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Masumbuko Claude K, Mukadi-Bamuleka D, Kitenge-Omasumbu R, Edidi-Atani F, Kuamfumu MM, Mulangu S, Tshiani-Mbaya O, Malengera Vicky K, Mbala-Kingebeni P, Ahuka-Mundeke S, Muyembe-Tamfum JJ, Lee BE, Houston S, Mumtaz Z, Hawkes MT. Rhabdomyolysis, acute kidney injury, and mortality in Ebola virus disease: retrospective analysis of cases from Eastern Democratic Republic of the Congo, 2019. J Infect Dis 2024:jiae224. [PMID: 38696335 DOI: 10.1093/infdis/jiae224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/13/2024] [Accepted: 04/26/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Skeletal muscle injury in Ebola virus disease (EVD) has been reported, but its association with morbidity and mortality remains poorly defined. METHODS Retrospective study of patients admitted to two EVD Treatment Units, over an eight-month period in 2019, during a large EVD epidemic in the Democratic Republic of the Congo. RESULTS 333 patients (median age 30 years, 58% female) had at least one creatine kinase (CK) measurement (total 2,229 CK measurements, median 5 (IQR 1-11) per patient). 271 patients (81%) had an elevated CK (>380U/L), 202 (61%) had rhabdomyolysis (CK>1,000 IU/L), and 45 (14%) had severe rhabdomyolysis (≥5,000U/L). Among survivors, the maximum CK level was median 1,600 (IQR 550 to 3,400), peaking 3.4 days after admission (IQR 2.3 to 5.5) and decreasing thereafter. Among fatal cases, the CK rose monotonically until death, with maximum CK level of median 2,900 U/L (IQR 1,500 to 4,900). Rhabdomyolysis at admission was an independent predictor of AKI (aOR 2.2 [95%CI 1.2-3.8], p=0.0065) and mortality (aHR 1.7 [95%CI 1.03-2.9], p=0.037). CONCLUSIONS Rhabdomyolysis is associated with AKI and mortality in EVD patients. These findings may inform clinical practice by identifying lab monitoring priorities and highlighting the importance of fluid management.
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Affiliation(s)
- Kasereka Masumbuko Claude
- Department of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Daniel Mukadi-Bamuleka
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Richard Kitenge-Omasumbu
- Programme National d'Urgences et Actions Humanitaires (PNUAH), Ministry of Health of the Democratic Republic of the Congo, Kinshasa, Democratic Republic of the Congo
| | - François Edidi-Atani
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Meris Matondo Kuamfumu
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Sabue Mulangu
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Olivier Tshiani-Mbaya
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Kambale Malengera Vicky
- Department of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe-Tamfum
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Bonita E Lee
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Stan Houston
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Zubia Mumtaz
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Michael T Hawkes
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Nkuba-Ndaye A, Dilu-Keti A, Tovar-Sanchez T, Diallo MSK, Mukadi-Bamuleka D, Kitenge R, Formenty P, Legand A, Edidi-Atani F, Thaurignac G, Pelloquin R, Mbala-Kingebeni P, Toure A, Ayouba A, Muyembe-Tamfum JJ, Delaporte E, Peeters M, Ahuka-Mundeke S. Effect of anti-Ebola virus monoclonal antibodies on endogenous antibody production in survivors of Ebola virus disease in the Democratic Republic of the Congo: an observational cohort study. Lancet Infect Dis 2024; 24:266-274. [PMID: 38043556 DOI: 10.1016/s1473-3099(23)00552-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/10/2023] [Accepted: 08/23/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND The use of specific anti-Ebola virus therapy, especially monoclonal antibodies, has improved survival in patients with Ebola virus disease. We aimed to assess the effect of monoclonal antibodies on anti-Ebola virus antibody responses in survivors of the 2018-20 Ebola outbreak in the Democratic Republic of the Congo. METHODS In this observational prospective cohort study, participants were enrolled at three Ebola survivor clinics in Beni, Mangina, and Butembo (Democratic Republic of the Congo). Eligible children and adults notified as survivors of Ebola virus disease (ie, who had confirmed Ebola virus disease [RT-PCR positive in blood sample] and were subsequently declared recovered from the virus [RT-PCR negative in blood sample] with a certificate of recovery from Ebola virus disease issued by an Ebola treatment centre) during the 2018-20 Ebola virus disease outbreak were invited to participate in the study. Participants were recruited on discharge from Ebola treatment centres and followed up for 12-18 months depending on recruitment date. Routine follow-up assessments were done at 1, 3, 6, and 12-18 months after inclusion. We collected sociodemographic (age, sex, visit site), clinical (anti-Ebola virus drugs), and laboratory data (RT-PCR and Ct values). The primary outcome was the antibody concentrations against Ebola virus glycoprotein, nucleoprotein, and 40-kDa viral protein antigens over time assessed in all participants. Antibody concentrations were measured by the multiplex immunoassay, and the association between anti-Ebola virus antibody levels and the relevant exposures, such as anti-Ebola virus disease drugs (ansuvimab, REGN-EB3, ZMapp, or remdesivir), was assessed using both linear and logistic mixed regression models. This study is registered at ClinicalTrials.gov, NCT04409405. FINDINGS Between April 16, 2020, and Oct 18, 2021, 1168 survivors were invited to participate in the Les Vainqueurs d'Ebola cohort study. 