Clinical Management of Filovirus-Infected Patients

Abstract

Filovirus infection presents many unique challenges to patient management. Currently no approved treatments are available, and the recommendations for supportive care are not evidence based. The austere clinical settings in which patients often present and the sporadic and at times explosive nature of filovirus outbreaks have effectively limited the information available to evaluate potential management strategies. This review will summarize the management approaches used in filovirus outbreaks and provide recommendations for collecting the information necessary for evaluating and potentially improving patient outcomes in the future.

An Overview on Biological Weapons and Bioterrorism

“…In a later period, during the battle of Tortona, Italy, 1155 bodies of dead soldiers and animals were used to contaminate water wells by Emperor Barbarossa's troops [18]. In the 14 th century, during the siege of Kaffa by the Tartars among the Tartar army, an epidemic of plague was spread.…”

Ethical issues in the management of patients with Ebola virus disease

“…The analysis poses a major challenge for several reasons. First, since clinical recording of Ebola cases is hampered by the recommended biosafety measures, there is very little scientific evidence on the clinical evolution of critical cases, with only a few reported cases with access to advanced life support, all without impact on the prognosis and thus with no documentation on the benefit of such measures 10 . Second, although the risk to staffers involved in patient care is well-documented 11 , quantification of the risk specifically associated with invasive procedures has not been well-established.…”

Backs against the Wall: Novel and Existing Strategies Used during the 2014-2015 Ebola Virus Outbreak

“…administrations are more difficult to perform properly for the reasons mentioned above. Anticoagulants such as heparin were also administered to some patients in response to certain disorders, such as disseminated intravascular coagulation (70). For patients in high-resource medical settings, such as those airlifted to the United States and Europe for intensive treatment, it is possible to monitor and rapidly respond to changes in the patient's renal, hepatic, and pulmonary/respiratory functions (61,72).…”

“…Antiviral drugs used in past outbreaks include acyclovir and ribavirin. Other treatments include painkillers, sedatives, as well as anti-inflammatory, antidiarrheal, and antipsychotic drugs administered at the medical doctor's discretion (70). Intravenous rehydration was routinely used in later outbreaks (71); however, oral rehydration was encouraged whenever possible because of the risk of EBOV transmission through contaminated needles used for i.v.…”

“…fluid administration. Coagulants such as fibrinogen and prothrombin were given to prevent hemorrhaging during a previous outbreak of MARV (70), although their use may be more restricted in resource-poor locations, as i.v. administrations are more difficult to perform properly for the reasons mentioned above.…”