Biochemical testing in a laboratory tent and semi-intensive care of Ebola patients on-site in a remote part of Guinea: a paradigm shift based on a bleach-sensitive point-of-care device

2017 ◽  
Vol 55 (12) ◽  
Author(s):  
Leonid M. Irenge ◽  
Jean-Michel Dindart ◽  
Jean-Luc Gala
Keyword(s):  
Paradigm Shift ◽  
Ebola Virus ◽  
Virus Disease ◽  
Care Delivery ◽  
Point Of Care ◽  
Operating Conditions ◽  
Supportive Treatment ◽  
Treatment Unit ◽  
Life Threatening ◽  
Biochemical Testing

Abstract:Background:During the West Africa Ebola virus disease (EVD) outbreak, a Belgian laboratory was deployed for supporting the Ebola treatment unit (ETU) of N’Zerekore, Guinea. Besides diagnosis of EVD and malaria, biochemical parameters were tested and used to guide supportive treatment of EVD.Methods:To preserve analytes stability, lithium-heparin blood samples were analyzed using the i-STATResults:Providing the medical staff with real-time biochemical data modified their therapeutic attitude, shifting from empiric to a semi-intensive laboratory-guided treatment of hydro-electrolytic disturbances, metabolic acidosis and/or impaired kidney function. As illustrated with representative EVD cases (n=8), optimized supportive treatment with intravenous fluid therapy and electrolyte replacement often helped correct these abnormalities. However, the harsh operating conditions, especially the use of bleach decontamination inside the glovebox, caused several technical failures and the final breakdown of the POCT device.Conclusions:POCT availability resulted in a paradigm shift in laboratory practice and care delivery at the N’Zerekore ETU. We conclude that there is urgent need for novel well-designed and validated POCT devices usable by non-expert operators in high ambient temperature and limited space. These devices should withstand regular and thorough decontamination by the personnel working on-site with life-threatening pathogens and be compatible with high biosafety level procedures. Such specific users’ requirements need a European validation and standardization process of proposed solutions led by the EU Standardization Committee (CEN).

scholarly journals Ebola or Not? Evaluating the Ill Traveler From Ebola-Affected Countries in West Africa

2016 ◽  
Vol 3 (1) ◽  
Author(s):  
Jessica K. Fairley ◽  
Phyllis E. Kozarsky ◽  
Colleen S. Kraft ◽  
Jeannette Guarner ◽  
James P. Steinberg ◽  
...  
Keyword(s):  
West Africa ◽  
Infection Control ◽  
Ebola Virus ◽  
Virus Disease ◽  
Plasmodium Falciparum Malaria ◽  
The United States ◽  
Case Definition ◽  
Lessons Learned ◽  
Treatment Unit ◽  
Life Threatening

Abstract Background.  The 2014–2015 Ebola epidemic in West Africa had global impact beyond the primarily affected countries of Guinea, Liberia, and Sierra Leone. Other countries, including the United States, encountered numerous patients who arrived from highly affected countries with fever or other signs or symptoms consistent with Ebola virus disease (EVD). Methods.  We describe our experience evaluating 25 travelers who met the US Centers for Disease Control and Prevention case definition for a person under investigation (PUI) for EVD from July 20, 2014 to January 28, 2015. All patients were triaged and evaluated under the guidance of institutional protocols to the emergency department, outpatient tropical medicine clinic, or Emory's Ebola treatment unit. Strict attention to infection control and early involvement of public health authorities guided the safe evaluation of these patients. Results.  None were diagnosed with EVD. Respiratory illnesses were common, and 8 (32%) PUI were confirmed to have influenza. Four patients (16%) were diagnosed with potentially life-threatening infections or conditions, including 3 with Plasmodium falciparum malaria and 1 with diabetic ketoacidosis. Conclusions.  In addition to preparing for potential patients with EVD, Ebola assessment centers should consider other life-threatening conditions requiring urgent treatment, and travelers to affected countries should be strongly advised to seek pretravel counseling. Furthermore, attention to infection control in all aspects of PUI evaluation is paramount and has presented unique challenges. Lessons learned from our evaluation of potential patients with EVD can help inform preparations for future outbreaks of highly pathogenic communicable diseases.

