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Published in: BMC Infectious Diseases 1/2015

Open Access 01-12-2015 | Case report

Ebola virus disease complicated with viral interstitial pneumonia: a case report

Authors: Nicola Petrosillo, Emanuele Nicastri, Simone Lanini, Maria Rosaria Capobianchi, Antonino Di Caro, Mario Antonini, Vincenzo Puro, Francesco Nicola Lauria, Nakono Shindo, Nicola Magrini, Gary P. Kobinger, Giuseppe Ippolito, INMI EBOV Team

Published in: BMC Infectious Diseases | Issue 1/2015

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Abstract

Background

In the current Ebola epidemic in Western Africa, many healthcare workers have become infected. Some of these have been medically evacuated to hospitals in Europe and the USA. These clinical experiences provide unique insights into the course of Ebola virus disease under optimized condition within high level isolation units.

Case presentation

A 50-year-old Caucasian male physician contracted Ebola virus diseases in Sierra Leone and was medically evacuated to Italy. Few days after the admission the course of the illness was characterized by severe gastro-intestinal symptoms followed by respiratory failure, accompanied by pulmonary infiltration and high Ebola viral load in the bronchial aspirate and Plasmodium vivax co-infection. The patient received experimental antiviral therapy with favipiravir, convalescent plasma and ZMAb. Ebola viral load started to steadily decrease in the blood after ZMAb administration and became undetectable by day 19 after admission, while it persisted longer in urine samples. No temporal association was observed between viral load decay in plasma and administration of favipiravir. The patient completely recovered and was discharged 39 days after admission.

