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Ebola Virus Disease Complicated by Late-Onset Encephalitis and Polyarthritis, Sierra Leone.

Howlett P, Brown C, Helderman T, Brooks T, Lisk D, Deen G, Solbrig M, Lado M - Emerging Infect. Dis. (2016)

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Ebola virus (EBOV) disease is usually an acute illness, but increasing evidence exists of persistent infections and post-Ebola syndromes... On day 8 of illness, after testing EBOV PCR–positive (cycle threshold [Ct] value of 23.5), she was given intravenous ceftriaxone (2 g) for 7 days, artesunate (180 mg) for 3 days, and Ringer’s lactate (4–6 L) with supplemental KCl for 5 days... During days 13–15, the patient improved, moving independently and talking... She was given intravenous fluconazole (800 mg 1×/d)... Admission blood test results showed anemia, elevated and C-reactive protein, and low creatinine (Technical Appendix)... HIV test results were negative... Lumbar puncture was performed; opening pressure (30 cm H2O) was elevated, and cerebrospinal fluid (CSF) was EBOV PCR–positive (Ct value 37.6), as determined by using the Public Health England in-house, optimized version of the Trombley assay with a cutoff Ct value of 40... On day 44, an underarm sweat swab sample was PCR-positive (Ct value 39.6) and a buccal swab sample PCR-negative for EBOV... On day 51, a midstream urine sample was EBOV PCR–positive (Ct value 35.7), and an underarm sweat swab sample was EBOV PCR–negative... A midstream urine test was still EBOV PCR–positive (Ct value 39.6); PCR of her sweat swab sample was inhibited (Technical Appendix)... This case raises the practical issue that Ebola treatment requires understanding of multiorgan virologic and inflammatory complications; survivor care and research programs should screen for neurocognitive impairment and consider appropriate imaging... The case confirms previously reported intermittent EBOV PCR positivity in urine... The development of arthritis with synovitis, treated with corticosteroids, supports the diagnosis of reactive arthritis... Blood test and cycle threshold results for a 30-year-old woman with Ebola virus disease, Sierra Leone.

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Representative axial cuts from noncontrast head computed tomography scan imaging of a 30-year-old woman with encephalitis resulting from Ebola virus infection, Sierra Leone. Images show global atrophy in keeping with nonobstructive ventriculomegaly and no periventricular low attenuation: A) subcortical atrophy; B) cortical atrophy. There was no evidence of hydrocephalus, previous stroke, or intracranial hemorrhage. A cavum septum pellucidum was noted in other images.
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Figure 1: Representative axial cuts from noncontrast head computed tomography scan imaging of a 30-year-old woman with encephalitis resulting from Ebola virus infection, Sierra Leone. Images show global atrophy in keeping with nonobstructive ventriculomegaly and no periventricular low attenuation: A) subcortical atrophy; B) cortical atrophy. There was no evidence of hydrocephalus, previous stroke, or intracranial hemorrhage. A cavum septum pellucidum was noted in other images.

Mentions: By day 41 she was more alert, although her family reported she had slowed responses. Lumbar puncture was performed; opening pressure (30 cm H2O) was elevated, and cerebrospinal fluid (CSF) was EBOV PCR–positive (Ct value 37.6), as determined by using the Public Health England in-house, optimized version of the Trombley assay (2) with a cutoff Ct value of 40. Concurrent catheter specimens of urine and blood samples tested EBOV-negative. FilmArray (BioFire Diagnostics, Salt Lake City, UT, USA) testing showed methicillin-resistant Staphylococcus aureus and Klebsiella pneumoniae in CSF and mixed pathogens in urine. A computer tomographic scan image of the patient’s head showed substantial cerebral atrophy without hydrocephalus (Figure).


Ebola Virus Disease Complicated by Late-Onset Encephalitis and Polyarthritis, Sierra Leone.

Howlett P, Brown C, Helderman T, Brooks T, Lisk D, Deen G, Solbrig M, Lado M - Emerging Infect. Dis. (2016)

Representative axial cuts from noncontrast head computed tomography scan imaging of a 30-year-old woman with encephalitis resulting from Ebola virus infection, Sierra Leone. Images show global atrophy in keeping with nonobstructive ventriculomegaly and no periventricular low attenuation: A) subcortical atrophy; B) cortical atrophy. There was no evidence of hydrocephalus, previous stroke, or intracranial hemorrhage. A cavum septum pellucidum was noted in other images.
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Related In: Results  -  Collection

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Figure 1: Representative axial cuts from noncontrast head computed tomography scan imaging of a 30-year-old woman with encephalitis resulting from Ebola virus infection, Sierra Leone. Images show global atrophy in keeping with nonobstructive ventriculomegaly and no periventricular low attenuation: A) subcortical atrophy; B) cortical atrophy. There was no evidence of hydrocephalus, previous stroke, or intracranial hemorrhage. A cavum septum pellucidum was noted in other images.
Mentions: By day 41 she was more alert, although her family reported she had slowed responses. Lumbar puncture was performed; opening pressure (30 cm H2O) was elevated, and cerebrospinal fluid (CSF) was EBOV PCR–positive (Ct value 37.6), as determined by using the Public Health England in-house, optimized version of the Trombley assay (2) with a cutoff Ct value of 40. Concurrent catheter specimens of urine and blood samples tested EBOV-negative. FilmArray (BioFire Diagnostics, Salt Lake City, UT, USA) testing showed methicillin-resistant Staphylococcus aureus and Klebsiella pneumoniae in CSF and mixed pathogens in urine. A computer tomographic scan image of the patient’s head showed substantial cerebral atrophy without hydrocephalus (Figure).

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Ebola virus (EBOV) disease is usually an acute illness, but increasing evidence exists of persistent infections and post-Ebola syndromes... On day 8 of illness, after testing EBOV PCR–positive (cycle threshold [Ct] value of 23.5), she was given intravenous ceftriaxone (2 g) for 7 days, artesunate (180 mg) for 3 days, and Ringer’s lactate (4–6 L) with supplemental KCl for 5 days... During days 13–15, the patient improved, moving independently and talking... She was given intravenous fluconazole (800 mg 1×/d)... Admission blood test results showed anemia, elevated and C-reactive protein, and low creatinine (Technical Appendix)... HIV test results were negative... Lumbar puncture was performed; opening pressure (30 cm H2O) was elevated, and cerebrospinal fluid (CSF) was EBOV PCR–positive (Ct value 37.6), as determined by using the Public Health England in-house, optimized version of the Trombley assay with a cutoff Ct value of 40... On day 44, an underarm sweat swab sample was PCR-positive (Ct value 39.6) and a buccal swab sample PCR-negative for EBOV... On day 51, a midstream urine sample was EBOV PCR–positive (Ct value 35.7), and an underarm sweat swab sample was EBOV PCR–negative... A midstream urine test was still EBOV PCR–positive (Ct value 39.6); PCR of her sweat swab sample was inhibited (Technical Appendix)... This case raises the practical issue that Ebola treatment requires understanding of multiorgan virologic and inflammatory complications; survivor care and research programs should screen for neurocognitive impairment and consider appropriate imaging... The case confirms previously reported intermittent EBOV PCR positivity in urine... The development of arthritis with synovitis, treated with corticosteroids, supports the diagnosis of reactive arthritis... Blood test and cycle threshold results for a 30-year-old woman with Ebola virus disease, Sierra Leone.

No MeSH data available.


Related in: MedlinePlus