Bacterial co-infection is rare in patients with Ebola virus disease in a military Ebola virus disease treatment unit in Sierra Leone

2015 ◽  
Vol 71 (3) ◽  
pp. 406-407 ◽  
Author(s):  
Lucy Lamb ◽  
Jack Robson ◽  
Christian Ardley ◽  
Mark Bailey ◽  
Stuart Dickson ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Ebola Virus ◽  
Virus Disease ◽  
Ebola Virus Disease ◽  
Disease Treatment ◽  
Treatment Unit

scholarly journals 2311. Bacteremia Is Not Commonly Detected in Ebola Virus Disease

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S792-S792
Author(s):  
Matthew J Matson ◽  
Moses Massaquoi ◽  
Armand Sprecher ◽  
Ruggero Giuliani ◽  
Jeffrey K Edwards ◽  
...  
Keyword(s):  
Ebola Virus ◽  
Treatment Guidelines ◽  
Virus Disease ◽  
Current Treatment ◽  
Ebola Virus Disease ◽  
Coagulase Negative Staphylococci ◽  
Treatment Unit ◽  
Blood Samples ◽  
16S Sequencing ◽  
Low Culture

Abstract Background Rates of bacteremia in Ebola virus disease (EVD) are not currently known. Given the potential for secondary bacterial infection during acute EVD, current treatment guidelines recommend empiric use of broad-spectrum antibiotics. We sought to determine rates of bacteremia among patients evaluated for EVD at the ELWA-3 Ebola Treatment Unit in Monrovia, Liberia during the 2013–16 West Africa epidemic. Methods Deidentified blood samples and matched clinical data from 235 Ebola virus (EBOV)-positive patients and 102 EBOV-negative patients were evaluated under a University of Liberia Pacific Institute for Research and Evaluation IRB-approved protocol. 0.2 mL aliquots of frozen whole blood samples collected at triage, prior to the administration of antibiotics, were inoculated into BD BACTEC Peds Plus bottles and incubated under aerobic conditions in a BD BACTEC FX40 for 5 days in the National Institute of Allergy and Infectious Disease Biosafety Level 4 laboratory in Hamilton, MT. Positive samples were sub-cultured on nonselective sheep blood agar and chocolate agar and pure colonies were selected for identification by 16S sequencing and by matrix assisted laser desorption ionization time-of-flight mass spectrometry. Results No difference in rates of bacteremia was detected among EBOV-positive vs. EBOV-negative patients – 3.8% and 3.9%, respectively. Predominant isolates included Staphylococcus epidermidis and other coagulase-negative staphylococci, thought consistent with contaminants. Pathogenic species included Staphylococcus aureus and possibly Paenibacillus spp. Conclusion These data suggest that bacteremia does not commonly complicate EVD. However, as both prolonged sample storage and low culture volume may negatively affect sensitivity, additional molecular analyses are needed to support this conclusion. The Intramural Research Program of the National Institutes of Health supported this work. Disclosures All authors: No reported disclosures.

scholarly journals Clinical Evaluation of QuickNaviTM-Ebola in the 2018 Outbreak of Ebola Virus Disease in the Democratic Republic of the Congo

Viruses ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 589 ◽  
Author(s):  
Sheila Makiala ◽  
Daniel Mukadi ◽  
Anja De Weggheleire ◽  
Shino Muramatsu ◽  
Daisuke Kato ◽  
...  
Keyword(s):  
West Africa ◽  
Diagnostic Tests ◽  
Ebola Virus ◽  
Democratic Republic ◽  
Virus Disease ◽  
Point Of Care ◽  
Rapid Diagnostic Tests ◽  
Ebola Virus Disease ◽  
Blood Samples ◽  
Republic Of The Congo

The recent large outbreaks of Ebola virus disease (EVD) in West Africa and the Democratic Republic of the Congo (DRC) have highlighted the need for rapid diagnostic tests to control this disease. In this study, we clinically evaluated a previously developed immunochromatography-based kit, QuickNaviTM-Ebola. During the 2018 outbreaks in DRC, 928 blood samples from EVD-suspected cases were tested with QuickNaviTM-Ebola and the WHO-approved GeneXpert. The sensitivity and specificity of QuickNaviTM-Ebola, estimated by comparing it to GeneXpert-confirmed cases, were 85% (68/80) and 99.8% (846/848), respectively. These results indicate the practical reliability of QuickNaviTM-Ebola for point-of-care diagnosis of EVD.

scholarly journals Post-Ebola Syndrome among Ebola Virus Disease Survivors in Montserrado County, Liberia 2016