Conclusions

This is the first case of Ebola-related interstitial pneumonia documented by molecular testing of lung fluid specimens. This reports underlines the pivotal role of fluid replacement and advanced life support with mechanical ventilation in the management of patients with Ebola virus diseases respiratory failure. Beside our finding indicates a close temporal association between administration of cZMAb and Ebola virus clearance from blood.
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Literature
2.
go back to reference Chevalier MS, Chung W, Smith J, Weil LM, Hughes SM, Joyner SN, et al. Centers for Disease Control and Prevention (CDC). Ebola virus disease cluster in the United States--Dallas County, Texas, 2014. MMWR Morb Mortal Wkly Rep. 2014;63(46):1087–8.PubMed Chevalier MS, Chung W, Smith J, Weil LM, Hughes SM, Joyner SN, et al. Centers for Disease Control and Prevention (CDC). Ebola virus disease cluster in the United States--Dallas County, Texas, 2014. MMWR Morb Mortal Wkly Rep. 2014;63(46):1087–8.PubMed
5.
go back to reference Health worker critically ill, as Ebola exposures prompt flurry of medical evacuations. Center for Infectious Diseases Research and Policy (CIDRAP) Website. http://www.cidrap.umn.edu/news-perspective/2015/03/health-worker-critically-ill-ebola-exposures-prompt-flurry-medical. Updated March 16, 2015. Accessed on June 5, 2015 Health worker critically ill, as Ebola exposures prompt flurry of medical evacuations. Center for Infectious Diseases Research and Policy (CIDRAP) Website. http://​www.​cidrap.​umn.​edu/​news-perspective/​2015/​03/​health-worker-critically-ill-ebola-exposures-prompt-flurry-medical.​ Updated March 16, 2015. Accessed on June 5, 2015
6.
go back to reference Kreuels B, Wichmann D, Emmerich P, Schmidt-Chanasit J, de Heer G, Kluge S, et al. A case of severe Ebola virus infection complicated by gram-negative septicemia. N Engl J Med. 2014;371(25):2394–401. doi:10.1056/NEJMoa1411677.CrossRefPubMed Kreuels B, Wichmann D, Emmerich P, Schmidt-Chanasit J, de Heer G, Kluge S, et al. A case of severe Ebola virus infection complicated by gram-negative septicemia. N Engl J Med. 2014;371(25):2394–401. doi:10.​1056/​NEJMoa1411677.CrossRefPubMed
7.
go back to reference Wolf T, Kann G, Becker S, Stephan C, Brodt HR, de Leuw P et al Severe Ebola virus disease with vascular leakage and multiorgan failure: treatment of a patient in intensive care. Lancet. 2014. doi:10.1016/S0140-6736(14)62384-9. Wolf T, Kann G, Becker S, Stephan C, Brodt HR, de Leuw P et al Severe Ebola virus disease with vascular leakage and multiorgan failure: treatment of a patient in intensive care. Lancet. 2014. doi:10.​1016/​S0140-6736(14)62384-9.​
8.
go back to reference Mora-Rillo M, Arsuaga M, Ramírez-Olivencia G, de la Calle F, Borobia AM, et al. Acute respiratory distress syndrome after convalescent plasma use: treatment of a patient with Ebola virus disease contracted in Madrid. Spain Lancet Respir Med. 2015;3(7):554–62. doi:10.1016/S2213-2600(15)00180-0.CrossRefPubMed Mora-Rillo M, Arsuaga M, Ramírez-Olivencia G, de la Calle F, Borobia AM, et al. Acute respiratory distress syndrome after convalescent plasma use: treatment of a patient with Ebola virus disease contracted in Madrid. Spain Lancet Respir Med. 2015;3(7):554–62. doi:10.​1016/​S2213-2600(15)00180-0.CrossRefPubMed
9.
10.
go back to reference Liddell AM, Davey RT Jr, Mehta AK, Varkey JB, Kraft CS, Tseggay GK et al. Characteristics and Clinical Management of a Cluster of 3 Patients With Ebola Virus Disease, Including the First Domestically Acquired Cases in the United States. Ann Intern Med. 2015. doi:10.7326/M15-0530. Liddell AM, Davey RT Jr, Mehta AK, Varkey JB, Kraft CS, Tseggay GK et al. Characteristics and Clinical Management of a Cluster of 3 Patients With Ebola Virus Disease, Including the First Domestically Acquired Cases in the United States. Ann Intern Med. 2015. doi:10.​7326/​M15-0530.​
11.
12.
13.
go back to reference Noera G, Lamarra M, Guarini S, Bertolini A. Survival rate after early treatment for acute type-A aortic dissection with ACTH-(1-24). Lancet. 2001;358(9280):469–70.CrossRefPubMed Noera G, Lamarra M, Guarini S, Bertolini A. Survival rate after early treatment for acute type-A aortic dissection with ACTH-(1-24). Lancet. 2001;358(9280):469–70.CrossRefPubMed
14.
go back to reference Audet J, Wong G, Wang H, Lu G, Gao GF, Kobinger G, et al. Molecular characterization of the monoclonal antibodies composing ZMAb: a protective cocktail against Ebola virus. Sci Rep. 2014;4:6881. doi:10.1038/srep06881.CrossRefPubMed Audet J, Wong G, Wang H, Lu G, Gao GF, Kobinger G, et al. Molecular characterization of the monoclonal antibodies composing ZMAb: a protective cocktail against Ebola virus. Sci Rep. 2014;4:6881. doi:10.​1038/​srep06881.CrossRefPubMed
15.
go back to reference Qiu X, Wong G, Fernando L, Audet J, Bello A, Strong J et al. MAbs and Ad-vectored IFN-α therapy rescue Ebola-infected nonhuman primates when administered after the detection of viremia and symptoms. Sci Transl Med. 2013;5(207):207ra143. doi:10.1126/scitranslmed.3006605. Qiu X, Wong G, Fernando L, Audet J, Bello A, Strong J et al. MAbs and Ad-vectored IFN-α therapy rescue Ebola-infected nonhuman primates when administered after the detection of viremia and symptoms. Sci Transl Med. 2013;5(207):207ra143. doi:10.​1126/​scitranslmed.​3006605.​
16.
go back to reference Brouqui P, Puro V, Fusco FM, Bannister B, Schilling S, Follin P, et al. Infection control in the management of highly pathogenic infectious diseases: consensus of the European Network of Infectious Disease. Lancet Infect Dis. 2009;9(5):301–11. doi:10.1016/S1473-3099(09)70070-2.CrossRefPubMed Brouqui P, Puro V, Fusco FM, Bannister B, Schilling S, Follin P, et al. Infection control in the management of highly pathogenic infectious diseases: consensus of the European Network of Infectious Disease. Lancet Infect Dis. 2009;9(5):301–11. doi:10.​1016/​S1473-3099(09)70070-2.CrossRefPubMed
