Analysis of Diagnostic Findings From the European Mobile Laboratory in Guéckédou, Guinea, March 2014 Through March 2015

Abstract

Background. A unit of the European Mobile Laboratory (EMLab) consortium was deployed to the Ebola virus disease (EVD) treatment unit in Guéckédou, Guinea, from March 2014 through March 2015.Methods. The unit diagnosed EVD and malaria, using the RealStar Filovirus Screen reverse transcription–polymerase chain reaction (RT-PCR) kit and a malaria rapid diagnostic test, respectively.Results. The cleaned EMLab database comprised 4719 samples from 2741 cases of suspected EVD from Guinea. EVD was diagnosed in 1231 of 2178 hospitalized patients (57%) and in 281 of 563 who died in the community (50%). Children aged <15 years had the highest proportion of Ebola virus–malaria parasite coinfections. The case-fatality ratio was high in patients aged <5 years (80%) and those aged >74 years (90%) and low in patients aged 10–19 years (40%). On admission, RT-PCR analysis of blood specimens from patients who died in the hospital yielded a lower median cycle threshold (Ct) than analysis of blood specimens from survivors (18.1 vs 23.2). Individuals who died in the community had a median Ct of 21.5 for throat swabs. Multivariate logistic regression on 1047 data sets revealed that low Ct values, ages of <5 and ≥45 years, and, among children aged 5–14 years, malaria parasite coinfection were independent determinants of a poor EVD outcome.Conclusions. Virus load, age, and malaria parasite coinfection play a role in the outcome of EVD.

South African Ebola diagnostic response in Sierra Leone: A modular high biosafety field laboratory

“…Our results confirm earlier findings that buccal swabs are a useful alternative specimen source to whole blood/serum [31], and that this non-invasive specimen collection should be considered in testing unexpected community deaths. Testing of post-mortem throat swabs was also shown to be a reliable and sensitive method for EVD diagnosis and surveillance [32]. The levels of EBOV RNA detection and duration of viremia in our study were similar to other published results [33, 34].…”

“…The levels of EBOV RNA detection and duration of viremia in our study were similar to other published results [33, 34]. EVD patients who have a Ct of <17 have a casa fatality rate (CFR) of 95%, and those with a Ct of >26 have a CFR of 15% [32]. It was also shown that most blood samples having Ct value > 33.7 tested negative for replicating EBOV [28].…”

Characteristics and survival of patients with Ebola virus infection, malaria, or both in Sierra Leone: a retrospective cohort study

“…A laboratory-based study 7 from Liberia reported that coinfection was associated with reduced mortality among patients with EVD admitted at a single Ebola Treatment Unit (ETU). Another study in Guinea, by Kerber and colleagues, 8 found a high case fatality rate in patients co-infected with Ebola virus and malaria parasites. To our knowledge, no multisite studies have been published evaluating clinical characteristics and mortality in patients with variable malaria parasite and Ebola virus infection states.…”

Sociodemographic and clinical determinants of in-facility case fatality rate for 938 Ebola patients treated in Sierra Leone

“…Many studies have reported different treatment outcomes for EVD patients co-infected with malaria. (30)(31)(32)(33)(34)(35)(36) Treating patients for EVD and malaria simultaneously will invariably improve the prognosis of these patients and hence lower the CFR. In addition to the specific case management offered to our EVD patients, medical staffs also provided analgesic such as paracetamol tablets 500 mg (twice daily for 2 days) to relieve their pain as well as the vitamin supplement; immunoboost capsules to boost their appetite.…”