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Case Reports
. 2015 Oct 16:15:432.
doi: 10.1186/s12879-015-1169-4.

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

Nicola Petrosillo  1 , Emanuele Nicastri  2 , Simone Lanini  3 , Maria Rosaria Capobianchi  4 , Antonino Di Caro  5 , Mario Antonini  6 , Vincenzo Puro  7 , Francesco Nicola Lauria  8 , Nakono Shindo  9 , Nicola Magrini  10 , Gary P Kobinger  11 , Giuseppe Ippolito  12 ; INMI EBOV Team
Collaborators, Affiliations
Case Reports

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

Nicola Petrosillo et al. BMC Infect Dis. .

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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Figures

Fig. 1
Fig. 1
EBOV viral load in different clinical specimen and time of administration of experimental antiviral therapies
Fig. 2
Fig. 2
Blood counts during hospital stay. ICU= intensive care unit; WBC= white blood cells; Neu.= neutrophils; Lym.=lymphocytes; Mono.= Monocytes; PLTS= platelets; HB= hemoglobin
Fig. 3
Fig. 3
Clinical chemistry assays during hospital stay (all tests were performed on venous blood specimens). ICU= intensive care unit; GLU= glucose; ALT= alanine transaminase; BIL.= bilirubin; CREA.= creatinine; BUN.= blood urea nitrogen; Na+= sodium ; K+= potassium; INR= international normalized ratio
Fig. 4
Fig. 4
Chest XR carried out on December 2 2014. SN= left side; the white square was added for patient’s privacy protection
See this image and copyright information in PMC

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