17.
go back to reference Lichtenstein D, Mezière G. The BLUE points: three standardized points used in the BLUE-protocol for ultrasound assessment of the lung in acute respiratory failure. Crit Ultrasound J. 2011;3:109–10.CrossRef Lichtenstein D, Mezière G. The BLUE points: three standardized points used in the BLUE-protocol for ultrasound assessment of the lung in acute respiratory failure. Crit Ultrasound J. 2011;3:109–10.CrossRef
20.
go back to reference Sissoko D, Anglaret X, Malvy D Abdoul, Beavogui H, Gunther S, Shepherd S et al. Favipiravir in patients with Ebola virus disease: early results of the JIKI trial in Guinea. Conference on Retroviruses and Opportunistic Infections: Seattle, WA. February 23–26, 2015. 103-ALB Sissoko D, Anglaret X, Malvy D Abdoul, Beavogui H, Gunther S, Shepherd S et al. Favipiravir in patients with Ebola virus disease: early results of the JIKI trial in Guinea. Conference on Retroviruses and Opportunistic Infections: Seattle, WA. February 23–26, 2015. 103-ALB
21.
go back to reference Falasca L, Agrati C, Petrosillo N, Di Caro A, Capobianchi MR, Ippolito G et al. Molecular mechanisms of Ebola virus pathogenesis: focus on cell death. Cell Death Differ. 2015. doi: 10.1038/cdd.2015.67. Falasca L, Agrati C, Petrosillo N, Di Caro A, Capobianchi MR, Ippolito G et al. Molecular mechanisms of Ebola virus pathogenesis: focus on cell death. Cell Death Differ. 2015. doi: 10.​1038/​cdd.​2015.​67.​
22.
go back to reference Lamontagne F, Clément C, Fletcher T, Jacob ST, Fischer 2nd WA, Fowler RA, et al. Doing Today's Work Superbly Well - Treating Ebola with Current Tools. N Engl J Med. 2014;371:1565–6.CrossRefPubMed Lamontagne F, Clément C, Fletcher T, Jacob ST, Fischer 2nd WA, Fowler RA, et al. Doing Today's Work Superbly Well - Treating Ebola with Current Tools. N Engl J Med. 2014;371:1565–6.CrossRefPubMed
23.
go back to reference Gupta M, Spiropoulou C, Rollin PE. Ebola virus infection of human PBMCs causes massive death of macrophages, CD4 and CD8 T cell sub-populations in vitro. Virology. 2007;364(1):45–54.CrossRefPubMed Gupta M, Spiropoulou C, Rollin PE. Ebola virus infection of human PBMCs causes massive death of macrophages, CD4 and CD8 T cell sub-populations in vitro. Virology. 2007;364(1):45–54.CrossRefPubMed
24.
25.
go back to reference Baluna R, Vitetta ES. Vascular leak syndrome: a side effect of immunotherapy. Immunopharmacology. 1997;37(2-3):117–32.CrossRefPubMed Baluna R, Vitetta ES. Vascular leak syndrome: a side effect of immunotherapy. Immunopharmacology. 1997;37(2-3):117–32.CrossRefPubMed
26.
27.
go back to reference Londhe C, Ganeriwal A, deSouza R. Study of clinical profile of acute respiratory distress syndrome and acute lung injury in Plasmodium vivax malaria. J Vector Borne Dis. 2014;51(4):339–42.PubMed Londhe C, Ganeriwal A, deSouza R. Study of clinical profile of acute respiratory distress syndrome and acute lung injury in Plasmodium vivax malaria. J Vector Borne Dis. 2014;51(4):339–42.PubMed
29.
go back to reference Dissanaike S, Shelton M, Warner K, O'Keefe GE. The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition. Crit Care. 2007;11(5):R114.PubMedCentralCrossRefPubMed Dissanaike S, Shelton M, Warner K, O'Keefe GE. The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition. Crit Care. 2007;11(5):R114.PubMedCentralCrossRefPubMed
30.
go back to reference Herbinger KH, Fleischmann E, Weber C, Perona P, Löscher T, et al. Epidemiological, clinical, and diagnostic data on intestinal infections with Entamoeba histolytica and Entamoeba dispar among returning travelers. Infection. 2011;39(6):527–35. doi:10.1007/s15010-011-0155-z.CrossRefPubMed Herbinger KH, Fleischmann E, Weber C, Perona P, Löscher T, et al. Epidemiological, clinical, and diagnostic data on intestinal infections with Entamoeba histolytica and Entamoeba dispar among returning travelers. Infection. 2011;39(6):527–35. doi:10.​1007/​s15010-011-0155-z.CrossRefPubMed
32.
go back to reference Lanini S, Zumla A, Ioannidis JP, Caro AD, Krishna S, Gostin L et al. Are adaptive randomised trials or non-randomised studies the best way to address the Ebola outbreak in west Africa? Lancet Infect Dis. 2015. doi: 10.1016/S1473-3099(15)70106-4. Lanini S, Zumla A, Ioannidis JP, Caro AD, Krishna S, Gostin L et al. Are adaptive randomised trials or non-randomised studies the best way to address the Ebola outbreak in west Africa? Lancet Infect Dis. 2015. doi: 10.​1016/​S1473-3099(15)70106-4.
33.
go back to reference Toy P, Popovsky MA, Abraham E, Ambruso DR, Holness LG, Kopko PM, et al. National Heart, Lung and Blood Institute Working Group on TRALI. Transfusion-related acute lung injury: definition and review. Crit Care Med. 2005;33(4):721–6.CrossRefPubMed Toy P, Popovsky MA, Abraham E, Ambruso DR, Holness LG, Kopko PM, et al. National Heart, Lung and Blood Institute Working Group on TRALI. Transfusion-related acute lung injury: definition and review. Crit Care Med. 2005;33(4):721–6.CrossRefPubMed
34.
go back to reference Qiu X, Audet J, Wong G, Fernando L, Bello A, Pillet S, et al. Sustained protection against Ebola virus infection following treatment of infected nonhuman primates with ZMAb. Sci Rep. 2013;3:3365. doi:10.1038/srep03365.PubMedCentralPubMed Qiu X, Audet J, Wong G, Fernando L, Bello A, Pillet S, et al. Sustained protection against Ebola virus infection following treatment of infected nonhuman primates with ZMAb. Sci Rep. 2013;3:3365. doi:10.​1038/​srep03365.PubMedCentralPubMed
Metadata
Title
Ebola virus disease complicated with viral interstitial pneumonia: a case report
Authors
Nicola Petrosillo
Emanuele Nicastri
Simone Lanini
Maria Rosaria Capobianchi
Antonino Di Caro
Mario Antonini
Vincenzo Puro
Francesco Nicola Lauria
Nakono Shindo
Nicola Magrini
Gary P. Kobinger
Giuseppe Ippolito
INMI EBOV Team
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2015
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-015-1169-4

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