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Characterization of anti-BCG benz[α]anthraquinones and new siderophores from a Xinjiang desert-isolated rare actinomycete Nocardia sp. XJ31. Appl Microbiol Biotechnol 2020; 104:8267-8278. [PMID: 32830291 PMCID: PMC7443361 DOI: 10.1007/s00253-020-10842-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/05/2020] [Accepted: 08/14/2020] [Indexed: 02/05/2023]
Abstract
Abstract The current global demand for novel anti-TB drugs has drawn urgent attention on the discovery of natural product compounds with anti-TB activity. Lots of efforts have emphasized on environmental samples from unexplored or underexplored natural habits and identified numerous rare actinomycete taxa producing structurally diverse bioactive natural products. Herein, we report a survey of the rare actinobacteria diversity in Xinjiang region together with the discovery of anti-TB active natural products from these strains. We have collected 17 soil samples at different sites with different environmental conditions, from which 39 rare actinobacteria were identified by using a selective isolation strategy with 5 media variations. Among those isolated strains, XJ31 was identified as a new Nocardia sp. based on 16S rRNA gene analysis. Through one strain-many compounds (OSMAC) strategy combined with anti-Bacillus Calmette-Guérin bioassay-guided isolation, two groups of compounds were identified. They were twelve siderophores (nocardimicins, 1-12) and two anthraquinones (brasiliquinones, 13 and 14) and ten of them were identified as new compounds. The structures of the purified compounds were elucidated using HR-ESI-MS, 1D NMR, and 2D NMR techniques. The anti-TB bioassays revealed that the two benz[α]anthraquinones have potent activity against BCG (MICs = 25 μM), which can be used as a promising start point for further anti-TB drug development. Key points • Ten new natural products were identified from Nocardia sp. XJ31. • Brasiliquinones13and14showed moderate anti-BCG activity. Electronic supplementary material The online version of this article (10.1007/s00253-020-10842-2) contains supplementary material, which is available to authorized users.
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Uppal V, Sondekoppam RV, Landau R, El-Boghdadly K, Narouze S, Kalagara HKP. Neuraxial anaesthesia and peripheral nerve blocks during the COVID-19 pandemic: a literature review and practice recommendations. Anaesthesia 2020; 75:1350-1363. [PMID: 32344456 PMCID: PMC7267450 DOI: 10.1111/anae.15105] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2020] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID‐19) has had a significant impact on global healthcare services. In an attempt to limit the spread of infection and to preserve healthcare resources, one commonly used strategy has been to postpone elective surgery, whilst maintaining the provision of anaesthetic care for urgent and emergency surgery. General anaesthesia with airway intervention leads to aerosol generation, which increases the risk of COVID‐19 contamination in operating rooms and significantly exposes the healthcare teams to COVID‐19 infection during both tracheal intubation and extubation. Therefore, the provision of regional anaesthesia may be key during this pandemic, as it may reduce the need for general anaesthesia and the associated risk from aerosol‐generating procedures. However, guidelines on the safe performance of regional anaesthesia in light of the COVID‐19 pandemic are limited. The goal of this review is to provide up‐to‐date, evidence‐based recommendations or expert opinion when evidence is limited, for performing regional anaesthesia procedures in patients with suspected or confirmed COVID‐19 infection. These recommendations focus on seven specific domains including: planning of resources and staffing; modifying the clinical environment; preparing equipment, supplies and drugs; selecting appropriate personal protective equipment; providing adequate oxygen therapy; assessing for and safely performing regional anaesthesia procedures; and monitoring during the conduct of anaesthesia and post‐anaesthetic care. Implicit in these recommendations is preserving patient safety whilst protecting healthcare providers from possible exposure.
