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Ebola--in people, DRC

By tsmith on December 29, 2008.

As the Philippines requests international assistance to investigate the finding of Ebola Reston in their pigs, another human outbreak of Ebola has been confirmed in the Democratic Republic of Congo:

The Ministry of Health (MoH) of the Democratic Republic of the Congo declared on 25 December an outbreak of Ebola haemorrhagic fever in Mweka District, Kasai Occidental province based on laboratory results from the Centre International de Recherches Médicales de Franceville (CIRMF) in Gabon. CIRMF confirmed the presence of Ebola virus in 2 samples from 2 of the patients in the outbreak by antigen detection. In addition, laboratory tests conducted by Institut National de Recherches Biologiques (INRB) in Kinshasa, also confirmed the presence of Shigella.

As of 26 December, WHO is aware of 34 suspected cases including 9 deaths (CFR 26%) associated with the ongoing event. Additional samples have been collected and are en route to INRB.

This is the same area that was hit with an outbreak last year (also complicated by concurrent Shigella infections), and this story reports an additional 2 deaths this weekend, bringing the death toll to 11 since it was first noticed in late November.

Tags
General Epidemiology
infectious disease
outbreak
public health
Various viruses

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Shigella concurrent with Ebola? That's strange, are they investigating this further? I wonder if there's more literature out there.

Hmmm.

I'm not sure what they're doing about it, and I've not seen anything published in the scientific literature yet about last year's outbreak either. It's hard to tell from the report if the same patients had both Ebola and Shigella, or if it was simply present in the area in other individuals.

There were a few cases of Shigella but they were likely acquired after the filovirus infection. Shigella is fairly common here and showed up during last year's outbreak as well.

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Mary wrote, "Shigella concurrent with Ebola? That's strange, are they investigating this further? I wonder if there's more literature out there."

Why is this strange? Shigella-infected bacteria are going to be more common in less antiseptic parts of the world, particularly where sewage and drinking water more often become mixed, and both Shigella-infected bacteria and ebola rely upon the exchange of bodily fluids for their transmission. Additionally, if you are speaking of Shigella-infected e. coli, e. coli is common enough that you are going to find it in the digestive system of most mammals (human, cattle, etc.), reptiles (e.g., turtles), and even in insects (e.g., catepillars).

These could simply be opportunistic coinfections, or alternatively, ebola's natural host might be infected with both ebola (an RNA virus) and a bacteria that is host to the Shigella phage. But even assuming the latter, it doesn't narrow down the possible natural hosts of ebola all that much.