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Himiede W. Wilson ◽  
Maame Amo-Addae ◽  
Ernest Kenu ◽  
Olayinka Stephen Ilesanmi ◽  
Donne K. Ameme ◽  
...  
Keyword(s):  
Ebola Virus ◽  
Psychological Symptoms ◽  
Virus Disease ◽  
Clinical Care ◽  
Adult Population ◽  
Cross Sectional Study ◽  
Ebola Virus Disease ◽  
Cross Sectional ◽  
Treatment Unit ◽  
Health History

Introduction. An increased number of survivors have emerged from the 2014 West African Ebola Virus Disease (EVD) epidemic. Post-Ebola Syndrome (PES) is a group of physical and psychological symptoms affecting EVD survivors. This study aimed to estimate the prevalence of PES among EVD survivors in Montserrado County, Liberia. Method. A cross-sectional study design was conducted to determine the prevalence of PES, types, onset, and duration among survivors. Survivors in Montserrado County were recruited using multistage sampling methods. Quantitative data was collected using semistructured questionnaire. Variables were collected on EVD survivors demographics, pre- and post-Ebola health history. Result. Prevalence of Post-Ebola Syndrome was estimated to be 90% (242/268). PES was experienced by 67% (162/242) females. PES occurred mainly in the adult population between ages 25-34, 35% (84/242). The commonest symptoms were reported from the following systems of the human body: neurological system (eyes problem, headache, sleep disorder, and unusual tiredness) and musculoskeletal system (abdominal pain, chest pain, and joints pains). The onset of PES occurred between the first 1-12 weeks after being discharged from a treatment unit. Conclusion. Prevalence of PES is high. Clinical care for survivors should be strengthened.

scholarly journals Essential Medications for Patients With Suspected or Confirmed Ebola Virus Disease in Resource-Limited Environments

2017 ◽  
Vol 182 (9-10) ◽  
pp. e2006-e2016 ◽  
Author(s):  
William F. Pierce ◽  
Selena D. Ready ◽  
John Tyson Chapman ◽  
Corrinne Kulick ◽  
Anastasia Shields ◽  
...  
Keyword(s):  
Ebola Virus ◽  
Virus Disease ◽  
Ebola Virus Disease ◽  
World Health ◽  
Clinical Environment ◽  
Treatment Unit ◽  
Resource Limited ◽  
Pharmacy Dispensing Data ◽  
Dispensing Data ◽  
The U.S

ABSTRACT Background: In 2014, the U.S. Public Health Service (USPHS) Commissioned Corps deployed to Monrovia, Liberia, to operate a 25-bed Ebola treatment unit (ETU) constructed by the U.S. Military. The ETU was named the Monrovia Medical Unit (MMU) and was constructed from an U.S. Air Force Expeditionary Medical Support (EMEDS) unit with modifications on the basis of consultation from Médecins Sans Frontières, the World Health Organization, and expert panels from the U.S. Department of Defense and Department of Health and Human Services. From November 12, 2014, to April 30, 2015, 42 patients (18 confirmed Ebola virus disease [EVD] and 24 suspected EVD) from nine countries were treated by USPHS providers at the MMU. The medications used in the MMU were primarily procured from the EMEDS 25-bed pharmacy cache. However, specific formulary additions were made for treatment of EVD. Methods: Using the MMU pharmacy dispensing data, we compared and contrasted the medications used in the MMU with recommendations in published EVD treatment guidelines for austere settings. Findings: After comparing and contrasting the MMU pharmacy dispensing data with publications with EVD medication recommendations applicable to resource-limited settings, 101 medications were included in the USPHS Essential Medications for the Management of EVD List (EML) for an austere, isolated clinical environment. Discussion/impact/recommendations: Because Ebola outbreaks often occur in remote areas, proactive planning, improved preparedness, and optimal patient care for EVD are needed, especially in the context of austere environments with a scarcity of resources. We developed the EML to assist in the planning for future Ebola outbreaks in a remote clinical environment and to provide a list of medications that have been used in an ETU. The EML is a comprehensive medication list that builds on the existing publications with EVD treatment recommendations applicable to supply-constrained clinical environments. As well, it is a resource for the provision of medications when evaluating donations, procurement, and may help inform estimates for product inventory requirements for an ETU. We hope the EML will improve readiness and enhance the capabilities of local and regional international responders.

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