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Affiliation(s)
- V Uppal
- Department of Anesthesia, Peri-operative Medicine and Pain Management, Dalhousie University, Nova Scotia Health Authority and IWK Health Centre, Halifax, NS, Canada
| | - R V Sondekoppam
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - R Landau
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA
| | - K El-Boghdadly
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust and King's College London, UK
| | - S Narouze
- Northeast Ohio Medical University, Center for Pain Medicine, Western Reserve Hospital, Rootstown, OH, USA
| | - H K P Kalagara
- Department of Anesthesiology and Peri-operative Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
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Marshall Lyon G, Mehta AK, Ribner BS. Clinical Management of Patients with Ebola Virus Disease in High-Resource Settings. Curr Top Microbiol Immunol 2019; 411:115-137. [PMID: 28601946 PMCID: PMC7120076 DOI: 10.1007/82_2017_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Like most viral illnesses in humans, supportive care of the patient is the mainstay of clinical care for patients with Ebola virus disease (EVD). The goal is to maintain and sustain the patient until a specific immune response develops and clears the viral infection. Clearly, antiviral therapy may eventually help speed recovery, but supportive care will likely always be the centerpiece of care of the patient with EVD. While terrible in terms of human suffering and loss, the EVD outbreak of 2014–2016 provided an unheralded opportunity to advance our understanding in the care of patients (WHO 2016). Regardless of the care setting, resource-rich or resource-constrained, it is beneficial to have an established team of care providers. This team should consist of nurses and physicians who are familiar with clinical care of patients with EVD and have demonstrated competency using necessary personal protective equipment (PPE). Consideration should be given to having several physician specialties on the team, including critical care, infectious diseases, and anesthesiology. Additional individuals in other medical specialties should be identified in case needed during the course of caring for a patient. The National Ebola Training and Education Center (NETEC) has detailed guidance on preparations for developing a high-containment unit and care team (NETEC 2016).
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Affiliation(s)
- G Marshall Lyon
- Division of Infectious Diseases, Emory University School of Medicine, 101 Woodruff Circle, WMRB 2101, Atlanta, GA, 30322, USA
| | - Aneesh K Mehta
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 101 Woodruff Circle, WMRB 2101, Atlanta, GA, 30322, USA
| | - Bruce S Ribner
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Emory University Hospital, 1364 Clifton Road NE, Suite B705, Atlanta, GA, 30322, USA.
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Zhang Y, Gong Y, Wang C, Liu W, Wang Z, Xia Z, Bu Z, Lu H, Sun Y, Zhang X, Cao Y, Yang F, Su H, Hu Y, Deng Y, Zhou B, Zhao Z, Fu Y, Kargbo D, Dafae F, Kargbo B, Kanu A, Liu L, Qian J, Guo Z. Rapid deployment of a mobile biosafety level-3 laboratory in Sierra Leone during the 2014 Ebola virus epidemic. PLoS Negl Trop Dis 2017; 11:e0005622. [PMID: 28505171 PMCID: PMC5444861 DOI: 10.1371/journal.pntd.0005622] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 05/25/2017] [Accepted: 05/04/2017] [Indexed: 11/23/2022] Open
Abstract
Background Ebola virus emerged in West Africa in December 2013. The high population mobility and poor public health infrastructure in this region led to the development of the largest Ebola virus disease (EVD) outbreak to date. Methodology/Principal findings On September 26, 2014, China dispatched a Mobile Biosafety Level-3 Laboratory (MBSL-3 Lab) and a well-trained diagnostic team to Sierra Leone to assist in EVD diagnosis using quantitative real-time PCR, which allowed the diagnosis of suspected EVD cases in less than 4 hours from the time of sample receiving. This laboratory was composed of three container vehicles equipped with advanced ventilation system, communication system, electricity and gas supply system. We strictly applied multiple safety precautions to reduce exposure risks. Personnel, materials, water and air flow management were the key elements of the biosafety measures in the MBSL-3 Lab. Air samples were regularly collected from the MBSL-3 Lab, but no evidence of Ebola virus infectious aerosols was detected. Potentially contaminated objects were also tested by collecting swabs. On one occasion, a pipette tested positive for EVD. A total of 1,635 suspected EVD cases (824 positive [50.4%]) were tested from September 28 to November 11, 2014, and no member of the diagnostic team was infected with Ebola virus or other pathogens, including Lassa fever. The specimens tested included blood (69.2%) and oral swabs (30.8%) with positivity rates of 54.2% and 41.9%, respectively. The China mobile laboratory was thus instrumental in the EVD outbreak response by providing timely and reliable diagnostics. Conclusions/Significance The MBSL-3 Lab significantly contributed to establishing a suitable laboratory response capacity during the emergence of EVD in Sierra Leone. A Mobile Biosafety Level-3 Laboratory (MBSL-3 Lab) and a well-trained diagnostic team were dispatched to Sierra Leone to assist in Ebola virus disease (EVD) diagnosis when the largest outbreak of EVD to date emerged in West Africa in 2014. This setup allowed for the diagnosis of suspected EVD cases in less than 4 hours from the time of sample receiving. The laboratory was composed of three container vehicles and was equipped with advanced ventilation system, communication system, electricity and gas supply system. Multiple safety precautions were strictly applied to reduce exposure risks. A total of 1,635 suspected EVD cases were evaluated from September 28 to November 11, 2014, and none of the staff members was infected with Ebola virus or other pathogens. The China mobile laboratory was thus instrumental in the EVD outbreak response by providing timely and accurate diagnostics. Therefore, the MBSL-3 Lab played a significant role in establishing a suitable laboratory response capacity during the emergence of EVD in Sierra Leone.
