Archive for December 20, 2014

Clinical Care of Two Patients with Ebola Virus Disease in the United States

N Engl J of Medicine Dec.18, 2014 V.371 P.2402-2409

Brief Report

Marshall Lyon, M.D., M.M.Sc., Aneesh K. Mehta, M.D., Jay B. Varkey, M.D., Kent Brantly, M.D., Lance Plyler, M.D., Anita K. McElroy, M.D., Ph.D., Colleen S. Kraft, M.D., Jonathan S. Towner, Ph.D., Christina Spiropoulou, Ph.D., Ute Ströher, Ph.D., Timothy M. Uyeki, M.D., M.P.H., M.P.P., and Bruce S. Ribner, M.D., M.P.H. for the Emory Serious Communicable Diseases Unit

West Africa is currently experiencing the largest outbreak of Ebola virus disease (EVD) in history.

Two patients with EVD were transferred from Liberia to our hospital in the United States for ongoing care. Malaria had also been diagnosed in one patient, who was treated for it early in the course of EVD.

The two patients had substantial intravascular volume depletion and marked electrolyte abnormalities.

We undertook aggressive supportive measures of hydration (typically, 3 to 5 liters of intravenous fluids per day early in the course of care) and electrolyte correction.

As the patients’ condition improved clinically, there was a concomitant decline in the amount of virus detected in plasma…



December 20, 2014 at 7:55 pm

A Case of Severe Ebola Virus Infection Complicated by Gram-Negative Septicemia

N Engl J of Medicine Dec.18, 2014 V.371 P.2394-2401

Brief Report

Benno Kreuels, M.D., Dominic Wichmann, M.D., Petra Emmerich, Ph.D., Jonas Schmidt-Chanasit, M.D., Geraldine de Heer, M.D., Stefan Kluge, M.D., Abdourahmane Sow, M.D., Thomas Renné, M.D., Ph.D., Stephan Günther, M.D., Ansgar W. Lohse, M.D., Marylyn M. Addo, M.D., Ph.D., and Stefan Schmiedel, M.D.

Ebola virus disease (EVD) developed in a patient who contracted the disease in Sierra Leone and was airlifted to an isolation facility in Hamburg, Germany, for treatment.

During the course of the illness, he had numerous complications, including septicemia, respiratory failure, and encephalopathy.

Intensive supportive treatment consisting of high-volume fluid resuscitation (approximately 10 liters per day in the first 72 hours), broad-spectrum antibiotic therapy, and ventilatory support resulted in full recovery without the use of experimental therapies.

Discharge was delayed owing to the detection of viral RNA in urine (day 30) and sweat (at the last assessment on day 40) by means of polymerase-chain-reaction (PCR) assay, but the last positive culture was identified in plasma on day 14 and in urine on day 26.

This case shows the challenges in the management of EVD and suggests that even severe EVD can be treated effectively with routine intensive care….


December 20, 2014 at 7:53 pm

Stillbirth During Infection With Middle East Respiratory Syndrome Coronavirus

Journal of Infectious Diseases June 15, 2014 V.209 N.12 P.1870-1872


Daniel C. Payne1, Ibrahim Iblan6, Sultan Alqasrawi7, Mohannad Al Nsour9, Brian Rha1,2, Rania A. Tohme3, Glen R. Abedi1, Noha H. Farag4, Aktham Haddadin8, Tarek Al Sanhouri8, Najwa Jarour7, David L. Swerdlow1, Denise J. Jamieson5, Mark A. Pallansch1, Lia M. Haynes1, Susan I. Gerber1, Mohammad Mousa Al Abdallat7, for the Jordan MERS-CoV Investigation Teama

1Division of Viral Diseases, National Center for Immunization and Respiratory Diseases

2Epidemic Intelligence Service

3Global Immunization Division, Center for Global Health

4Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases

5Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

6Jordan Field Epidemiology Training Program

7Communicable Diseases Directorate

8Directorate of Laboratories, Jordan Ministry of Health

9Eastern Mediterranean Public Health Network, Amman, Jordan

Correspondence: Daniel C. Payne, PhD, MSPH, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop A-34, Atlanta, GA 30333 (


We conducted an epidemiologic investigation among survivors of an outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Jordan.

A second-trimester stillbirth occurred during the course of an acute respiratory illness that was attributed to MERS-CoV on the basis of exposure history and positive results of MERS-CoV serologic testing.

This is the first occurrence of stillbirth during an infection with MERS-CoV and may have bearing upon the surveillance and management of pregnant women in settings of unexplained respiratory illness potentially due to MERS-CoV.

