Clinical Features and Outcome of Ebola Virus Disease in Pediatric Patients: A Retrospective Case Series

Damkjær, Mads; Rudolf, Frauke; Mishra, Sharmistha; Young, Alyssa J.; Storgaard, Merete

doi:10.1016/j.jpeds.2016.11.034

Cited by 13 publications

(15 citation statements)

References 19 publications

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“…Our findings support a model of viremic seeding of the GI tract, GI tract injury, and systemic inflammatory response, exacerbated by bacterial translocation and sepsis, and suggest that intussusception may be an under-recognized complication. These findings coupled with reports suggesting improved CFRs with supportive care during the 2014–2016 West Africa Ebola outbreak [ 8 , 29 , 30 ], that included empiric antibiotic therapy directed against gram-negative enteric microflora warrant further study in both NHP models and in future outbreaks of human disease.…”

Section: Discussionmentioning

confidence: 55%

“…In human EVD, both Ansumana et al [ 29 ] and Damkjaer et al [ 30 ] adopted a “one size fits all” approach in their West African facilities, wherein all in-patients were provided the same supportive care treatment protocol regardless of the degree of symptomatology. Their supportive care regimens included broad-spectrum antibiotics for all patients.…”

Section: Discussionmentioning

confidence: 99%

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Ebola Virus Causes Intestinal Tract Architectural Disruption and Bacterial Invasion in Non-Human Primates

Reisler

Zeng

Schellhase

et al. 2018

Viruses

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In the 2014–2016 West Africa Ebola Virus (EBOV) outbreak, there was a significant concern raised about the potential for secondary bacterial infection originating from the gastrointestinal tract, which led to the empiric treatment of many patients with antibiotics. This retrospective pathology case series summarizes the gastrointestinal pathology observed in control animals in the rhesus EBOV-Kikwit intramuscular 1000 plaque forming unit infection model. All 31 Non-human primates (NHPs) exhibited lymphoid depletion of gut-associated lymphoid tissue (GALT) but the severity and the specific location of the depletion varied. Mesenteric lymphoid depletion and necrosis were present in 87% (27/31) of NHPs. There was mucosal barrier disruption of the intestinal tract with mucosal necrosis and/or ulceration most notably in the duodenum (16%), cecum (16%), and colon (29%). In the intestinal tract, hemorrhage was noted most frequently in the duodenum (52%) and colon (45%). There were focal areas of bacterial submucosal invasion in the gastrointestinal (GI) tract in 9/31 (29%) of NHPs. Only 2/31 (6%) had evidence of pancreatic necrosis. One NHP (3%) experienced jejunal intussusception which may have been directly related to EBOV. Immunofluorescence assays demonstrated EBOV antigen in CD68+ macrophage/monocytes and endothelial cells in areas of GI vascular injury or necrosis.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Ebola Virus Causes Intestinal Tract Architectural Disruption and Bacterial Invasion in Non-Human Primates

Reisler

Zeng

Schellhase

et al. 2018

Viruses

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“…Over 3,000 patients with EVD were of <15 years of age during the 2013-2016 Western African outbreak. The clinical characteristics of paediatric patients with EVD have been described, and CFRs of 42-76% in this population were reported in the 2013-2016 Western African outbreak 44,[217][218][219] . The clinical management of children with EVD introduces unique challenges, including the need for health-care workers trained in paediatrics and the issue of parental presence and its associated benefits and risks 220 .…”

