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woensdag 1 maart 2017

The Lancet: [Comment] Asymptomatic Ebola virus infections—myth or reality?

[Comment] Asymptomatic Ebola virus infections—myth or reality?
Ebola virus captures the imagination of the public and experts alike.1 This fascination is in part due to the overall rare occurrence of typically very few outbreaks of Ebola virus disease (EVD) and extremely high case-fatality rates (mean 41·4%).2 More importantly, the identity of the natural Ebola virus reservoir remains unknown.3 This lack of knowledge means that novel Ebola virus introductions into human populations cannot be predicted, let alone be prevented, which adds to the enigma of the virus in the public eye.
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[Comment] Ebola virus and malaria parasite positivity: a febrile illness quagmire
Before the Ebola virus outbreak in parts of west Africa, the differential diagnoses of febrile illnesses were primarily centred around common medical conditions prevalent in the tropics that overburdened the weakened health systems there, predominantly malaria, typhoid fever, tuberculosis, meningitis, Lassa fever, and measles.1 With the 2014–15 Ebola virus disease (EVD) epidemic and its devastating effects, the need for differential diagnoses of febrile illnesses has taken on new urgency, as well as become more complicated.
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[Articles] Characteristics and survival of patients with Ebola virus infection, malaria, or both in Sierra Leone: a retrospective cohort study
Malaria parasite co-infection was common in patients presenting to ETUs and conferred an increased mortality risk in patients infected with Ebola virus, supporting empirical malaria treatment in ETUs. The high mortality among patients without EVD or malaria suggests expanded testing and treatment might improve care in future EVD epidemics.
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[Comment] What is changing, and what is not, in childhood encephalitis
In The Lancet Infectious Diseases, Mildred Iro and colleagues1 use hospital admission statistics data to describe long-term trends over 30 years for childhood encephalitis in England. Encephalitis has been well known to pediatricians for centuries and was first described by the Swedish pediatrician Arvid Wallgren in 1924.2 Since then, a few studies have reported incidence figures over time in Finland,3 the USA,4 and Sweden,5 with varying populations and longevity. In Iro and colleagues' study,1 the authors use two different national data sources to calculate prevalence figures, clinical characteristics, and aetiological aspects of childhood encephalitis in England, spanning from 1979 to 2011.
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[Articles] 30-year trends in admission rates for encephalitis in children in England and effect of improved diagnostics and measles-mumps-rubella vaccination: a population-based observational study
Hospital admission rates for all-cause childhood encephalitis in England are increasing. Admissions for measles and mumps encephalitis have decreased substantially. The numbers of encephalitis admissions without a specific diagnosis are increasing despite availability of PCR testing, indicating the need for strategies to improve aetiological diagnosis in children with encephalitis.
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