Ebola Virus Disease in Pregnancy: Clinical, Histopathologic, and Immunohistochemical Findings

Atis Muehlenbachs; Olimpia de la Rosa Vázquez; Daniel G Bausch; Ilana J Schafer; Christopher D Paddock; Jean Paul Nyakio; Papys Lame; Eric Bergeron; Andrea M McCollum; Cynthia S Goldsmith; Brigid C Bollweg; Miriam Alía Prieto; Robert Shongo Lushima; Benoit Kebela Ilunga; Stuart T Nichol; Wun-Ju Shieh; Ute Ströher; Pierre E Rollin; Sherif R Zaki

doi:10.1093/infdis/jiw206

Ebola Virus Disease in Pregnancy: Clinical, Histopathologic, and Immunohistochemical Findings

J Infect Dis. 2017 Jan 1;215(1):64-69. doi: 10.1093/infdis/jiw206. Epub 2016 May 25.

Authors

Atis Muehlenbachs¹, Olimpia de la Rosa Vázquez², Daniel G Bausch³, Ilana J Schafer³, Christopher D Paddock⁴, Jean Paul Nyakio⁵, Papys Lame⁵, Eric Bergeron³, Andrea M McCollum⁶, Cynthia S Goldsmith¹, Brigid C Bollweg¹, Miriam Alía Prieto², Robert Shongo Lushima⁷, Benoit Kebela Ilunga⁷, Stuart T Nichol³, Wun-Ju Shieh¹, Ute Ströher³, Pierre E Rollin³, Sherif R Zaki¹

Affiliations

¹ Infectious Diseases Pathology Branch.
² Médecins Sans Frontières, Barcelona, Spain.
³ Viral Special Pathogens Branch.
⁴ Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
⁵ Médecins Sans Frontières.
⁶ Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology.
⁷ Ministry of Health, Kinshasa, Democratic Republic of the Congo.

PMID: 27226206
DOI: 10.1093/infdis/jiw206

Abstract

Here we describe clinicopathologic features of Ebola virus disease in pregnancy. One woman infected with Sudan virus in Gulu, Uganda, in 2000 had a stillbirth and survived, and another woman infected with Bundibugyo virus had a live birth with maternal and infant death in Isiro, the Democratic Republic of the Congo in 2012. Ebolavirus antigen was seen in the syncytiotrophoblast and placental maternal mononuclear cells by immunohistochemical analysis, and no antigen was seen in fetal placental stromal cells or fetal organs. In the Gulu case, ebolavirus antigen localized to malarial parasite pigment-laden macrophages. These data suggest that trophoblast infection may be a mechanism of transplacental ebolavirus transmission.

Keywords: Bundibugyo virus; Ebola virus disease; Sudan virus; malaria; pathology; placenta; pregnancy.

Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Publication types

Case Reports

MeSH terms

Adult
Antibodies, Viral / blood
Antigens, Viral / immunology
Antigens, Viral / isolation & purification
Democratic Republic of the Congo
Ebolavirus / chemistry
Ebolavirus / genetics
Ebolavirus / immunology
Ebolavirus / isolation & purification*
Female
Hemorrhagic Fever, Ebola / immunology
Hemorrhagic Fever, Ebola / pathology*
Hemorrhagic Fever, Ebola / transmission
Hemorrhagic Fever, Ebola / virology*
Humans
Immunoglobulin G / blood
Immunoglobulin M / blood
Immunohistochemistry
Macrophages / parasitology
Macrophages / ultrastructure
Macrophages / virology
Malaria / complications
Malaria / immunology
Malaria / virology
Microscopy, Electron, Transmission
Placenta / ultrastructure
Placenta / virology
Polymerase Chain Reaction
Pregnancy
Pregnancy Complications, Infectious / immunology
Pregnancy Complications, Infectious / parasitology
Pregnancy Complications, Infectious / pathology*
Pregnancy Complications, Infectious / virology*
Stillbirth
Stromal Cells / ultrastructure
Stromal Cells / virology
Trophoblasts / parasitology
Trophoblasts / ultrastructure
Trophoblasts / virology

Substances

Antibodies, Viral
Antigens, Viral
Immunoglobulin G
Immunoglobulin M