787 survivors were included in the study, of whom 358 had data available for antibody responses. 85 (24%) of 358 were seronegative for at least two Ebola virus antigens on discharge from the Ebola treatment centre. The antibody response over time fluctuated but a continuous decrease in an overall linear evolution was observed. Quantitative modelling showed a decrease in nucleoprotein, glycoprotein, and VP-40 antibody concentrations over time (p<0·0001) with the fastest decrease observed for glycoprotein. The probability of being seropositive for at least two antigens after 36 months was 53·6% (95% CI 51·6-55·6) for participants who received ansuvimab, 73·5% (71·5-75·5) for participants who received REGN-EB3, 76·8% (74·8-78·8) for participants who received remdesivir, and 78·5% (76·5-80·5) for participants who received ZMapp. INTERPRETATION Almost a quarter of survivors were seronegative on discharge from the Ebola treatment centre and antibody concentrations decreased rapidly over time. These results indicate that monoclonal antibodies might negatively affect the production of anti-Ebola virus antibodies in survivors of Ebola virus disease which could increase the risk of reinfection or reactivation. FUNDING The French National Agency for AIDS Research-Emergent Infectious Diseases-The French National Institute of Health and Medical Research, the French National Research Institute for Development, and the European and Developing Countries Clinical Trials Partnership. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Antoine Nkuba-Ndaye
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo; TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France.
| | - Angele Dilu-Keti
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Tamara Tovar-Sanchez
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Mamadou Saliou Kalifa Diallo
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France; Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea; Department of Infectious Diseases, Donka National Hospital, Conakry, Guinea
| | - Daniel Mukadi-Bamuleka
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Richard Kitenge
- Programme National de Soins et de Suivi des Personnes Guéries, Ministère de Santé Publique, city, Democratic Republic of the Congo
| | | | - Anaïs Legand
- Health Emergencies Program, WHO, Geneva, Switzerland
| | - François Edidi-Atani
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Guillaume Thaurignac
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Raphael Pelloquin
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Placide Mbala-Kingebeni
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Abdoulaye Toure
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea; Department of Infectious Diseases, Donka National Hospital, Conakry, Guinea
| | - Ahidjo Ayouba
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Jean-Jacques Muyembe-Tamfum
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Eric Delaporte
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France; Montpellier University Hospital, Montpellier, France
| | - Martine Peeters
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Steve Ahuka-Mundeke
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
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Mukadi-Bamuleka D, Bulabula-Penge J, Jacobs BKM, De Weggheleire A, Edidi-Atani F, Mambu-Mbika F, Legand A, Klena JD, Fonjungo PN, Mbala-Kingebeni P, Makiala-Mandanda S, Kajihara M, Takada A, Montgomery JM, Formenty P, Muyembe-Tamfum JJ, Ariën KK, van Griensven J, Ahuka-Mundeke S. Head-to-head comparison of diagnostic accuracy of four Ebola virus disease rapid diagnostic tests versus GeneXpert® in eastern Democratic Republic of the Congo outbreaks: a prospective observational study. EBioMedicine 2023; 91:104568. [PMID: 37084479 PMCID: PMC10148093 DOI: 10.1016/j.ebiom.2023.104568] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Ebola virus disease (EVD) outbreaks have emerged in Central and West Africa. EVD diagnosis relies principally on RT-PCR testing with GeneXpert®, which has logistical and cost restrictions at the peripheral level of the health system. Rapid diagnostic tests (RDTs) would offer a valuable alternative at the point-of-care to reduce the turn-around time, if they show good performance characteristics. We evaluated the performance of four EVD RDTs against the reference standard GeneXpert® on stored EVD positive and negative blood samples collected between 2018 and 2021 from outbreaks in eastern Democratic Republic of the Congo (DRC). METHODS We conducted a prospective and observational study in the laboratory