Posts Tagged ‘Emory University Hospital’

American doctor Ian Crozier was treated for Ebola in Atlanta last year and declared free of the virus in his blood. But he had no way of knowing it still lurked in his eye.

About two months after being released from the hospital, he experienced a piercing pain in his left eye, he told The New York Times. The pressure in his eye elevated while his vision decreased.

After repeated tests, doctors discovered the virus was still living in his eye.

“It felt almost personal that the virus could be in my eye without me knowing it,” he told the paper.

His case has left doctors stunned and highlighted the need for eye checkups for Ebola survivors.

Crozier, 44, was hospitalized at Emory University Hospital for more than a month in September after contracting the disease in Sierra Leone, where he worked at a hospital.

At the time, the hospital said he was the sickest of all the four Ebola patients treated there.

Crozier was discharged in October, and about two months later, he developed eye problems and returned to Emory. Doctors stuck a needle in his eye and removed some fluid, which tested positive for the virus.

“Following recovery from Ebola virus disease, patients should be followed for the development of eye symptoms including pain, redness, light sensitivity and blurred vision, which may be signs of uveitis,” said Steven Yeh, associate professor of ophthalmology at Emory University School of Medicine.

Uveitis is an inflammation of the eye’s middle layer. Ebola is also known to live in semen months after it’s gone from the blood.

No risk of spreading the virus

Despite the presence of the virus in the eye, samples from tears and the outer eye membrane tested negative, which means the patient was not at risk of spreading the disease during casual contact, Emory said in a statement Thursday.

It did not name the patient, but The New York Times did. The New England Journal of Medicine also released a study on the case.

Though the patient was not at risk of spreading the virus, all health care providers treating survivors, including eye doctors, must follow Ebola safety protocols, said Jay Varkey, assistant professor at Emory University School of Medicine.

Ebola patient for a second time

When the virus was found in Crozier’s eye, the eye started losing its original blue hue, he told the paper.

Bewildered, doctors tried different forms of treatment as he relived his Ebola nightmare.

They gave him a steroid shot above his eyeball and had him take an experimental antiviral pill that required special approval from the Food and Drug Administration, the Times reported.

His eye gradually returned to normal, but it’s unclear whether it was as a result of the steroid shot, pill or his body’s immune system.

While Ebola survivors in West Africa have reported eye problems, it’s unclear how prevalent the condition is and how often it happens.

“These findings have implications for the thousands of Ebola virus disease survivors in West Africa and also for health care providers who have been evacuated to their home countries for ongoing care,” Varkey said. “Surveillance for the development of eye disease in the post-Ebola period is needed.”

http://www.cnn.com/2015/05/08/health/ebola-eye-american-doctor/index.html

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Freelance journalist Ashoka Mukpo, who contracted Ebola in Liberia, arrived at the University of Nebraska Medical Center today, becoming the second patient with the deadly disease to be treated there.

Why is he being sent to Nebraska instead of some other facility? Because the hospital is home to the largest of four high-level biocontainment patient care units in the U.S.

The Nebraska Medical Center says the unit was commissioned in 2005 as a joint project with Nebraska Health and Human Services and the University of Nebraska Medical Center.

“It was designed to provide the first line of treatment for people affected by bio terrorism or extremely infectious naturally occurring diseases,” the center’s website says.

“The Ebola virus is very difficult to contract,” says Dr. Phil Smith, medical director of the unit, on its website. “The risk it would pose to people outside the unit would be zero, and this is something that can be very safely treated without infecting health care workers.”

The three other high-level biocontainment facilities in the U.S. are at Rocky Mountain Laboratories (RML) in Hamilton, Mont., the National Institutes of Health in Maryland and Emory University Hospital in Atlanta, where two infected patients were treated this summer.
Dr. Rick Sacra, 51, was treated last month at Nebraska Medical Center. He has since recovered.

In an interview with NPR in August, Bruce Ribner, director of Emory’s Serious Communicable Disease Unit, says caregivers use “personal protective equipment designed to prevent … staff from coming into contact with blood, body fluids and large respiratory droplets.”

Ribner said that the doors at the facility don’t need to be sealed “because all airflow goes into the patient room since the rooms are under negative pressure.”

Gizmodo writes:
“[The] isolation unit in Nebraska is isolated from the rest of the general hospital. It runs on its own air circulation system, and the air is passed through a high-efficiency particulate air (HEPA) filter before it is vented outside of the building. That’s the same kind of precautions that you would see in a biosafety level 4 lab (the highest) that works with deadly or highly contagious diseases.

“In addition, the biocontainment unit has negative air pressure, which means that air pressure inside the isolation rooms is slightly lower than that outside. Essentially, air is gently sucked into the room, so particles from inside the room can’t float out when you open a door. As another line of protection, ultraviolet lights zap any viruses or bacteria in the air or on surfaces.”

