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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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    Footnotes

    • Collaborators Members of the INMI's Ebola Team (to be listed in PubMed as collaborators). IDs specialists: Nicola Petrosillo, Emanuele Nicastri, Nazario Bevilacqua, Evangelo Boumis, Pierangelo Chinello, Stefania Cicalini, Angela Corpolongo, Vincenzo Galati, Andrea Mariano, Silvia Rosati, Fabrizio Taglietti, Laura Vincenzi; Intensive care Physicians: Mario Antonini, Ilaria Caravella, Gabriele Garotto, Luisa Marchioni, Micaela Maritti; Psychologists: Pietro Balestra and Martina Ricottini, Radiologist: Elisa Busi Rizzi; Virology and Microbiology Laboratorians: Maria Rosaria Capobianchi, Antonino di Caro, Concetta Castilletti, Licia Bordi, Eleonora Lalle, Silvia Meschi, Daniele Lapa, Patrizia Marsella, Francesca Colavita, Roberta Chiappini, Antonio Mazzarelli, Serena Quartu, Chiara Agrati, Fabrizio Carletti, Federica Forbici, Maria Beatrice Valli, Isabella Abbate, Alessandra Amendola, Anna Rosa Garbuglia, Maria Grazia Paglia, Eugenio Bordi, Damiano Travaglini, Antonietta Toffoletti; Nurses: Gianni Battisti, Alessanda Coppola, Loredana De Marchis, Nicola De Marco, Paolo Giacomini, Fabio Di Gianbattista, Mario Guiducci, Antonio Marasco, Antonella Marzolini, Alessandro Mercuri, Paola Nieddu, Silvia Ondedei, Maurizio Vescovo, Laura Vitolo; Radiology Technician: Maurizio Morea; Drivers’ biocontainment ambulance: Gaetano Battisti, Marco Liguori; Members of the INMI Crisis unit: Nicola Petrosillo, Emanuele Nicastri, Francesco Nicola Lauria, Vincenzo Puro, Mario Antonini, Antonio Russo, Maria Rosaria Capobianchi, Antonino Di Caro, Paolo D'Aprile, Antonella Petrecchia, Evangelo Boumis, Marco Gentile, Damiano Travaglini, Silvia Pittalis, Lorena Martini, Concetta Castilletti, Francesco Maria Fusco, Simone Lanini, Andrea Antinori, Marina Cerimele, Giuseppe Ippolito and Marta Branca.

    • Contributors EN has been involved in the study concept, manuscript writing and clinical assistance. PB has been involved in the study design and in the neuropsychological test administration. MR has been involved in the neuropsychological tests analysis and interpretation. NP has been involved in the clinical assistance and in the manuscript revision. ADC has been involved in the study concept and in the virological test performance. MRC has been involved in the virological test performance, data analysis and interpretation. MLG has been involved in the manuscript drafting and revision. And GI has been involved in the critical revision of the manuscript for important intellectual content and in the study supervision.

    • Funding This work has been supported by grants from the Italian Ministry of Health (Ricerca Corrente and Ricerca Finalizzata).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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