on QuickNavi-Ebola™, OraQuick® Ebola Rapid Antigen, Coris® EBOLA Ag K-SeT, and Standard® Q Ebola Zaïre Ag RDTs using left-over archived frozen EDTA whole blood samples. We randomly selected 450 positive and 450 negative samples from the EVD biorepositories in DRC, across a range of GeneXpert® cycle threshold values (Ct-values). RDT results were read by three persons and we considered an RDT result as "positive", when it was flagged as positive by at least two out of the three readers. We estimated the sensitivity and specificity through two independent generalized (logistic) linear mixed models (GLMM). FINDINGS 476 (53%) of 900 samples had a positive GeneXpert Ebola result when retested. The QuickNavi-Ebola™ showed a sensitivity of 56.8% (95% CI 53.6-60.0) and a specificity of 97.5% (95% CI 96.2-98.4), the OraQuick® Ebola Rapid Antigen test displayed 61.6% (95% CI 57.0-65.9) sensitivity and 98.1% (95% CI 96.2-99.1) specificity, the Coris® EBOLA Ag K-SeT showed 25.0% (95% CI 22.3-27.9) sensitivity and 95.9% (95% CI 94.2-97.1) specificity, and the Standard® Q Ebola Zaïre Ag displayed 21.6% (95% CI 18.1-25.7) sensitivity and 99.1% (95% CI 97.4-99.7) specificity. INTERPRETATION None of the RDTs evaluated approached the "desired or acceptable levels" for sensitivity set out in the WHO target product profile, while all of the tests met the "desired level" for specificity. Nevertheless, the QuickNavi-Ebola™ and OraQuick® Ebola Rapid Antigen Test demonstrated the most favorable profiles, and may be used as frontline tests for triage of suspected-cases while waiting for RT-qPCR confirmatory testing. FUNDING Institute of Tropical Medicine Antwerp/EDCTP PEAU-EBOV-RDC project.
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Affiliation(s)
- Daniel Mukadi-Bamuleka
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Rodolphe Mérieux INRB-Goma Laboratory, Goma, North Kivu, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo.
| | - Junior Bulabula-Penge
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | | | | | - François Edidi-Atani
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Rodolphe Mérieux INRB-Goma Laboratory, Goma, North Kivu, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | - Fabrice Mambu-Mbika
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | - Anaïs Legand
- Health Emergencies Program, World Health Organization, Geneva, Switzerland
| | - John D Klena
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | - Sheila Makiala-Mandanda
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | - Masahiro Kajihara
- International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Ayato Takada
- International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | | | - Pierre Formenty
- Health Emergencies Program, World Health Organization, Geneva, Switzerland
| | - Jean-Jacques Muyembe-Tamfum
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | - Kevin K Ariën
- Institute of Tropical Medicine, Antwerp, Belgium; University of Antwerp, Antwerp, Belgium
| | | | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
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Mukadi-Bamuleka D, Mambu-Mbika F, De Weggheleire A, Edidi-Atani F, Bulabula-Penge J, Mfumu MMK, Legand A, Nkuba-Ndaye A, N’kasar YTT, Mbala-Kingebeni P, Klena JD, Montgomery JM, Muyembe-Tamfum JJ, Formenty P, van Griensven J, Ariën KK, Ahuka-Mundeke S. Efficiency of Field Laboratories for Ebola Virus Disease Outbreak during Chronic Insecurity, Eastern Democratic Republic of the Congo, 2018–2020. Emerg Infect Dis 2023. [DOI: 10.3201/2901.221025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Mukadi-Bamuleka D, Mambu-Mbika F, De Weggheleire A, Edidi-Atani F, Bulabula-Penge J, Mfumu MMK, Legand A, Nkuba-Ndaye A, N'kasar YTT, Mbala-Kingebeni P, Klena JD, Montgomery JM, Muyembe-Tamfum JJ, Formenty P, van Griensven J, Ariën KK, Ahuka-Mundeke S. Efficiency of Field Laboratories for Ebola Virus Disease Outbreak during Chronic Insecurity, Eastern Democratic Republic of the Congo, 2018-2020. Emerg Infect Dis 2023; 29:1-9. [PMID: 36573642 PMCID: PMC9796222 DOI: 10.3201/eid2901.221025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
During the 10th outbreak of Ebola virus disease in the Democratic Republic of the Congo, the Institut National de Recherche Biomédicale strategically positioned 13 decentralized field laboratories with dedicated equipment to quickly detect cases as the outbreak evolved. The laboratories were operated by national staff, who quickly handed over competencies and skills to local persons to successfully manage future outbreaks. Laboratories analyzed ≈230,000 Ebola diagnostic samples under stringent biosafety measures, documentation, and database management. Field laboratories diversified their activities (diagnosis, chemistry and hematology, survivor follow-up, and genomic sequencing) and shipped 127,993 samples from the field to a biorepository in Kinshasa under good conditions. Deploying decentralized and well-equipped laboratories run by local personnel in at-risk countries for Ebola virus disease outbreaks is an efficient response; all activities are quickly conducted in the field.
