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Letter
Temporary neurocognitive impairment with Ebola virus
  1. Emanuele Nicastri1,
  2. Pietro Balestra1,
  3. Martina Ricottini1,
  4. Nicola Petrosillo1,
  5. Antonino Di Caro2,
  6. Maria Rosaria Capobianchi2,
  7. Maria Letizia Giancola1,
  8. Giuseppe Ippolito3,
  9. the INMI's Ebola Team
    1. 1Clinical Department, National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, IRCCS, Rome, Italy
    2. 2Diagnostic Department, National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, IRCCS, Rome, Italy
    3. 3Scientific Direction, National Institute for Infectious Diseases ‘Lazzaro Spallanzani’, IRCCS, Rome, Italy
    1. Correspondence to Dr Emanuele Nicastri, Clinical Department, National Institute for Infectious Diseases—INMI—Lazzaro Spallanzani IRCCS, Via Portuense 292, Rome 00149, Italy; emanuele.nicastri{at}inmi.it

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    Introduction

    As of April 2016, the WHO reported a total of 28 616 Ebola virus disease (EVD) cases worldwide.1 This epidemic has the highest record of survivors who are now facing their challenges, including long-term sequelae. We present two patients with EVD2 with a complete neurocognitive recovery after impairment.

    Case report

    Two EVD cases were admitted to the National Institute for Infectious Diseases ‘Lazzaro Spallanzani’ in Rome. The first patient, a 50-year-old male physician, experienced EVD symptoms on 20 November 2014 and was medically evacuated from Sierra Leone, where he contracted the infection. At diagnosis, Ebola virus (EBOV) load was 6.8 log10 copies/mL. He had severe gastrointestinal symptoms, followed by an altered level of consciousness since day 10 of EVD for 5 days. An adult respiratory distress syndrome, which required mechanical ventilation, and a Plasmodium vivax coinfection were also diagnosed a few days later. At intensive care unit discharge, a clinically evident mild neurocognitive impairment, also reported by the patient, was observed for a further 5 days. He was discharged from the hospital on day 38.2 The second case, a 36-year-old male nurse, was admitted to the hospital on day 2 of EVD symptoms onset. EBOV load was 7.70 log10 copies/mL. His clinical history was complicated by an acute pericarditis and mild cognitive deficits were reported by physicians on day 3 for the next 48 hours. He was discharged on day 28. No bacterial infections or bleeding disorders were observed. Both patients were treated with fluids, empiric antibiotic therapy and antivirals (favipiravir and a mixture of EBOV monoclonal antibodies).

    A neuropsychological examination was performed to deeply investigate the clinical suspicion of neurocognitive impairment. The evaluation was repeated at follow-up. Neurological examination of both patients was normal at baseline and follow-up neurocognitive assessment. Tests …

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