RESUMO
We collected data on 1054 children admitted to Ebola Holding Units in Sierra Leone and describe outcomes of 697/1054 children testing negative for Ebola virus disease (EVD) and accompanying caregivers. Case-fatality was 9%; 3/630 (0.5%) children discharged testing negative were readmitted EVD-positive. Nosocomial EVD transmission risk may be lower than feared.
Assuntos
Infecção Hospitalar/mortalidade , Infecção Hospitalar/transmissão , Surtos de Doenças/estatística & dados numéricos , Doença pelo Vírus Ebola/mortalidade , Doença pelo Vírus Ebola/transmissão , Isolamento de Pacientes/estatística & dados numéricos , Criança , Pré-Escolar , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/terapia , Surtos de Doenças/prevenção & controle , Ebolavirus , Feminino , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/terapia , Humanos , Lactente , Masculino , Serra Leoa/epidemiologiaRESUMO
We present a case of tubercular liver abscess with disseminated tuberculosis, associated with underlying HIV infection. The patient responded well to percutaneous drainage of the abscess and first-line quadruple antitubercular therapy. We report this case to highlight a rare manifestation of a common disease and to create greater awareness which may ensure timely diagnosis and avoid unnecessary surgical intervention.
Assuntos
Abscesso Hepático/diagnóstico , Abscesso Hepático/etiologia , Tuberculose Miliar/complicações , Adulto , Antituberculosos/uso terapêutico , Drenagem , Humanos , Abscesso Hepático/terapia , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento , UltrassonografiaRESUMO
Current Ebola virus disease (EVD) diagnosis relies on reverse transcription-PCR (RT-PCR) technology, requiring skilled laboratory personnel and technical infrastructure. Lack of laboratory diagnostic capacity has led to diagnostic delays in the current West African EVD outbreak of 2014 and 2015, compromising outbreak control. We evaluated the diagnostic accuracy of the EVD bedside rapid diagnostic antigen test (RDT) developed by the United Kingdom's Defence Science and Technology Laboratory, compared with Ebola virus RT-PCR, in an operational setting for EVD diagnosis of suspected cases admitted to Ebola holding units in the Western Area of Sierra Leone. From 22 January to 16 February 2015, 138 participants were enrolled. EVD prevalence was 11.5%. All EVD cases were identified by a positive RDT with a test line score of 6 or more, giving a sensitivity of 100% (95% confidence interval (CI): 78.2-100). The corresponding specificity was high (96.6%, 95% CI: 91.3-99.1). The positive and negative predictive values for the population prevalence were 79.0% (95% CI: 54.4-93.8) and 100% (95% CI: 96.7-100), respectively. These results, if confirmed in a larger study, suggest that this RDT could be used as a 'rule-out' screening test for EVD to improve rapid case identification and resource allocation.
Assuntos
Surtos de Doenças/prevenção & controle , Ebolavirus/isolamento & purificação , Testes Hematológicos/métodos , Doença pelo Vírus Ebola/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Ebolavirus/genética , Epidemias , Feminino , Doença pelo Vírus Ebola/sangue , Doença pelo Vírus Ebola/epidemiologia , Humanos , Masculino , Valor Preditivo dos Testes , Prevalência , RNA Viral/análise , Sensibilidade e Especificidade , Serra Leoa/epidemiologia , Fatores de TempoRESUMO
The unprecedented scale of the 2013-2016 West African Ebola virus disease (EVD) outbreak was in a large part due to failings in surveillance: contacts of confirmed cases were not systematically identified, monitored and diagnosed early, and new cases appearing in previously unaffected communities were similarly not rapidly identified, diagnosed and isolated. Over the course of this epidemic, traditional surveillance methods were strengthened and novel methods introduced. The wealth of experience gained, and the systems introduced in West Africa, should be used in future EVD outbreaks, as well as for other communicable diseases in the region and beyond.