. A core member of the New World Tacaribe serocomplex
Show answer
Correct answer: B
Lujo virus is broadly an Old World arenavirus but a marked phylogenetic outlier, its glycoprotein so divergent that it clusters with neither the Old World nor the New World complex.

It is not a New World, reptile or Tacaribe-complex virus, and despite an almost identical syndrome it is genetically distant from Lassa.