Ebola virus disease complicated with viral interstitial pneumonia

A case report

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, Vincenzo Puro, Mario Antonini, Antonio Russo, Antonella Petrecchia, Evangelo Boumis, Marco Gentile, Damiano Travaglini, Silvia Pittalis & 68 others Lorena Martini, Concetta Castilletti, Francesco Maria Fusco, Simone Lanini, Andrea Antinori, Giuseppe Ippolito, Valerio Fabio Alberti, Nazario Bevilacqua, Evangelo Boumis, Stefania Cicalini, Pierangelo Chinello, Angela Corpolongo, Andrea Mariano, Fabrizio Taglietti, Laura Vincenzi, Telma Azevedo, Mario Antonini, Ilaria Caravella, Gabriele Garotto, Luisa Marchioni, Micaela Maritti, Gianni Battisti, Alessanda Coppola, Loredana De Marchis, Nicola De Marco, Fabio Di Gianbattista, Mario Guiducci, Daniela Imola, Antonio Marasco, Antonella Marzolini, Alessandro Mercuri, Paola Nieddu, Silvia Ondedei, Maurizio Vescovo, Laura Vitolo, Elisa Busi Rizzi, Silvia Murachelli, Maria Rosaria Capobianchi, Antonino di Caro, Concetta Castilletti, Licia Bordi, Eleonora Lalle, Silvia Meschi, Daniele Lapa, Patrizia Marsella, Francesca Colavita, Roberta Chiappini, Antonio Mazzarelli, Serena Quartu, Chiara Agrati, Fabrizio Carletti, Federica Forbici, Maria Beatrice Valli, Isabella Abbate, Alessandra Amendola, Anna Rosa Garbuglia, Maria Grazia Paglia, Eugenio Bordi, Antonietta Toffoletti, Gaetano Battisti, Marco Liguori, Paolo D'Aprile, Raffaella Barbaro, Lorella Salce, Daniela Renna, Simona Barbato, Paola Vaccaro, Francesco Bianchini

Research output: Contribution to journalArticle

25 Citations (Scopus)

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 39days 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.

Original languageEnglish
Article number432
JournalBMC Infectious Diseases
Volume15
Issue number1
DOIs
Publication statusPublished - Oct 16 2015

Fingerprint

Ebola Hemorrhagic Fever
Viral Pneumonia
Interstitial Lung Diseases
Viral Load
Respiratory Insufficiency
Sierra Leone
Ebolavirus
Plasmodium vivax
Lung
Investigational Therapies
Western Africa
Coinfection
Artificial Respiration
Italy
Antiviral Agents
Urine
Delivery of Health Care
Physicians
favipiravir

Keywords

  • Antibodies, monoclonal
  • Ebola
  • Favipiravir
  • Fluid therapy
  • Hemorrhagic fever
  • Hospitals, isolation
  • Immunization, passive
  • Life support care
  • Malaria, vivax
  • Pneumonia, viral

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Ebola virus disease complicated with viral interstitial pneumonia : A case report. / Petrosillo, Nicola; Nicastri, Emanuele; Lanini, Simone; Capobianchi, Maria Rosaria; Di Caro, Antonino; Antonini, Mario; Puro, Vincenzo; Lauria, Francesco Nicola; Shindo, Nakono; Magrini, Nicola; Kobinger, Gary P.; Ippolito, Giuseppe; Puro, Vincenzo; Antonini, Mario; Russo, Antonio; Petrecchia, Antonella; Boumis, Evangelo; Gentile, Marco; Travaglini, Damiano; Pittalis, Silvia; Martini, Lorena; Castilletti, Concetta; Fusco, Francesco Maria; Lanini, Simone; Antinori, Andrea; Ippolito, Giuseppe; Alberti, Valerio Fabio; Bevilacqua, Nazario; Boumis, Evangelo; Cicalini, Stefania; Chinello, Pierangelo; Corpolongo, Angela; Mariano, Andrea; Taglietti, Fabrizio; Vincenzi, Laura; Azevedo, Telma; Antonini, Mario; Caravella, Ilaria; Garotto, Gabriele; Marchioni, Luisa; Maritti, Micaela; Battisti, Gianni; Coppola, Alessanda; Marchis, Loredana De; De Marco, Nicola; Gianbattista, Fabio Di; Guiducci, Mario; Imola, Daniela; Marasco, Antonio; Marzolini, Antonella; Mercuri, Alessandro; Nieddu, Paola; Ondedei, Silvia; Vescovo, Maurizio; Vitolo, Laura; Rizzi, Elisa Busi; Murachelli, Silvia; Capobianchi, Maria Rosaria; di Caro, Antonino; Castilletti, Concetta; Bordi, Licia; Lalle, Eleonora; Meschi, Silvia; Lapa, Daniele; Marsella, Patrizia; Colavita, Francesca; Chiappini, Roberta; Mazzarelli, Antonio; Quartu, Serena; Agrati, Chiara; Carletti, Fabrizio; Forbici, Federica; Valli, Maria Beatrice; Abbate, Isabella; Amendola, Alessandra; Garbuglia, Anna Rosa; Paglia, Maria Grazia; Bordi, Eugenio; Toffoletti, Antonietta; Battisti, Gaetano; Liguori, Marco; D'Aprile, Paolo; Barbaro, Raffaella; Salce, Lorella; Renna, Daniela; Barbato, Simona; Vaccaro, Paola; Bianchini, Francesco.

