Interpretation of Negative Molecular Test Results in Patients With Suspected or Confirmed Ebola Virus Disease: Report of Two Cases

Jeffrey K Edwards; Christian Kleine; Vincent Munster; Ruggero Giuliani; Moses Massaquoi; Armand Sprecher; Daniel S Chertow

doi:10.1093/ofid/ofv137

Interpretation of Negative Molecular Test Results in Patients With Suspected or Confirmed Ebola Virus Disease: Report of Two Cases

Open Forum Infect Dis. 2015 Sep 19;2(4):ofv137. doi: 10.1093/ofid/ofv137. eCollection 2015 Dec.

Authors

Jeffrey K Edwards¹, Christian Kleine², Vincent Munster³, Ruggero Giuliani⁴, Moses Massaquoi⁵, Armand Sprecher⁴, Daniel S Chertow⁶

Affiliations

¹ Médecins Sans Frontières , Operational Center of Brussels , Belgium ; Department of International Health , School of Public Health, Johns Hopkins University , Baltimore , Maryland.
² Médecins Sans Frontières , Operational Center of Brussels , Belgium ; Department of Infectious Diseases and Tropical Medicine , J.W. Goethe-University Hospital , Frankfurt , Germany.
³ Laboratory of Virology, National Institute of Allergy and Infectious Diseases , National Institutes of Health , Rocky Mountain Laboratories , Hamilton , Montana.
⁴ Médecins Sans Frontières , Operational Center of Brussels , Belgium.
⁵ Clinton Health Initiative , Monrovia , Liberia.
⁶ Médecins Sans Frontières , Operational Center of Brussels , Belgium ; Department of Critical Care Medicine, Clinical Center , National Institutes of Health , Bethesda , Maryland.

Abstract

Quantitative reverse-transcription polymerase chain reaction (qRT-PCR) is the most sensitive quantitative diagnostic assay for detection of Ebola virus in multiple body fluids. Despite the strengths of this assay, we present 2 cases of Ebola virus disease (EVD) and highlight the potential for false-negative results during the early and late stages of EVD. The first case emphasizes the low negative-predictive value of qRT-PCR during incubation and the early febrile stage of EVD, and the second case emphasizes the potential for false-negative results during recovery and late neurologic complications of EVD. Careful interpretation of test results are needed to guide difficult admission and discharge decisions in suspected or confirmed EVD.

Keywords: Ebola; Liberia; PCR; West Africa; hemorrhagic fever.