Imaging of Emerging Infectious Diseases
Purpose of Review
Emerging infectious diseases have seen a record increase in prevalence, and understanding their management is critical in an increasingly global community. In this paper, we review current literature detailing the role of radiology in the diagnosis and treatment of the Ebola (EVD), Zika (ZVD), Chikungunya (CHIKF), H1N1, Middle East Respiratory (MERS), and Severe Acute Respiratory Syndrome (SARS) viruses.
Complex protocols are required to safely use portable imaging in EVD to prevent nosocomial spread of disease. In ZVD, antenatal ultrasound can detect fetal abnormalities early, allowing implementation of care and support to affected families. Imaging is useful in assessing the extent of involvement of chronic CHIKF and monitoring treatment effect. Chest radiography and CT play a more direct role in the diagnosis and monitoring of the viral infections with primarily respiratory manifestations (H1N1, MERS, and SARS).
Radiology plays a variable role in emerging infectious diseases, requiring an understanding of disease transmission and safe imaging practices, as well as imaging features that affect clinical management.
KeywordsEmerging disease Ebola Zika Chikungunya H1N1 MERS SARS
We would like to express our great appreciation to the following individuals who provided their expertise as well as sample imaging for entities not routinely encountered in our own clinical practices: Drs. Karin Nielsen and Kristina Adachi from the Department of Pediatrics at UCLA (ZVD); Dr. Clarissa Canella from the Department of Radiology at Universidade Federal Fluminense, Rio De Janeiro (CHIKF); and Dr. KM Das from the Department of Radiology at the College of Medicine & Health Sciences at UAE University (MERS).
Compliance with Ethical Standards
Conflict of interest
All the authors declared that they have no potential conflicts of interest.
Recently published papers of particular interest have been highlighted as: • Of importance •• Of major importance
- 1.World Health Organization. The World Health Report 2007: a safer future: global public health security in the 21st century, 2007, ISBN 978 92 4 156344 4. https://www.who.int/whr/2007/en/. Accessed 1 Feb 2019.
- 2.The National Institute for Occupational Safety and Health. Emerging Infectious Diseases, 2018, Centers for Disease Control, https://www.cdc.gov/niosh/topics/emerginfectdiseases/default.html. Accessed 1 Feb 2019.
- 4.World Health Organization. Ebola Virus Disease, 2018. https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease. Accessed 1 Feb 2019.
- 5.Centers for Disease Control. Ebola in Democratic Republic of the Congo, 2018. http://wwwnc.cdc.gov/trave/notices/alert/ebola-democratic-republic-of-the-congo. Accessed 1 Feb 2019.
- 8.∙∙ Moreno CC, Kraft CS, Vanairsdale S, Kandiah P, Klopman MA, Ribner BS et al. Performance of bedside diagnostic ultrasound in an Ebola isolation unit: the Emory University Hospital experience. AJR Am J Roentgenol. 2015;204(6):1157–9. https://doi.org/10.2214/ajr.15.14344. This paper details Emory University’s initial successful treatment of Ebola patients in their specialized isolation unit, where portable ultrasound techniques were safely utilized without nosocomial spread of infection. CrossRefGoogle Scholar
- 11.Mollura DJ, Palmore TN, Folio LR, Bluemke DA. Radiology preparedness in ebola virus disease: guidelines and challenges for disinfection of medical imaging equipment for the protection of staff and patients. Radiology. 2015;275(2):538–44. https://doi.org/10.1148/radiol.15142670.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Auffermann WF, Kraft CS, Vanairsdale S, Lyon GM 3rd, Tridandapani S. Radiographic imaging for patients with contagious infectious diseases: how to acquire chest radiographs of patients infected with the Ebola virus. AJR Am J Roentgenol. 2015;204(1):44–8. https://doi.org/10.2214/ajr.14.14041.CrossRefPubMedGoogle Scholar
- 13.Abi-Jaoudeh N, Walser EM, Bartal G, Cohen AM, Collins JD, Gross KA, et al. Ebola and other highly contagious diseases: strategies by the society of interventional radiology for interventional radiology. J Vasc Interven Radiol. 2016;27(2):200–2. https://doi.org/10.1016/j.jvir.2015.10.014.CrossRefGoogle Scholar
- 15.Parra-Saavedra M, Reefhuis J, Piraquive JP, Gilboa SM, Badell ML, Moore CA, et al. Serial head and brain imaging of 17 fetuses with confirmed zika virus infection in Colombia, South America. Obstet Gynecol. 2017;130(1):207–12. https://doi.org/10.1097/aog.0000000000002105.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.World Health Organization. Zika Strategic Response Plan, 2016. https://www.who.int/emergencies/zika-virus/strategic-response-plan/en/. Accessed 1 Feb 2019.