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Kjaldgaard L, Claude KM, Mukadi-Bamuleka D, Kitenge-Omasumbu R, Dixit D, Edidi-Atani F, Kuamfumu MM, Bulabula-Penge J, Mambu-Mbika F, Tshiani-Mbaya O, Diaz J, Mulangu S, Legand A, Mbala-Kingebeni P, Formenty P, Ahuka-Mundeke S, Muyembe-Tamfum JJ, Hawkes MT. Virus kinetics and biochemical derangements among children with Ebolavirus disease. EClinicalMedicine 2022; 53:101638. [PMID: 36105872 PMCID: PMC9465268 DOI: 10.1016/j.eclinm.2022.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A paucity of data is available on virologic and biochemical characteristics of paediatric Ebolavirus disease (EVD), compared to adults. METHODS We conducted a retrospective chart review of children (<16 years old) and a comparator group of young adults (16-44 years) from two treatment centres during the 2018-2020 EVD epidemic in Eastern Democratic Republic of the Congo. Statistical methods included chi-squared and Fisher's exact tests (dichotomous and categorical variables), Mann-Whitney U-test (continuous variables), multivariable linear regression (for determinants of admission viral load), linear mixed-effects models (for analysis of longitudinal viral load), and Cox proportional hazard models (to examine risk factors for mortality). FINDINGS We included 73 children and 234 adults admitted from April to October 2019. Paediatric patients commonly had electrolytes imbalances: hypokalaemia in 26/73 (36%), hyperkalaemia in 38/73 (52%), and hyponatraemia in 54/73 (74%). Hypoglycaemia occurred in 20/73 (27%), acute kidney injury in 43/73 (59%), and rhabdomyolysis in 35/73 (48%). Biochemical abnormalities were detected in a similar proportion of children and adults. The viral load (VL, log10 copies/mL) at admission (7.2 versus 6.5, p=0.0001), the peak viral load (7.5 versus 6.7, p=<0.0001), and the time for viraemia clearance (16 days versus 12 days, p=<0.0001) were significantly different in children. The duration of hospital stay was prolonged in children (20 versus 16 days, p=<0.0001). Risk factors for mortality in children were: VL >7.6 log10copies/mL, alanine transaminase >525 U/L, C-reactive protein >100 mg/L, blood urea nitrogen >7.5 mmol/L, rhabdomyolysis, and.acute kidney injury. INTERPRETATION Paediatric EVD patients, like adults, experience multiorgan dysfunction with life-threatening electrolyte imbalances, hypoglycaemia, kidney injury, liver injury, and rhabdomyolysis. Paediatric patients have significantly higher VLs throughout the course of EVD than adults. FUNDING This study was not funded.
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Affiliation(s)
- Lindsey Kjaldgaard
- Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
- Member, Women and Children's Research Institute, University of Alberta, Edmonton, AB, Canada
| | | | - Daniel Mukadi-Bamuleka
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Richard Kitenge-Omasumbu
- Programme National d'Urgences et Actions Humanitaires (PNUAH), Ministry of Health of the Democratic Republic of the Congo (DRC), Democratic Republic of the Congo
| | - Devika Dixit
- Department of Medicine, Division of Infectious Diseases, University of Saskatchewan, Saskatoon, SK, Canada
| | - François Edidi-Atani
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Meris Matondo Kuamfumu
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Junior Bulabula-Penge
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Fabrice Mambu-Mbika
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Olivier Tshiani-Mbaya
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Janet Diaz
- World Health Organization (WHO), Geneva, Switzerland
| | - Sabue Mulangu
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Anais Legand
- World Health Organization (WHO), Geneva, Switzerland
| | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | | | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | | | - Michael T. Hawkes
- Member, Women and Children's Research Institute, University of Alberta, Edmonton, AB, Canada
- Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Distinguished Researcher, Stollery Science Lab, University of Alberta, Edmonton, AB, Canada
- Corresponding author at: Department of Paediatrics, University of Alberta, 3-588D Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada.
