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Case of the Month - June 2015

S Kotzé, SASTM

A 33-year old woman presented to the Emergency Department (ED) 21 days after return from Sierra Leone. She was part of a response team to the Ebola-stricken country testing blood samples for the presence of Ebola virus.

Her symptoms included acute onset arthralgia, fever (38.5°C at home), myalgia and backache. She had a background medical history of repeated urinary tract infections and pyelonephritis.

She took Malanil® (atovaquone-proguanil) malaria chemoprophylaxis – she was compliant. She had previously been vaccinated against rabies, hepatitis A and hepatitis B.

During her time in Sierra Leone, she drank bottled water, ate canned food and hotel/restaurant food. Her meals consisted mainly of a combination of eggs, bread, burgers and chips. She denied eating uncooked meat, unpeeled fruit or unprepared vegetables.

She recalled being stung by a flying ant on the neck one week prior to return to South Africa self-medicating with oral antihistamines and the area remained bothersome for three days.

On examination she had no skin changes. She had a resting tachycardia of 112 bpm with a blood pressure of 121/83 mmHg. On respiratory examination she had a minimally productive cough, SaO2 of 96%, respiratory rate of 19 bpm. Abdominal examination revealed left renal angle tenderness with paraspinal low back muscle spasm. She had thick nasal secretions and signs suggestive of sinusitis.

Urine dipstix showed blood ++, protein ++ and bilirubin +. Note was made that she was menstruating at the time of consultation.

Question 1: Does the patient meet the criteria for the case definition of Ebola Virus Disease (EVD) and isolation of the patient?

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