title: Ebola virus disease complicated with viral interstitial pneumonia: a case report.
abstract: BACKGROUND
  In the current Ebola epidemic in Western Africa, many healthcare workers have become infected. Some of these have been medically evacuated to hospitals in Europe and the USA. These clinical experiences provide unique insights into the course of Ebola virus disease under optimized condition within high level isolation units.
  
  
  METHODS
  A 50-year-old Caucasian male physician contracted Ebola virus diseases in Sierra Leone and was medically evacuated to Italy. Few days after the admission the course of the illness was characterized by severe gastro-intestinal symptoms followed by respiratory failure, accompanied by pulmonary infiltration and high Ebola viral load in the bronchial aspirate and Plasmodium vivax co-infection. The patient received experimental antiviral therapy with favipiravir, convalescent plasma and ZMAb. Ebola viral load started to steadily decrease in the blood after ZMAb administration and became undetectable by day 19 after admission, while it persisted longer in urine samples. No temporal association was observed between viral load decay in plasma and administration of favipiravir. The patient completely recovered and was discharged 39 days after admission.
  
  
  CONCLUSIONS
  This is the first case of Ebola-related interstitial pneumonia documented by molecular testing of lung fluid specimens. This reports underlines the pivotal role of fluid replacement and advanced life support with mechanical ventilation in the management of patients with Ebola virus diseases respiratory failure. Beside our finding indicates a close temporal association between administration of cZMAb and Ebola virus clearance from blood.
authors.affiliation: National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy. nicola.petrosillo@inmi.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Petrosillo
authors.affiliation: National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy. emanuele.nicastri@inmi.it.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Nicastri
authors.affiliation: National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy. simone.lanini@inmi.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Lanini
authors.affiliation: National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy. maria.capobianchi@inmi.it.
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Capobianchi
authors.affiliation: National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy. antonino.dicaro@inmi.it.
authors.forename: Antonino
authors.initials: A
authors.lastname: Di Caro
authors.affiliation: National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy. mario.antonini@inmi.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Antonini
authors.affiliation: National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy. vincenzo.puro@inmi.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Puro
authors.affiliation: National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy. francesco.lauria@inmi.it.
authors.forename: Francesco Nicola
authors.initials: FN
authors.lastname: Lauria
authors.affiliation: Pandemic and Epidemic Diseases Department, World Health Organization, Geneva, Switzerland. shindon@who.int.
authors.forename: Nakono
authors.initials: N
authors.lastname: Shindo
authors.affiliation: Essential Medicines and Health Products Department, World Health Organization, Geneva, Switzerland. magrinin@who.int.
authors.forename: Nicola
authors.initials: N
authors.lastname: Magrini
authors.affiliation: Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada. gary.kobinger@phac-aspc.gc.ca.
authors.forename: Gary P
authors.initials: GP
authors.lastname: Kobinger
authors.affiliation: National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy. giuseppe.ippolito@inmi.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ippolito
mesh_terms: D000577:Amides / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D060085:Coinfection; D029043:Ebolavirus / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology; D019142:Hemorrhagic Fever, Ebola / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D016780:Malaria, Vivax / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010966:Plasmodium vivax / Q000302:isolation & purification; D011719:Pyrazines / Q000627:therapeutic use; D012367:RNA, Viral / Q000097:blood / Q000652:urine; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology; D019562:Viral Load
chemical_list: D000577:Amides; D000911:Antibodies, Monoclonal; D000998:Antiviral Agents; D011719:Pyrazines; D012367:RNA, Viral; C462182:favipiravir