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Mukadi-Bamuleka D, Bulabula-Penge J, De Weggheleire A, Jacobs BKM, Edidi-Atani F, Mambu-Mbika F, Mbala-Kingebeni P, Makiala-Mandanda S, Faye M, Diagne CT, Diagne MM, Faye O, Kajihara M, Faye O, Takada A, Sall AA, Muyembe-Tamfum JJ, van Griensven J, Ariën KK, Ahuka-Mundeke S. Field performance of three Ebola rapid diagnostic tests used during the 2018-20 outbreak in the eastern Democratic Republic of the Congo: a retrospective, multicentre observational study. Lancet Infect Dis 2022; 22:891-900. [PMID: 35298901 DOI: 10.1016/s1473-3099(21)00675-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Democratic Republic of the Congo has confronted 13 outbreaks of Ebola virus disease since 1976. Rapid diagnostic tests (RDTs) detecting viral antigens have been developed to circumvent difficulties encountered with RT-PCR for diagnosis in remote low-resource settings, but there is still uncertainty about their performance characteristics and usability during outbreaks. We aimed to assess the field performance of three antigen detection RDTs compared with the gold-standard Cepheid GeneXpert Ebola assay results. METHODS We conducted a retrospective, multicentre observational study using complete and de-identified databases of five mobile laboratories (managed by the Institut National de Recherche Biomédicale) to assess the performance of three Ebola virus disease RDTs (QuickNavi-Ebola, OraQuick Ebola Rapid Antigen Test, and Coris EBOLA Ag K-SeT rapid test) run on blood samples of patients with suspected Ebola virus disease in direct comparison with the Cepheid GeneXpert Ebola assay reference test during the 2018-20 outbreak in the eastern Democratic Republic of the Congo. We estimated the sensitivity and specificity of each test through generalised linear mixed models against the GeneXpert Ebola assay reference test and corrected for cycle threshold value and random site effects. FINDINGS 719 (7·9%) of 9157 samples had a positive GeneXpert Ebola assay result. The QuickNavi-Ebola RDT had a sensitivity of 87·4% (95% CI 63·6-96·8) around the mean cycle threshold value and a specificity of 99·6% (99·3-99·8). The OraQuick Ebola Rapid Antigen Test had a sensitivity of 57·4% (95% CI 38·8-75·8) and specificity of 98·3% (97·5-99·0), and the Coris EBOLA Ag K-SeT rapid test had a sensitivity of 38·9% (23·0-63·6) against the GeneXpert Ebola assay reference and specificity of 97·4% (85·3-99·6). The QuickNavi-Ebola RDT showed a robust performance with good sensitivity, particularly with increasing viral loads (ie, low cycle threshold values), and specificity. INTERPRETATION The three RDTs evaluated did not achieve the desired sensitivity and specificity of the WHO target product profile. Although the RDTs cannot triage and rule out Ebola virus infection among clinical suspects, they can still help to sort people with suspected Ebola virus disease into high-risk and low-risk groups while waiting for GeneXpert Ebola assay reference testing. FUNDING None. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Daniel Mukadi-Bamuleka
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
| | - Junior Bulabula-Penge
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Anja De Weggheleire
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bart K M Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - François Edidi-Atani
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Fabrice Mambu-Mbika
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Sheila Makiala-Mandanda
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Oumar Faye
- Institut Pasteur de Dakar, Dakar, Senegal
| | - Masahiro Kajihara
- International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | | | - Ayato Takada
- International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | | | - Jean-Jacques Muyembe-Tamfum
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kevin K Ariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Steve Ahuka-Mundeke
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
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Nkuba-Ndaye A, Mukadi-Bamuleka D, Bulabula-Penge J, Thaurignac G, Edidi-Atani F, Mambu-Mbika F, Danga-Yema B, Matondo-Kuamfumu M, Kinganda-Lusamaki E, Bisento N, Lumembe-Numbi R, Kabamba-Lungenyi G, Kitsa-Mutsumbirwa D, Kambale-Sivihwa N, Boillot F, Delaporte E, Mbala-Kingebeni P, Ayouba A, Peeters M, Ahuka-Mundeke S. Added value of an anti-Ebola serology for the management of clinically suspect Ebola virus disease patients discharged as negative in an epidemic context. J Infect Dis 2022; 226:352-356. [PMID: 35176762 PMCID: PMC9400424 DOI: 10.1093/infdis/jiac057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/16/2022] [Indexed: 11/14/2022] Open
Abstract
Background Survivors from Ebola virus disease (EVD) may be at the origin of EVD resurgence. Methods Simultaneous reactivity to at least 2 Ebola virus or Zaire ebolavirus (EBOV) antigens was detected in 11 of 488 (2.3%; 95% confidence interval [CI], 1.1–4.0) suspected EVD patients who were discharged as negative after 2 consecutive negative tests during the 10th Ebola outbreak in the Democratic Republic of the Congo. Results After extrapolating the total number of individuals discharged as negative during the entire outbreak, we estimated a total of 1314 additional missed Ebola cases. Conclusions These findings emphasize the usefulness of an EBOV serology analysis and the importance of extending epidemic surveillance to clinically suspected cases who were discharged as negative.