Future prospective investigations of MERS-CoV should ascertain pregnancy status and obtain further pregnancy-related data, including biological specimens for confirmatory testing.


December 20, 2014 at 3:24 pm

Respiratory Syncytial Virus and Other Respiratory Viral Infections in Older Adults With Moderate to Severe Influenza-like Illness

Journal of Infectious Diseases June 15, 2014 V.209 N.12 P.1873-1881

Ann R. Falsey1,a, Janet E. McElhaney2,a,b, Jiri Beran3,a,b, Gerrit A. van Essen4,a,b, Xavier Duval5,6,c, Meral Esen7,b,c, Florence Galtier6,8,c, Pierre Gervais9,c, Shinn-Jang Hwang10,11,c, Peter Kremsner7,c, Odile Launay6,12,13,b,c, Geert Leroux-Roels14,b,c, Shelly A. McNeil15,c, Andrzej Nowakowski16,17,c, Jan Hendrik Richardus18,c, Guillermo Ruiz-Palacios19,b,c, Suzanne St Rose20,c, Jeanne-Marie Devaster21,a,b, Lidia Oostvogels20,a,b, Serge Durviaux20 and Sylvia Taylor20,a

1University of Rochester School of Medicine, Rochester General Hospital, Rochester, New York, United States

2HSN Volunteer Association Chair in Geriatric Research, Advanced Medical Research Institute of Canada, Sudbury, Ontario, Canada

3Vaccination and Travel Medicine Centre, Hradec Kralove, Czech Republic

4Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

5Inserm CIC, Hôpital Bichat Claude Bernard

6National Network of Clinical Investigation in Vaccinology (REIVAC), France

7Institut für Tropenmedizin, Tübingen, Germany

8Inserm CIC, CHRU de Montpellier, Hôpital Saint Eloi, Montpellier, France

9Q&T Research Sherbrooke, Sherbrooke, Quebec, Canada

10Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

11National Yang-Ming University School of Medicine, Taipei, Taiwan

12Inserm, CIC BT505

13Université Paris Descartes, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Paris Centre, CIC de Vaccinologie Cochin/Pasteur, Paris, France

14Centre for Vaccinology, Ghent University and University Hospital, Ghent, Belgium

15Canadian Center for Vaccinology and Capital Health, Dalhousie University Health Sciences Centre, Halifax, Nova Scotia, Canada

16Family Medicine Centre, Lubartów, Poland

17Department of Gynaecology and Oncologic Gynaecology, Military Institute of Medicine, Warsaw, Poland

18GGD Rotterdam-Rijnmond, Rotterdam, The Netherlands

19Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México City, México

20GlaxoSmithKline Vaccines, Wavre, Belgium

21GlaxoSmithKline Vaccines, Rixensart, Belgium

Correspondence: Sylvia Taylor, MD, PhD, GlaxoSmithKline Vaccines, Avenue Fleming 20, Parc de la Noire Epine, 1300 Wavre, Belgium (



Few studies have prospectively assessed viral etiologies of acute respiratory infections in community-based elderly individuals. We assessed viral respiratory pathogens in individuals ≥65 years with influenza-like illness (ILI).


Multiplex reverse-transcriptase polymerase chain reaction identified viral pathogens in nasal/throat swabs from 556 episodes of moderate-to-severe ILI, defined as ILI with pneumonia, hospitalization, or maximum daily influenza symptom severity score (ISS) >2. Cases were selected from a randomized trial of an adjuvanted vs nonadjuvanted influenza vaccine conducted in elderly adults from 15 countries.


Respiratory syncytial virus (RSV) was detected in 7.4% (41/556) moderate-to-severe ILI episodes in elderly adults. Most (39/41) were single infections. There was a significant association between country and RSV detection (P = .004). RSV prevalence was 7.1% (2/28) in ILI with pneumonia, 12.5% (8/64) in ILI with hospitalization, and 6.7% (32/480) in ILI with maximum ISS > 2. Any virus was detected in 320/556 (57.6%) ILI episodes: influenza A (104/556, 18.7%), rhinovirus/enterovirus (82/556, 14.7%), coronavirus and human metapneumovirus (each 32/556, 5.6%).


This first global study providing data on RSV disease in ≥65 year-olds confirms that RSV is an important respiratory pathogen in the elderly. Preventative measures such as vaccination could decrease severe respiratory illnesses and complications in the elderly.


December 20, 2014 at 3:20 pm


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