Severe Meningoencephalitis in a Case of Ebola Virus Disease: A Case Report
Authors: Daniel S. Chertow, Avindra Nath, Anthony F. Suffredini, Robert L. Danner, Daniel S. Reich, Rachel J. Bishop, Richard W. Childs, Andrew E. Arai, Tara N. Palmore, H. Clifford Lane, Anthony S. Fauci, Richard T. Davey
Journal: Annals of Internal Medicine (2016)

Letters16 August 2016Severe Meningoencephalitis in a Case of Ebola Virus Disease: A Case ReportDaniel S. Chertow, MD, MPH, Avindra Nath, MD, Anthony F. Suffredini, MD, Robert L. Danner, MD, Daniel S. Reich, MD, PhD, Rachel J. Bishop, MD, Richard W. Childs, MD, Andrew E. Arai, MD, Tara N. Palmore, MD, H. Clifford Lane, MD, Anthony S. Fauci, MD, and Richard T. Davey, MDDaniel S. Chertow, MD, MPHFrom Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; National Eye Institute, National Institutes of Health, Bethesda, Maryland;National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Hospital Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland., Avindra Nath, MDFrom Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; National Eye Institute, National Institutes of Health, Bethesda, Maryland;National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Hospital Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland., Anthony F. Suffredini, MDFrom Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; National Eye Institute, National Institutes of Health, Bethesda, Maryland;National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Hospital Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland., Robert L. Danner, MDFrom Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; National Eye Institute, National Institutes of Health, Bethesda, Maryland;National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Hospital Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland., Daniel S. Reich, MD, PhDFrom Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; National Eye Institute, National Institutes of Health, Bethesda, Maryland;National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Hospital Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland., Rachel J. Bishop, MDFrom Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; National Eye Institute, National Institutes of Health, Bethesda, Maryland;National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Hospital Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland., Richard W. Childs, MDFrom Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; National Eye Institute, National Institutes of Health, Bethesda, Maryland;National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Hospital Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland., Andrew E. Arai, MDFrom Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; National Eye Institute, National Institutes of Health, Bethesda, Maryland;National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Hospital Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland., Tara N. Palmore, MDFrom Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; National Eye Institute, National Institutes of Health, Bethesda, Maryland;National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Hospital Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland., H. Clifford Lane, MDFrom Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; National Eye Institute, National Institutes of Health, Bethesda, Maryland;National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Hospital Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland., Anthony S. Fauci, MDFrom Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; National Eye Institute, National Institutes of Health, Bethesda, Maryland;National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Hospital Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland., and Richard T. Davey, MDFrom Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; National Eye Institute, National Institutes of Health, Bethesda, Maryland;National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Hospital Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-3066 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Meningoencephalitis has been described as an acute or late complication of Ebola virus disease (EVD) (1–3), but detailed physical examination and brain magnetic resonance imaging (MRI) findings have not been reported. Here we report findings in a patient with severe EVD complicated by meningoencephalitis and multiorgan failure managed with supportive care only.Case Report: A 34-year-old male health care worker in Sierra Leone was evacuated on day 7 of documented EVD to the National Institutes of Health Clinical Center. On arrival, he had no discrete cognitive abnormalities. Figure 1 describes his clinical course.Figure 1.Sequential multiorgan failure in a ...References1. Chertow DS, Kleine C, Edwards JK, Scaini R, Giuliani R, Sprecher A. Ebola virus disease in West Africa—clinical manifestations and management. N Engl J Med. 2014;371:2054-7. [PMID: 25372854] doi:10.1056/NEJMp1413084 CrossrefMedlineGoogle Scholar2. Edwards JK, Kleine C, Munster V, Giuliani R, Massaquoi M, Sprecher A, et al. Interpretation of negative molecular test results in patients with suspected or confirmed Ebola virus disease: report of two cases. Open Forum Infect Dis. 2015;2:ofv137. [PMID: 26512358] doi:10.1093/ofid/ofv137 CrossrefMedlineGoogle Scholar3. Howlett P, Brown C, Helderman T, Brooks T, Lisk D, Deen G, et al. Ebola virus disease complicated by late-onset encephalitis and polyarthritis, Sierra Leone [Letter]. Emerg Infect Dis. 2016;22:150-2. [PMID: 26690042] doi:10.3201/eid2201.151212 CrossrefMedlineGoogle Scholar4. Bechtelsheimer H, Korb G, Gedigk P. [The "Marburg-virus"-hepatitis Studies in man and guinea pigs]. Virchows Arch A Pathol Pathol Anat. 1970;351:273-90. [PMID: 5312756] CrossrefMedlineGoogle Scholar5. Slenczka WG. The Marburg virus outbreak of 1967 and subsequent episodes. Curr Top Microbiol Immunol. 1999;235:49-75. [PMID: 9893378] MedlineGoogle Scholar6. Larsen T, Stevens EL, Davis KJ, Geisbert JB, Daddario-DiCaprio KM, Jahrling PB, et al. Pathologic findings associated with delayed death in nonhuman primates experimentally infected with Zaire Ebola virus. J Infect Dis. 2007;196 Suppl 2:S323-8. [PMID: 17940967] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; National Eye Institute, National Institutes of Health, Bethesda, Maryland;National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Hospital Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.Disclaimer: The content of this publication does not necessarily reflect the views or policies of the U.S. Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government.Acknowledgment: The successful care of this patient is attributed to the efforts of the multidisciplinary team at the National Institutes of Health Clinical Center. This team comprised volunteers and included Special Clinical Studies Unit and critical care nurses, respiratory therapists, a radiology technician, laboratory technicians, a pharmacist, a dietitian, hospital epidemiologists, critical care and infectious diseases physicians, and WatSans from diverse backgrounds. To these individuals, the authors express their gratitude.Grant Support: The Intramural Research Program of National Institute of Allergy and Infectious Diseases, National Institutes of Health, supported this work.Disclosures: Dr. Reich reports grants from Vertex Pharmaceuticals outside the submitted work. Authors not named here have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-3066.This article was published at www.annals.org on 5 April 2016. 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