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Affiliation(s)
- Antoine Nkuba-Ndaye
- Recherches Translationnelles sur le VIH et Maladies Infectieuses, Université de Montpellier/INSERM U1175, Institut de Recherche pour le Développement, Montpellier, France.,Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Daniel Mukadi-Bamuleka
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Junior Bulabula-Penge
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Guillaume Thaurignac
- Recherches Translationnelles sur le VIH et Maladies Infectieuses, Université de Montpellier/INSERM U1175, Institut de Recherche pour le Développement, Montpellier, France
| | - François Edidi-Atani
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Fabrice Mambu-Mbika
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Bernice Danga-Yema
- Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Meris Matondo-Kuamfumu
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Eddy Kinganda-Lusamaki
- Recherches Translationnelles sur le VIH et Maladies Infectieuses, Université de Montpellier/INSERM U1175, Institut de Recherche pour le Développement, Montpellier, France.,Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Nella Bisento
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Raphaël Lumembe-Numbi
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Gabriel Kabamba-Lungenyi
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Divine Kitsa-Mutsumbirwa
- Laboratoire mobile pour MVE, Institut National de Recherche Biomédicale, Butembo, Nord-Kivu, Democratic Republic of the Congo
| | - Nelson Kambale-Sivihwa
- Laboratoire mobile pour MVE, Institut National de Recherche Biomédicale, Beni, Nord-Kivu, Democratic Republic of the Congo
| | | | - Eric Delaporte
- Recherches Translationnelles sur le VIH et Maladies Infectieuses, Université de Montpellier/INSERM U1175, Institut de Recherche pour le Développement, Montpellier, France
| | - Placide Mbala-Kingebeni
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ahidjo Ayouba
- Recherches Translationnelles sur le VIH et Maladies Infectieuses, Université de Montpellier/INSERM U1175, Institut de Recherche pour le Développement, Montpellier, France
| | - Martine Peeters
- Recherches Translationnelles sur le VIH et Maladies Infectieuses, Université de Montpellier/INSERM U1175, Institut de Recherche pour le Développement, Montpellier, France
| | - Steve Ahuka-Mundeke
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
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9
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Gryseels S, Mbala-Kingebeni P, Akonda I, Angoyo R, Ayouba A, Baelo P, Mukadi DB, Bugentho E, Bushmaker T, Butel C, Calvignac-Spencer S, Delaporte E, De Smet B, Düx A, Edidi-Atani F, Fischer R, Kahandi C, Kapetshi J, Sumba SK, Kouadio L, Bendeke AM, Mande C, Sepolo GM, Moudindo J, Ngole EM, Musaba P, Mutombo P, Bass IN, Nebesse C, Ngoy S, Kumogo SPN, Seifert SN, Tanzito J, Akaibe D, Amundala N, Ariën KK, Gembu GC, Leendertz FH, Leirs H, Mukinzi JC, Munster V, Muyembe-Tamfum JJ, Peeters M, Verheyen E, Ahuka-Mundeke S. Role of Wildlife in Emergence of Ebola Virus in Kaigbono (Likati), Democratic Republic of the Congo, 2017. Emerg Infect Dis 2021; 26:2205-2209. [PMID: 32818404 PMCID: PMC7454093 DOI: 10.3201/eid2609.191552] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
After the 2017 Ebola virus (EBOV) outbreak in Likati, a district in northern Democratic Republic of the Congo, we sampled small mammals from the location where the primary case-patient presumably acquired the infection. None tested positive for EBOV RNA or antibodies against EBOV, highlighting the ongoing challenge in detecting animal reservoirs for EBOV.
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