In: BMC Infectious Diseases, Vol. 15, No. 1, 432, 16.10.2015.

Research output: Contribution to journalArticle

Petrosillo, N, Nicastri, E, Lanini, S, Capobianchi, MR, Di Caro, A, Antonini, M, Puro, V, Lauria, FN, Shindo, N, Magrini, N, Kobinger, GP, Ippolito, G, Puro, V, Antonini, M, Russo, A, Petrecchia, A, Boumis, E, Gentile, M, Travaglini, D, Pittalis, S, Martini, L, Castilletti, C, Fusco, FM, Lanini, S, Antinori, A, Ippolito, G, Alberti, VF, Bevilacqua, N, Boumis, E, Cicalini, S, Chinello, P, Corpolongo, A, Mariano, A, Taglietti, F, Vincenzi, L, Azevedo, T, Antonini, M, Caravella, I, Garotto, G, Marchioni, L, Maritti, M, Battisti, G, Coppola, A, Marchis, LD, De Marco, N, Gianbattista, FD, Guiducci, M, Imola, D, Marasco, A, Marzolini, A, Mercuri, A, Nieddu, P, Ondedei, S, Vescovo, M, Vitolo, L, Rizzi, EB, Murachelli, S, Capobianchi, MR, di Caro, A, Castilletti, C, Bordi, L, Lalle, E, Meschi, S, Lapa, D, Marsella, P, Colavita, F, Chiappini, R, Mazzarelli, A, Quartu, S, Agrati, C, Carletti, F, Forbici, F, Valli, MB, Abbate, I, Amendola, A, Garbuglia, AR, Paglia, MG, Bordi, E, Toffoletti, A, Battisti, G, Liguori, M, D'Aprile, P, Barbaro, R, Salce, L, Renna, D, Barbato, S, Vaccaro, P & Bianchini, F 2015, 'Ebola virus disease complicated with viral interstitial pneumonia: A case report', BMC Infectious Diseases, vol. 15, no. 1, 432. https://doi.org/10.1186/s12879-015-1169-4
Petrosillo, Nicola ; Nicastri, Emanuele ; Lanini, Simone ; Capobianchi, Maria Rosaria ; Di Caro, Antonino ; Antonini, Mario ; Puro, Vincenzo ; Lauria, Francesco Nicola ; Shindo, Nakono ; Magrini, Nicola ; Kobinger, Gary P. ; Ippolito, Giuseppe ; Puro, Vincenzo ; Antonini, Mario ; Russo, Antonio ; Petrecchia, Antonella ; Boumis, Evangelo ; Gentile, Marco ; Travaglini, Damiano ; Pittalis, Silvia ; Martini, Lorena ; Castilletti, Concetta ; Fusco, Francesco Maria ; Lanini, Simone ; Antinori, Andrea ; Ippolito, Giuseppe ; Alberti, Valerio Fabio ; Bevilacqua, Nazario ; Boumis, Evangelo ; Cicalini, Stefania ; Chinello, Pierangelo ; Corpolongo, Angela ; Mariano, Andrea ; Taglietti, Fabrizio ; Vincenzi, Laura ; Azevedo, Telma ; Antonini, Mario ; Caravella, Ilaria ; Garotto, Gabriele ; Marchioni, Luisa ; Maritti, Micaela ; Battisti, Gianni ; Coppola, Alessanda ; Marchis, Loredana De ; De Marco, Nicola ; Gianbattista, Fabio Di ; Guiducci, Mario ; Imola, Daniela ; Marasco, Antonio ; Marzolini, Antonella ; Mercuri, Alessandro ; Nieddu, Paola ; Ondedei, Silvia ; Vescovo, Maurizio ; Vitolo, Laura ; Rizzi, Elisa Busi ; Murachelli, Silvia ; Capobianchi, Maria Rosaria ; di Caro, Antonino ; Castilletti, Concetta ; Bordi, Licia ; Lalle, Eleonora ; Meschi, Silvia ; Lapa, Daniele ; Marsella, Patrizia ; Colavita, Francesca ; Chiappini, Roberta ; Mazzarelli, Antonio ; Quartu, Serena ; Agrati, Chiara ; Carletti, Fabrizio ; Forbici, Federica ; Valli, Maria Beatrice ; Abbate, Isabella ; Amendola, Alessandra ; Garbuglia, Anna Rosa ; Paglia, Maria Grazia ; Bordi, Eugenio ; Toffoletti, Antonietta ; Battisti, Gaetano ; Liguori, Marco ; D'Aprile, Paolo ; Barbaro, Raffaella ; Salce, Lorella ; Renna, Daniela ; Barbato, Simona ; Vaccaro, Paola ; Bianchini, Francesco. / Ebola virus disease complicated with viral interstitial pneumonia : A case report. In: BMC Infectious Diseases. 2015 ; Vol. 15, No. 1.
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T1 - Ebola virus disease complicated with viral interstitial pneumonia

