Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone

Abstract

BACKGROUND Limited clinical and laboratory data are available on patients with Ebola virus disease (EVD). The Kenema Government Hospital in Sierra Leone, which had an existing infrastructure for research regarding viral hemorrhagic fever, has received and cared for patients with EVD since the beginning of the outbreak in Sierra Leone in May 2014. METHODS We reviewed available epidemiologic, clinical, and laboratory records of patients in whom EVD was diagnosed between May 25 and June 18, 2014. We used quantitative reverse-transcriptase–polymerase-chain-reaction assays to assess the load of Ebola virus (EBOV, Zaire species) in a subgroup of patients. RESULTS Of 106 patients in whom EVD was diagnosed, 87 had a known outcome, and 44 had detailed clinical information available. The incubation period was estimated to be 6 to 12 days, and the case fatality rate was 74%. Common findings at presentation included fever (in 89% of the patients), headache (in 80%), weakness (in 66%), dizziness (in 60%), diarrhea (in 51%), abdominal pain (in 40%), and vomiting (in 34%). Clinical and laboratory factors at presentation that were associated with a fatal outcome included fever, weakness, dizziness, diarrhea, and elevated levels of blood urea nitrogen, aspartate aminotransferase, and creatinine. Exploratory analyses indicated that patients under the age of 21 years had a lower case fatality rate than those over the age of 45 years (57% vs. 94%, P = 0.03), and patients presenting with fewer than 100,000 EBOV copies per milliliter had a lower case fatality rate than those with 10 million EBOV copies per milliliter or more (33% vs. 94%, P = 0.003). Bleeding occurred in only 1 patient. CONCLUSIONS The incubation period and case fatality rate among patients with EVD in Sierra Leone are similar to those observed elsewhere in the 2014 outbreak and in previous outbreaks. Although bleeding was an infrequent finding, diarrhea and other gastrointestinal manifestations were common. (Funded by the National Institutes of Health and others.)

Post-exposure treatments for Ebola and Marburg virus infections

“…From published articles and news reports, there were also likely 15 patients infected with EBOV in Europe during the epidemic (two imported cases, one infection identified in Spain and twelve medically evacuated patients), of whom three died (20%). By comparison, mortality for EBOV reported in treatment centres in West Africa was 37-74% 211,[219][220][221][222] . Advanced supportive care clearly improved patient survival.…”

“…However, these trials do provide valuable information that can be used to improve future clinical validation of experimental therapies, particularly reiteration of the association between high viral load and reduced survival [208][209][210] . A number of studies have correlated nonsurvival at 90% or more if the viral load exceeds 6 log copies per millilitre [210][211][212][213][214] in untreated patients. In a study of 84 patients infected with EBOV in West Africa, all patients with a viral load >7.71 log copies per millilitre of blood died, whereas all those with counts below this threshold survived 215 .…”

Severe Ebola virus disease with vascular leakage and multiorgan failure: treatment of a patient in intensive care

“…2,4,8 Similarly, gastrointestinal failure with haemorrhage, nausea, and anorexia has been reported in patients with vascular leak syndrome. 20 Inititally, our patient showed features of paralytic ileus, pan-enteritis, cholecystitis, peritonitis, and elevated pancreatic enzymes.…”

“…4 Although little information about resistance patterns is available, the use of cephalosporins is high in Sierra Leone, 8 and reports have shown the presence of extended spectrum β-lactamase resistance (Grünewald T, unpublished data). 9 Hence, we started treatment with imipenem-cilastatin on admission.…”

Essentials of filoviral load quantification

“…Measurement of viral load is an important parameter in Marburg virus disease and Ebola virus disease, because viral load correlates with severity of disease, survival, and infectivity. [9][10][11][12][13][14][15][16] Assessing the viral load, and thus the potential infectivity of a patient, can guide triage and admission placement to minimise risk of interperson trans mission. Viral load measurements are also important to better understand the clinical presentation and pathogenesis of fi lovirus disease, and to interpret the effi cacy of candidate therapies and vaccines in animal models and human beings.…”