Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-10T11:03:20.093Z Has data issue: false hasContentIssue false
  • English
  • Français

Preparedness Tested: Severe Cerebral Malaria Presenting as a High-Risk Person Under Investigation for Ebola Virus Disease at a US Hospital

Published online by Cambridge University Press:  08 May 2020

George L. Anesi Open the ORCID record for George L. Anesi [Opens in a new window] ,
Nuala J. Meyer ,
John P. Reilly ,
William D. Schweickert ,
Mark E. Mikkelsen ,
Emma V. Myers ,
Edward T. Dickinson ,
Matthew P. Kelly ,
David A. Pegues  and
Neil O. Fishman
George L. Anesi*
Affiliation:
Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Nuala J. Meyer
Affiliation:
Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
John P. Reilly
Affiliation:
Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
William D. Schweickert
Affiliation:
Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Mark E. Mikkelsen
Affiliation:
Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Emma V. Myers
Affiliation:
Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Edward T. Dickinson
Affiliation:
Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Matthew P. Kelly
Affiliation:
Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
David A. Pegues
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Neil O. Fishman
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
*
Correspondence and reprint requests to George L. Anesi, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, 824 Gates Building, Philadelphia, PA19104-6021 (e-mail: george.anesi@uphs.upenn.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

In 2019, a 42-year-old African man who works as an Ebola virus disease (EVD) researcher traveled from the Democratic Republic of Congo (DRC), near an ongoing EVD epidemic, to Philadelphia and presented to the Hospital of the University of Pennsylvania Emergency Department with altered mental status, vomiting, diarrhea, and fever. He was classified as a “wet” person under investigation for EVD, and his arrival activated our hospital emergency management command center and bioresponse teams. He was found to be in septic shock with multisystem organ dysfunction, including circulatory dysfunction, encephalopathy, metabolic lactic acidosis, acute kidney injury, acute liver injury, and diffuse intravascular coagulation. Critical care was delivered within high-risk pathogen isolation in the ED and in our Special Treatment Unit until a diagnosis of severe cerebral malaria was confirmed and EVD was definitively excluded.

This report discusses our experience activating a longitudinal preparedness program designed for rare, resource-intensive events at hospitals physically remote from any active epidemic but serving a high-volume international air travel port-of-entry.

Keywords

Ebola virus diseasemalariapersonal protective equipmentPPEpreparednessspecial treatment unit
Type
Report from the Field
Information
Disaster Medicine and Public Health Preparedness , Volume 15 , Issue 4 , August 2021 , pp. 528 - 533
Copyright
Copyright © 2020 Society for Disaster Medicine and Public Health, Inc.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

World Health Organizationa. Health Emergencies Programme. Ebola virus disease, Democratic Republic of Congo. 2019. http://who.int/emergencies/diseases/ebola/drc-2019/situation-reports. Accessed February 27, 2020.Google Scholar
Wadman, MC, Schwedhelm, SS, Watson, S, et al. Emergency department processes for the evaluation and management of persons under investigation for Ebola virus disease. Ann Emerg Med. 2015;66:306–314.CrossRefGoogle ScholarPubMed
Malvy, D, McElroy, AK, de Clerck, H, et al. Ebola virus disease. Lancet. 2019;393:936-948.CrossRefGoogle ScholarPubMed
Suen, LKP, Guo, YP, Tong, DWK, et al. Self-contamination during doffing of personal protective equipment by healthcare workers to prevent Ebola transmission. Antimicrob Resist Infect Control. 2018;7:157.CrossRefGoogle ScholarPubMed
Ota-Sullivan, K, Blecker-Shelly, DL. Use of the rapid BinaxNOW malaria test in a 24-hour laboratory associated with accurate detection and decreased malaria testing turnaround times in a pediatric setting where malaria is not endemic. J Clin Microbiol. 2013;51:1567-1569.CrossRefGoogle Scholar
Twomey, PS, Smith, BL, McDermott, C, et al. Intravenous artesunate for the treatment of severe and complicated malaria in the United States: clinical use under an investigational new drug protocol. Ann Intern Med. 2015;163:498-506.CrossRefGoogle ScholarPubMed
Broadhurst, MJ, Brooks, TJ, Pollock, NR. Diagnosis of Ebola virus disease: past, present, and future. Clin Microbiol Rev. 2016;29:773-793.CrossRefGoogle ScholarPubMed
Regules, JA, Beigel, JH, Paolino, KM, et al. A recombinant vesicular stomatitis virus Ebola vaccine. N Engl J Med. 2017;376:330-341.CrossRefGoogle ScholarPubMed
Idro, R, Jenkins, NE, Newton, CR. Pathogenesis, clinical features, and neurological outcome of cerebral malaria. Lancet Neurol. 2005;4:827-840.CrossRefGoogle ScholarPubMed
Waxman, M, Aluisio, AR, Rege, S, Levine, AC. Characteristics and survival of patients with Ebola virus infection, malaria, or both in Sierra Leone: a retrospective cohort study. Lancet Infect Dis. 2017;17:654-660.CrossRefGoogle ScholarPubMed
Jarrett, OD, Seward, JF, Fombah, AE, et al. Monitoring serious adverse events in the Sierra Leone trial to introduce a vaccine against Ebola. J Infect Dis. 2018;217:S24-S32.CrossRefGoogle ScholarPubMed
Stowell, JR, Kessler, R, Lewiss, RE, et al. Critical care ultrasound: a national survey across specialties. J Clin Ultrasound. 2018;46:167-177.CrossRefGoogle ScholarPubMed
Shrestha, GS, Weeratunga, D, Baker, K. Point-of-care lung ultrasound in critically ill patients. Rev Recent Clin Trials. 2018;13:15-26.CrossRefGoogle ScholarPubMed
Bou Chebl, R, Kiblawi, S, El Khuri, C, et al. Use of contrast-enhanced ultrasound for confirmation of central venous catheter placement: systematic review and meta-analysis. J Ultrasound Med. 2017;36:2503-2510.CrossRefGoogle ScholarPubMed