T2 - A case report

AU - Petrosillo, Nicola

AU - Nicastri, Emanuele

AU - Lanini, Simone

AU - Capobianchi, Maria Rosaria

AU - Di Caro, Antonino

AU - Antonini, Mario

AU - Puro, Vincenzo

AU - Lauria, Francesco Nicola

AU - Shindo, Nakono

AU - Magrini, Nicola

AU - Kobinger, Gary P.

AU - Ippolito, Giuseppe

AU - Puro, Vincenzo

AU - Antonini, Mario

AU - Russo, Antonio

AU - Petrecchia, Antonella

AU - Boumis, Evangelo

AU - Gentile, Marco

AU - Travaglini, Damiano

AU - Pittalis, Silvia

AU - Martini, Lorena

AU - Castilletti, Concetta

AU - Fusco, Francesco Maria

AU - Lanini, Simone

AU - Antinori, Andrea

AU - Ippolito, Giuseppe

AU - Alberti, Valerio Fabio

AU - Bevilacqua, Nazario

AU - Boumis, Evangelo

AU - Cicalini, Stefania

AU - Chinello, Pierangelo

AU - Corpolongo, Angela

AU - Mariano, Andrea

AU - Taglietti, Fabrizio

AU - Vincenzi, Laura

AU - Azevedo, Telma

AU - Antonini, Mario

AU - Caravella, Ilaria

AU - Garotto, Gabriele

AU - Marchioni, Luisa

AU - Maritti, Micaela

AU - Battisti, Gianni

AU - Coppola, Alessanda

AU - Marchis, Loredana De

AU - De Marco, Nicola

AU - Gianbattista, Fabio Di

AU - Guiducci, Mario

AU - Imola, Daniela

AU - Marasco, Antonio

AU - Marzolini, Antonella

AU - Mercuri, Alessandro

AU - Nieddu, Paola

AU - Ondedei, Silvia

AU - Vescovo, Maurizio

AU - Vitolo, Laura

AU - Rizzi, Elisa Busi

AU - Murachelli, Silvia

AU - Capobianchi, Maria Rosaria

AU - di Caro, Antonino

AU - Castilletti, Concetta

AU - Bordi, Licia

AU - Lalle, Eleonora

AU - Meschi, Silvia

AU - Lapa, Daniele

AU - Marsella, Patrizia

AU - Colavita, Francesca

AU - Chiappini, Roberta

AU - Mazzarelli, Antonio

AU - Quartu, Serena

AU - Agrati, Chiara

AU - Carletti, Fabrizio

AU - Forbici, Federica

AU - Valli, Maria Beatrice

AU - Abbate, Isabella

AU - Amendola, Alessandra

AU - Garbuglia, Anna Rosa

AU - Paglia, Maria Grazia

AU - Bordi, Eugenio

AU - Toffoletti, Antonietta

AU - Battisti, Gaetano

AU - Liguori, Marco

AU - D'Aprile, Paolo

AU - Barbaro, Raffaella

AU - Salce, Lorella

AU - Renna, Daniela

AU - Barbato, Simona

AU - Vaccaro, Paola

AU - Bianchini, Francesco

PY - 2015/10/16

Y1 - 2015/10/16

N2 - 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 39days 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.

AB - 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 39days 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.

KW - Antibodies, monoclonal

KW - Ebola

KW - Favipiravir

KW - Fluid therapy

KW - Hemorrhagic fever

KW - Hospitals, isolation

KW - Immunization, passive

KW - Life support care

KW - Malaria, vivax

KW - Pneumonia, viral

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