Wired says: “[Hospital] staff volunteers at Nebraska Medical Center run twice yearly drills with decontamination at their hospital’s 10-bed biocontainment unit. It’s the country’s largest, opened in 2005 with $1 million in federal and state funding. ‘It’s built like a concrete box,’ says Angela Hewlett, the unit’s associate medical director. ‘We want to keep our germs inside.’ But like Missoula, Nebraska hasn’t seen a single infectious disease patient. Sometimes they use it as overflow for the emergency room.”

http://www.npr.org/blogs/thetwo-way/2014/10/06/354083214/why-ebola-patients-are-getting-treatment-in-nebraska?utm_source=facebook.com&utm_medium=social&utm_campaign=npr&utm_term=nprnews&utm_content=202406

Because Kent Brantly is a physician who has watched people die of Ebola, there was an especially chilling prescience to his assessment last week, between labored breaths: “I am going to die.”

His condition was grave. But then on Saturday, we saw images of Brantly’s heroic return to U.S. soil, walking with minimal assistance from an ambulance into an isolation unit at Emory University Hospital.

“One of the doctors called it ‘miraculous,'” Dr. Sanjay Gupta reported from Emory this morning, of Brantly’s turnaround within hours of receiving a treatment delivered from the U.S. National Institutes of Health. “Not a term we scientists like to throw around.”

“The outbreak is moving faster than our efforts to control it,” Dr. Margaret Chan, director of the World Health Organization, said on Friday in a plea for international help containing the virus. “If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives, but also severe socioeconomic disruption and a high risk of spread to other countries.”

In that light, and because Ebola is notoriously incurable (and the strain at large its most lethal), it is overwhelming to hear that “Secret Serum Likely Saved Ebola Patients,” as we do this morning from Gupta’s every-20-minute CNN reports. He writes:

Three top secret, experimental vials stored at subzero temperatures were flown into Liberia last week in a last-ditch effort to save two American missionary workers [Dr. Kent Brantly and Nancy Writebol] who had contracted Ebola, according to a source familiar with details of the treatment.

Brantly had been working for the Christian aid organization Samaritan’s Purse as medical director of the Ebola Consolidation Case Management Center in Monrovia, Liberia. The group yesterday confirmed that he received a dose of an experimental serum before leaving the country.

In Gupta’s optimistic assessment, Brantly’s “near complete recovery” began within hours of receiving the treatment that “likely saved his life.” Writebol is also reportedly improved since receiving the treatment, known as zMapp. But to say that it was a secret implies a frigid American exceptionalism; that the people of West Africa are dying in droves while a classified cure lies in wait.

The “top-secret serum” is a monoclonal antibody. Administration of monoclonal antibodies is an increasingly common but time-tested approach to eradicating interlopers in the human body. In a basic monoclonal antibody paradigm, scientists infect animals (in this case mice) with a disease, the mice mount an immune response (antibodies to fight the disease), and then the scientists harvest those antibodies and give them to infected humans. It’s an especially promising area in cancer treatment.

In this case, the proprietary blend of three monoclonal antibodies known as zMapp had never been tested in humans. It had previously been tested in eight monkeys with Ebola who survived—though all received treatment within 48 hours of being infected. A monkey treated outside of that exposure window did not survive. That means very little is known about the safety and effectiveness of this treatment—so little that outside of extreme circumstances like this, it would not be legal to use. Gupta speculates that the FDA may have allowed it under the compassionate use exemption.

A small 2012 study of monoclonal antibody therapy against Ebola found that it was only effective when administered before or just after exposure to the virus. A 2013 study found that rhesus macaques given an antibody mix called MB-003 within the 48-hour window had a 43 percent chance of surviving—as opposed to their untreated counterparts, whose survival rate was zero.

This Ebola outbreak is the largest in the history of the disease, in terms of both cases and deaths, 729 887 known so far. As Chan warned in her call for urgent international action, the outbreak is geographically the largest, already in four countries with fluid population movement across porous borders and a demonstrated ability to spread by air travel. The outbreak will be stopped by strategic quarantines and preventive education, primarily proper handling of corpses. More than 60 aid workers have become infected, but many more will be needed to stem the tide.

Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Disease (NIAID), is encouraged by the antibody treatment.

“Obviously there are plans and enthusiasm to expand this,” Fauci told me. “The limiting factor is the extraordinary paucity of treatment regimens.” Right now the total amount available, to Fauci’s knowledge, is three treatment courses (in addition to what was given to Brantly and Writebol).

NIAID did some of the original research that led to the development, but this is owned by Mapp Biopharmaceuticals. “They are certainly trying to scale up,” Fauci said, “but I’ve heard that their capability is such that it’s going to be months before they have a substantial number of doses, and even then they’re going to be limited.”

“We’re hearing that the administration of this cocktail of antibodies improved both Dr. Brantly and Ms. Writebol, but you know, we don’t know that,” Fauci said, noting the sample size (two) of this small, ad hoc study. Proving effectiveness would require a much larger group of patients being compared to an untreated group. “And we don’t know that they weren’t getting better anyway.”

Thanks to Kebmodee for bringing this to the attention of the It’s Interesting community.

http://www.theatlantic.com/health/archive/2014/08/the-secret-ebola-treatment/375525/