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Affiliation(s)
- Yi Zhang
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Yan Gong
- School of Materials Science & Engineering, Beijing Institute of Fashion Technology, Beijing, China
| | - Chengyu Wang
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Wensen Liu
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Zhongyi Wang
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Zhiping Xia
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Zhaoyang Bu
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Huijun Lu
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Yang Sun
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Xiaoguang Zhang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuxi Cao
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fan Yang
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Haoxiang Su
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yi Hu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Yongqiang Deng
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Bo Zhou
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Zongzheng Zhao
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Yingying Fu
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - David Kargbo
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Foday Dafae
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Brima Kargbo
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Alex Kanu
- Sierra Leone-China Friendship Hospital, Freetown, Sierra Leone
| | - Linna Liu
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
- * E-mail: (ZDG); (JQ); (LNL)
| | - Jun Qian
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
- * E-mail: (ZDG); (JQ); (LNL)
| | - Zhendong Guo
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
- * E-mail: (ZDG); (JQ); (LNL)
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Obilade TT. The Political Economy of the Ebola Virus Disease (EVD); Taking Individual and Community Ownership in the Prevention and Control of EVD. Healthcare (Basel) 2015; 3:36-49. [PMID: 27417746 PMCID: PMC4934522 DOI: 10.3390/healthcare3010036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/20/2015] [Indexed: 11/16/2022] Open
Abstract
The outbreak of an emerging infectious disease of zoonotic origin has exposed the weaknesses in the health systems of the nations affected. The purpose of this paper was to explore the political economy of the existing outcome of the management strategies. In addition, it proposed a new strategy in the management of the current Ebola virus disease (EVD) outbreak. This paper admits that the current management strategy which is a top to bottom approach has not worked in reducing the spread of the disease. Instead of waiting for the disease before treatment is commenced, this paper suggests aggressively preventing infection from the EVD. It presents a bottom to top approach where there is individual ownership and community ownership in the prevention and control of the EVD outbreak. In addition, the paper presents the socio-economic situation of the three most affected countries including the ecology and stigmatization of EVD. It highlights the need for cross border surveillance across the West African nations to prevent importation of the disease as occurred in Nigeria and Senegal. It points out the need for aggressive international cooperation, an aggressive prevention and a sustainable control strategy.
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Affiliation(s)
- Titilola T Obilade
- Learning Sciences and Technology, Virginia Polytechnic Institute and State University, 144J Smyth Hall, Blacksburg, VA 24061-0488, USA.
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Grolla A, Jones SM, Fernando L, Strong JE, Ströher U, Möller P, Paweska JT, Burt F, Pablo Palma P, Sprecher A, Formenty P, Roth C, Feldmann H. The use of a mobile laboratory unit in support of patient management and epidemiological surveillance during the 2005 Marburg Outbreak in Angola. PLoS Negl Trop Dis 2011; 5:e1183. [PMID: 21629730 PMCID: PMC3101190 DOI: 10.1371/journal.pntd.0001183] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 04/11/2011] [Indexed: 12/12/2022] Open
Abstract
Background Marburg virus (MARV), a zoonotic pathogen causing severe hemorrhagic fever in man, has emerged in Angola resulting in the largest outbreak of Marburg hemorrhagic fever (MHF) with the highest case fatality rate to date. Methodology/Principal Findings A mobile laboratory unit (MLU) was deployed as part of the World Health Organization outbreak response. Utilizing quantitative real-time PCR assays, this laboratory provided specific MARV diagnostics in Uige, the epicentre of the outbreak. The MLU operated over a period of 88 days and tested 620 specimens from 388 individuals. Specimens included mainly oral swabs and EDTA blood. Following establishing on site, the MLU operation allowed a diagnostic response in <4 hours from sample receiving. Most cases were found among females in the child-bearing age and in children less than five years of age. The outbreak had a high number of paediatric cases and breastfeeding may have been a factor in MARV transmission as indicated by the epidemiology and MARV positive breast milk specimens. Oral swabs were a useful alternative specimen source to whole blood/serum allowing testing of patients in circumstances of resistance to invasive procedures but limited diagnostic testing to molecular approaches. There was a high concordance in test results between the MLU and the reference laboratory in Luanda operated by the US Centers for Disease Control and Prevention. Conclusions/Significance The MLU was an important outbreak response asset providing support in patient management and epidemiological surveillance. Field laboratory capacity should be expanded and made an essential part of any future outbreak investigation. A mobile laboratory unit (MLU) was deployed to Uige, Angola as part of the World Health Organization response to an outbreak of viral hemorrhagic fever caused by Marburg virus (MARV). Utilizing mainly quantitative real-time PCR assays, this laboratory provided specific MARV diagnostics in the field. The MLU operated for 88 consecutive days allowing MARV-specific diagnostic response in <4 hours from sample receiving. Most cases were found among females in the child-bearing age and in children less than five years of age including a high number of paediatric cases implicating breastfeeding as potential transmission route. Oral swabs were identified as a useful alternative specimen source to the standard whole blood/serum specimens for patients refusing blood draw. There was a high concordance in test results between the MLU and the reference laboratory in Luanda operated by the US Centers for Disease Control and Prevention. The MLU was an important outbreak response asset providing valuable support in patient management and epidemiological surveillance. Field laboratory capacity should be expanded and made an essential part of any future outbreak investigation.
