Maternal and fetal survival following Ebola, HIV and Malaria co-infection in the first trimester of gestation in resource-limited setting in Democratic Republic of Congo.
| Title: | Maternal and fetal survival following Ebola, HIV and Malaria co-infection in the first trimester of gestation in resource-limited setting in Democratic Republic of Congo. |
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| Authors: | Imani-Musimwa P; Department of Obstetrics and Gynecology, School of Medicine, University of Goma, Goma, Democratic Republic of Congo. princeimani12@gmail.com.; Centre Régional d'Expertise en Recherche et Actions Humanitaires (CIERAH-Africa), Goma, Democratic Republic of Congo. princeimani12@gmail.com.; School of Public Health, University of Goma, Goma, Democratic Republic of Congo. princeimani12@gmail.com.; Grant E; Centre Régional d'Expertise en Recherche et Actions Humanitaires (CIERAH-Africa), Goma, Democratic Republic of Congo.; Mukadi-Bamuleka D; Institut National de Recherche Bio-Médicale (INRB), Kinshasa, Democratic Republic of Congo.; Department of Medical Biology, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.; Rodolphe Mérieux INRB-Goma Loaboratry, Goma, Democratic Republic of Congo.; Tsongo-Kibendelwa Z; School of Public Health, University of Goma, Goma, Democratic Republic of Congo.; Department of Internal Medicine, School of Medicine, University of Kisangani, Kisangani, Democratic Republic of Congo.; Fraterne-Muhayangabo R; Centre Régional d'Expertise en Recherche et Actions Humanitaires (CIERAH-Africa), Goma, Democratic Republic of Congo.; School of Public Health, University of Goma, Goma, Democratic Republic of Congo.; Mbala-Kingebeni P; Department of Medical Biology, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.; Rodolphe Mérieux INRB-Goma Loaboratry, Goma, Democratic Republic of Congo.; Kitenge-Omasumbu R; Ministry of Public Health, Hygiene and Prevention, Kinshasa, Democratic Republic of Congo.; Nyakio-Ngeleza O; Department of Obstetrics and Gynecology, School of Medicine, Official University of Bukavu, Bukavu, Democratic Republic of Congo.; Barhwamire-Kabesha T; Department of Surgery, School of Medicine, Official University of Bukavu, Bukavu, Democratic Republic of Congo.; Minani-Ndabahweje M; Department of Internal Medicine, School of Medicine, University of Goma, Goma, Democratic Republic of Congo.; Sihali-Kyolov J; Department of Obstetrics and Gynecology, School of Medicine, University of Kisangani, Kisangani, Democratic Republic of Congo.; Bitwe-Mihanda R; School of Public Health, University of Goma, Goma, Democratic Republic of Congo.; Department of Pediatrics and Neonatology, School of Medicine, University of Goma, Goma, Democratic Republic of Congo.; Sengeyi-Mushengezi-Amani D; Department of Obstetrics and Gynecology, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.; Ververs M; Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America. |
| Source: | BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2025 Feb 26; Vol. 25 (1), pp. 210. Date of Electronic Publication: 2025 Feb 26. |
| Publication Type: | Journal Article; Case Reports |
| Language: | English |
| Journal Info: | Publisher: BioMed Central Country of Publication: England NLM ID: 100967799 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2393 (Electronic) Linking ISSN: 14712393 NLM ISO Abbreviation: BMC Pregnancy Childbirth Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: London : BioMed Central, [2001- |
| MeSH Terms: | Hemorrhagic Fever, Ebola*/complications ; Hemorrhagic Fever, Ebola*/therapy ; Hemorrhagic Fever, Ebola*/diagnosis ; HIV Infections*/complications ; HIV Infections*/drug therapy ; HIV Infections*/diagnosis ; Pregnancy Complications, Infectious*/virology ; Malaria*/complications ; Coinfection*; Humans ; Female ; Pregnancy ; Democratic Republic of the Congo ; Young Adult ; Pregnancy Trimester, First ; Viral Load ; Infant, Newborn ; Resource-Limited Settings |
| Abstract: | Background: Ebola-HIV and malaria co-infection is one of the rare clinical situations that remains complex to manage even in the context of unlimited resources. In pregnancy, each of these infections can compromise maternal and fetal outcomes. The synergy of their effects on maternal immunity are often fatal, and survival is an exception, especially in a context of limited resources, such as in Ebola Treatment Units (ETUs).; Case Presentation: Our 22-year-old patient, weighing 56 kg and nine weeks pregnant was admitted to the ETU during the 10th outbreak in DRC. She had HIV and had abandoned antiretroviral treatment (ART) seven months before. One month before her admission, her HIV viral load was high with a low CD4+ T cell count. She was vaccinated against EVD with rVSV-ZEBOV four days before her symptoms. She appeared generally in ill-health but her vital signs were within normal range. Without ultrasound, the fetal vitality could not be assessed. Laboratory tests confirmed malaria, pregnancy, HIV, and Ebola infection through RT-PCR. She received supportive treatment and a neutralizing monoclonal antibody (mAb114). On the 2nd day, we observed a significant decrease in Ebola viral load. Her clinical evolution improved with no disturbance in many biological parameters. She was negative for Ebola infection on 13th day and was discharged from the ETU after three weeks of admission. After referral to a health facility an ultrasound revealed 12 weeks of gestation and lab results showed a decrease of 47% in HIV viral load with 44% CD4+ T cell count increase. She began ART treatment and at 38 weeks gestation, the HIV viral load was undetectable and gave birth by caesarian section to a healthy male newborn. The mother and newborn' s blood, buccal swab and adnexal samples tested negative for Ebola virus and both were discharged 10 days after the delivery.; Conclusion: In case of Ebola, HIV and malaria co-infection, maternal and fetal survival remains possible even in the context of resources limited-setting. This case raises questions about the effects of the interactions of these co-infections and/or their antibodies, treatment during immune adaptation of the gravid organism.; (© 2025. The Author(s).) |
| Competing Interests: | Declarations. Ethics approval and consent to participate: This is a case report study, so no ethical approval was required. All the authors approved the final version of the manuscript. Consent for publication: Patient provided written informed consent for publication of this article. Competing interests: The authors declare no competing interests. |
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| Contributed Indexing: | Keywords: Antiretroviral treatment; Ebola-HIV and Malaria co-infection; Immune cell tropism; Maternal and fetal survival; Monoclonal therapy; Pregnancy; RD Congo; Resource-limited setting |
| Entry Date(s): | Date Created: 20250226 Date Completed: 20250227 Latest Revision: 20250528 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC11863912 |
| DOI: | 10.1186/s12884-025-07265-0 |
| PMID: | 40011840 |
| Database: | MEDLINE |
Journal Article; Case Reports