- 18.∙ Zare Mehrjardi M, Poretti A, Huisman TA, Werner H, Keshavarz E, Araujo Junior E. Neuroimaging findings of congenital Zika virus infection: a pictorial essay. Jpn J Radiol. 2017;35(3):89–94. https://doi.org/10.1007/s11604-016-0609-4. This paper provides a detailed multi-modality overview of imaging findings associated with congenital Zika infection. CrossRefGoogle Scholar
- 22.World Health Organization. Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, 2015. https://apps.who.int/iris/handle/10665/174652. Accessed 1 Feb 2019.
- 24.Mizuno Y, Kato Y, Takeshita N, Ujiie M, Kobayashi T, Kanagawa S, et al. Clinical and radiological features of imported chikungunya fever in Japan: a study of six cases at the National Center for Global Health and Medicine. J Infect Chemother. 2011;17(3):419–23. https://doi.org/10.1007/s10156-010-0124-y.CrossRefPubMedGoogle Scholar
- 31.Bramley AM, Dasgupta S, Skarbinski J, Kamimoto L, Fry AM, Finelli L, et al. Intensive care unit patients with 2009 pandemic influenza A (H1N1pdm09) virus infection - United States, 2009. Influenza Other Respir Vir. 2012;6(6):e134–42. https://doi.org/10.1111/j.1750-2659.2012.00385.x.CrossRefGoogle Scholar
- 34.Centers for Disease Control. Situation Update: Summary of Weekly FluView,2014. http://www.cdc.gov/flu/weekly/summary.htm. Accessed 1 Feb 2014.
- 35.Li P, Zhang JF, Xia XD, Su DJ, Liu BL, Zhao DL, et al. Serial evaluation of high-resolution CT findings in patients with pneumonia in novel swine-origin influenza A (H1N1) virus infection. Br J Radiol. 2012;85(1014):729–35. https://doi.org/10.1259/bjr/85580974.CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Norzailin AB, Norhafizah E. Chest radiograph findings in novel swine-origin influenza A (H1N1) virus (S-OIV) infection: a UKMMC experience. Med J Malays. 2015;70(2):93–7.Google Scholar
- 42.Assiri A, Al-Tawfiq JA, Al-Rabeeah AA, Al-Rabiah FA, Al-Hajjar S, Al-Barrak A, et al. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infect Dis. 2013;13(9):752–61. https://doi.org/10.1016/s1473-3099(13)70204-4.CrossRefPubMedGoogle Scholar
- 43.World Health Organization. WHO MERS Global Summary and Assessment of Risk, 2018. https://www.who.int/emergencies/mers-cov/en/. Accessed 1 Feb 2019.
- 49.∙ Das KM, Lee EY, Langer RD, Larsson SG. Middle East respiratory syndrome coronavirus: what does a radiologist need to know? Am J Roentgenol. 2016;206:1193–201. https://doi.org/10.2214/ajr.15.15363. This paper provides a detailed overview of clinical and imaging findings of MERS-CoV, as well as a detailed scoring system which allows for prediction of patient outcomes based on chest radiography findings. CrossRefGoogle Scholar
- 51.Cha MJ, Chung MJ, Kim K, Lee KS, Kim TJ, Kim TS. Clinical implication of radiographic scores in acute Middle East respiratory syndrome coronavirus pneumonia: report from a single tertiary-referral center of South Korea. Eur J Radiol. 2018;107:196–202. https://doi.org/10.1016/j.ejrad.2018.09.008.CrossRefPubMedGoogle Scholar
- 56.Case Definitions for Surveillance of Severe Acute Respiratory Syndrome (SARS). 2003.Google Scholar
- 60.Wan YL, Tsay PK, Cheung YC, Chiang PC, Wang CH, Tsai YH, et al. A correlation between the severity of lung lesions on radiographs and clinical findings in patients with severe acute respiratory syndrome. Korean J Radiol. 2007;8(6):466–74. https://doi.org/10.3348/kjr.2007.8.6.466.CrossRefPubMedPubMedCentralGoogle Scholar
- 64.∙ Gogna A, Tay KH, Tan BS. Severe acute respiratory syndrome: 11 years later–a radiology perspective. AJR Am J Roentgenol. 2014;203(4):746–8. https://doi.org/10.2214/ajr.14.13062. This paper reflects on the SARS pandemic of 2003 and highlights the importance of safe imaging practices in limiting the spread of highly infectious diseases. CrossRefGoogle Scholar