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Affiliation(s)
- Allen Grolla
- Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Steven M. Jones
- Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Fernando
- Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - James E. Strong
- Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ute Ströher
- Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peggy Möller
- Institut für Virologie, Philipps-Universität, Marburg, Hessen, Germany
| | - Janusz T. Paweska
- Special Pathogens Unit, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham, South Africa
| | - Felicity Burt
- Special Pathogens Unit, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham, South Africa
| | | | | | | | - Cathy Roth
- World Health Organization, Geneva, Switzerland
| | - Heinz Feldmann
- Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
- * E-mail:
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Kahlon SS, Peters CJ, Leduc J, Muchiri EM, Muiruri S, Njenga MK, Breiman RF, White AC, King CH. Severe Rift Valley fever may present with a characteristic clinical syndrome. Am J Trop Med Hyg 2010; 82:371-5. [PMID: 20207858 DOI: 10.4269/ajtmh.2010.09-0669] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Rift Valley fever (RVF) virus is an emerging pathogen that is transmitted in many regions of sub-Saharan Africa, parts of Egypt, and the Arabian peninsula. Outbreaks of RVF, like other diseases caused by hemorrhagic fever viruses, typically present in locations with very limited health resources, where initial diagnosis must be based only on history and physical examination. Although general signs and symptoms of human RVF have been documented, a specific clinical syndrome has not been described. In 2007, a Kenyan outbreak of RVF provided opportunity to assess acutely ill RVF patients and better delineate its presentation and clinical course. Our data reveal an identifiable clinical syndrome suggestive of severe RVF, characterized by fever, large-joint arthralgia, and gastrointestinal complaints and later followed by jaundice, right upper-quadrant pain, and delirium, often coinciding with hemorrhagic manifestations. Further characterization of a distinct RVF clinical syndrome will aid earlier detection of RVF outbreaks and should allow more rapid implementation of control.
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Affiliation(s)
- Summerpal S Kahlon
- Department of Medicine, Immunology, and Pathology, University of Texas Medical Branch, Galveston, TX, USA
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Lázaro ME, Cantoni GE, Calanni LM, Resa AJ, Herrero ER, Iacono MA, Enria DA, González Cappa SM. Clusters of hantavirus infection, southern Argentina. Emerg Infect Dis 2007; 13:104-10. [PMID: 17370522 PMCID: PMC2725835 DOI: 10.3201/eid1301.060404] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Person-to-person transmission should be suspected when Andes virus case-patients are linked. Person-to-person transmission of a hantavirus was first confirmed during a 1996 outbreak of hantavirus pulmonary syndrome in southern Argentina, where Andes virus is endemic. To identify other episodes of secondary transmission, we reviewed reports of 51 hantavirus infection cases from this region (November 1993–June 2005). Nine clusters involving 20 cases (39.2%) were found. Two patients, who had symptoms 3 weeks after they shared risks for rodent exposure, were considered a cluster. The other 8 clusters each began with an index case, which was almost always fatal, followed 19–40 days later by the illness of >1 person who had close and prolonged contact with the index case-patient. Person-to-person transmission was considered the probable source of these 8 clusters. The probability of initiating secondary cases was 41% for patients who died versus 4% for those who survived (p = 0.005). Interpersonal transmission of Andes virus infection should be considered even when rodent exposure cannot be definitively excluded.