Section: Special Populationsmentioning

confidence: 99%

Ebola virus disease

Jacob

Crozier

Fischer

et al. 2020

Nat Rev Dis Primers

421

345

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To date, 12 distinct filoviruses have been described 1. The seven filoviruses that have been found in humans belong either to the genus Ebolavirus (Bundibugyo virus (BDBV), Ebola virus (EBOV), Reston virus (RESTV), Sudan virus (SUDV) and Taï Forest virus (TAFV); Fig. 1) or to the genus Marburgvirus (Marburg virus (MARV) and Ravn virus (RAVV)) 2. The WHO International Classification of Diseases Revision 11 (ICD-11) of 2018 recognizes two major subcategories of filovirus disease (FVD): Ebola disease caused by BDBV, EBOV, SUDV or TAFV, and Marburg disease caused by MARV or RAVV. Ebola virus disease (EVD) is defined as a disease only caused by EBOV. This subcategorization of FVD is largely based on the increasing evidence of molecular differences between ebolaviruses and marburgviruses, differences that may influence virus-host reservoir tropism, pathogenesis and disease phenotype in accidental primate hosts 2. Since the discovery of filoviruses in 1967 (reF. 3), 43 FVD outbreaks (excluding at least five laboratoryacquired infections) have been recorded in or exported from Africa 4. The epidemiological definition of outbreak is one or more cases above the known endemic prevalence. For example, the single case of TAFV infection recorded in a setting in which FVD had never been reported before (Côte d'Ivoire) 5 is still considered an outbreak. All FVD outbreaks, with the exception of that caused by TAFV, were characterized by extremely high case-fatality rates (CFRs, also known as lethality). Until 2013, the most extensive outbreak, caused by SUDV, involved 425 cases and 224 deaths (CFR 52.7%) 6. The overall limited numbers of FVD cases (1967-2013: 2,886 cases including 1,982 deaths 4), the typical remote and rural locations of outbreaks and the often delayed announcement of new outbreaks to the international community 7 have prevented the systematic study of clinical FVD in humans. Thus, the commonly used description of FVD was derived either from observation of small groups of patients in care settings that were not well-equipped for diagnosis, treatment and disease characterization, or from observations of even smaller samples, such as individuals who were transferred from Equatorial Africa to Europe and the USA or who fell sick in Europe or the USA after contracting the virus elsewhere. Pathological characterization of FVD via autopsies has been rare 7,8. In the absence of extensive human clinical data, FVD could only be defined further via the use of experimental animal infections 9,10 .

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“…EVD is notoriously non-specific in presentation, particularly in children. Indeed, even fever which was key to the WHO clinical case definition in the West African outbreak was absent in 20–25% of cases in three studies [ 94 , 96 – 98 ]. In most studies from the West African and previous outbreaks, features in children have included (in order of frequency) fever (71–99%), fatigue/weakness (64–80%), appetite loss (60–79%), vomiting (28–62%) and diarrhoea (43–60%) [ 94 – 97 , 99 ].…”

Section: Presentationmentioning

confidence: 99%

“…Conjunctivitis was recorded in 13–22% and hiccoughs in 7–12% [ 94 , 95 , 99 , 100 ]. Difficulty breathing and swallowing were seen approximately 13–20% of patients [ 96 , 97 , 99 ]. Bleeding from various body sites tended to be rarer in the West African outbreak in children than previous outbreaks (1–10% compared with 20%) [ 95 , 97 , 99 , 101 ], although two cohort studies recorded bleeding in 15% [ 94 , 96 ], and a large study of Guinean children recorded bleeding in 24% [ 100 ].…”

Section: Presentationmentioning

confidence: 99%

Ebola Virus Disease in the Obstetric Population

Brown

Garde

Headrick

et al. 2018

Ebola Virus Disease

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The clinical management of Ebola created a significant challenge during the outbreak in West Africa, due to the paucity of previous research conducted into the optimum treatment regimen. That left many centres, to some extent, having to ‘work out’ best practice as they went along, and attempting to conduct real time prospective research. Médecins Sans Frontières (MSF) [1] were the only organization to have provided relatively in depth practical guidance prior to the outbreak and this manual was the basis of further planning between the WHO, national Ministry of Health and Sanitation in Sierra Leone, and other relevant stakeholders. Additionally, guidance changed over the epidemic as experience grew. This chapter will describe four key areas in the management of Ebola in West Africa. Firstly, it outlines the most recent WHO guidance; secondly, it looks back at how Ebola was managed in differing low and high resource settings; thirdly it outlines possible and optimal options for managing complications, paying particular attention to some of the controversies faced; fourthly it describes recent and ongoing studies into potential novel therapies that may shape future practice.

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Clinical Features and Outcome of Ebola Virus Disease in Pediatric Patients: A Retrospective Case Series

Cited by 13 publications

References 19 publications

Ebola Virus Causes Intestinal Tract Architectural Disruption and Bacterial Invasion in Non-Human Primates

Ebola Virus Causes Intestinal Tract Architectural Disruption and Bacterial Invasion in Non-Human Primates

Ebola virus disease

Ebola Virus Disease in the Obstetric Population

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