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9
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Tarantola A, Nabeth P, Tattevin P, Michelet C, Zeller H. Lookback exercise with imported Crimean-Congo hemorrhagic fever, Senegal and France. Emerg Infect Dis 2006; 12:1424-6. [PMID: 17073094 PMCID: PMC3294739 DOI: 10.3201/eid1209.060002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A patient with suspected malaria was hospitalized successively in 2 hospitals, first in Dakar, Senegal, then in Rennes, France, where tests diagnosed Crimean-Congo hemorrhagic fever. An international incident management group was set up in France and Senegal, which traced 181 contacts and analyzed 50 samples from 3 countries. No secondary cases were identified clinically.
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Casillas AM, Nyamathi AM, Sosa A, Wilder CL, Sands H. A current review of Ebola virus: pathogenesis, clinical presentation, and diagnostic assessment. Biol Res Nurs 2003; 4:268-75. [PMID: 12698919 DOI: 10.1177/1099800403252603] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ebola hemorrhagic fever (EHF) is an acute viral syndrome that presents with fever and an ensuing bleeding diathesis that is marked by high mortality in human and nonhuman primates. Fatality rates are between 50% and 100%. Due to its lethal nature, this filovirus is classified as a biological class 4 pathogen. The natural reservoir of the virus is unknown. As a result, little is understood about how Ebola virus is transmitted or how it replicates in its host. Although the primary source of infection is unknown, the epidemiologic mode of transmission is well defined. A variety of tests have proven to be specific and useful for Ebola virus identification. There is no FDA-approved antiviral treatment for EHF. Incubation ranges from 2 to 21 days. Patients who are able to mount an immune response to the virus will begin to recover in 7 to 10 days and start a period of prolonged convalescence. Supportive management of infected patients is the primary method of treatment, with particular attention to maintenance of hydration, circulatory volume, blood pressure, and the provision of supplemental oxygen. Since there is no specific treatment outside of supportive management and palliative care, containment of this potentially lethal virus is paramount. In almost all outbreaks of EHF, the fatality rate among health care workers with documented infections was higher than that of non-health care workers.
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Affiliation(s)
- Adrian M Casillas
- University of California, Los Angeles, School of Medicine, Room 52-175, Center for Health Sciences, Los Angeles, CA 90095, USA.
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11
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Nyamathi AM, Fahey JL, Sands H, Casillas AM. Ebola virus: immune mechanisms of protection and vaccine development. Biol Res Nurs 2003; 4:276-81. [PMID: 12698920 DOI: 10.1177/1099800403252574] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Vaccination is one of our most powerful antiviral strategies. Despite the emergence of deadly viruses such as Ebola virus, vaccination efforts have focused mainly on childhood communicable diseases. Although Ebola virus was once believed to be limited to isolated outbreaks in distant lands, forces of globalization potentiate outbreaks anywhere in the world through incidental transmission. Moreover, since this virus has already been transformed into weapon-grade material, the potential exists for it to be used as a biological weapon with catastrophic consequences for any population vulnerable to attack. Ebola hemorrhagic fever (EHF) is a syndrome that can rapidly lead to death within days of symptom onset. The disease directly affects the immune system and vascular bed, with correspondingly high mortality rates. Patients with severe disease produce dangerously high levels of inflammatory cytokines, which destroy normal tissue and microcirculation, leading to profound capillary leakage, renal failure, and disseminated intravascular coagulation. Vaccine development has been fraught with obstacles, primarily of a biosafety nature. Case reports of acutely ill patients with EHF showing improvement with the transfusion of convalescent plasma are at odds with animal studies demonstrating further viral replication with the same treatment. Using mRNA extracted from bone marrow of Ebola survivors, human monoclonal antibodies against Ebola virus surface protein have been experimentally produced and now raise the hope for the development of a safe vaccine.
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Affiliation(s)
- Adeline M Nyamathi
- School of Nursing, University of California, Los Angeles, Room 2-250, Factor Building, Box 951720, Los Angeles, CA 90095-1702, USA.
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12
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Schnittler HJ, Feldmann H. Molecular pathogenesis of filovirus infections: role of macrophages and endothelial cells. Curr Top Microbiol Immunol 1999; 235:175-204. [PMID: 9893384 DOI: 10.1007/978-3-642-59949-1_10] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- H J Schnittler
- Institut für Physiologie, Westfälische Friedrich-Wilhelms-Universität, Münster, Germany
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