Treatment of Ebola-related critical illness

Abstract

To explore contemporary clincial case management of patients with Ebola virus disease. Methods: A narrative review from a clinical perspective of clinical features, diagnostic tests, treatments and outcomes of patients with Ebola virus disease. Results: Substantial advances have been made in the care of patients with Ebola virus disease (EVD), precipitated by the unprecedented extent of the 2014-2016 outbreak. There has been improved point-of-care diagnostics, improved characterization of the clinical course of EVD, improved patient-optimized standards of care, evaluation of effective anti-Ebola therapies, administration of effective vaccines, and development of innovative Ebola treatment units. A better understanding of the Ebola virus disease clinical syndrome has led to the appreciation of a central role for critical care clinicians-over 50% of patients have life-threatening complications, including hypotension, severe electrolyte imbalance, acute kidney injury, metabolic acidosis and respiratory failure. Accordingly, patients often require critical care interventions such as monitoring of vital signs, intravenous fluid resuscitation, intravenous vasoactive medications, frequent diagnostic laboratory testing, renal replacement therapy, oxygen and occasionally mechanical ventilation. Conclusion: With advanced training and adherence to infection prevention and control practices, clinical interventions, including critical care, are feasible and safe to perform in critically ill patients. With specific anti-Ebola medications, most patients can survive Ebola virus infection.

COVID-19: Characteristics and Therapeutics

“…According to The New England Journal of Medicine [11], the first case in the United States (reported in Washington State) was treated with an intravenous administration of Remdesivir which mitigated symptoms, and did not cause any side-effects [11]. However, prior clinical trials in Ebola reported side effects such as liver inflammation, nausea, sweating, shivering, and low blood pressure [69]. Remdesivir is currently in clinical trial evaluation for the treatment of COVID-19 in various countries including France (NCT04365725), USA (NCT04431453), Canada (NCT04330690), Egypt (NCT04345419) (Table 1).…”

Parallel Outbreaks of Deadly Pathogens (SARS-CoV-2, H5N8, EVD, Black fungi) around the World in 2021: Priorities for Achieving Control with Socio-Economic and Public Health Impact

“…Supportive care includes oral rehydration that contains electrolytes [69] preventing complications of shock and fluid resuscitation in Ebola infected people [24,70]. A number of anti-Ebola therapeutics such as anti-viral drugs, monoclonal antibodies, anti-inflammatory agents, convalescent plasma etc were proposed and evaluated during Ebola Virus Outbreak to contain and reduce the risk of the virus [24,71]. Inmazeb, also called REGN-EB3, combination of three monoclonal antibodies and Ebanga (Mab114) -single monoclonal antibody were the only two drugs approved for Ebola treatment by the US Food and Drug Administration (FDA) in the late 2020 [72] which were previously used in a randomized control trial during 2018-2020 Ebola outbreak in Democratic Republic of Congo and resulted in high survival rate [68].…”

“…Inmazeb, also called REGN-EB3, combination of three monoclonal antibodies and Ebanga (Mab114) -single monoclonal antibody were the only two drugs approved for Ebola treatment by the US Food and Drug Administration (FDA) in the late 2020 [72] which were previously used in a randomized control trial during 2018-2020 Ebola outbreak in Democratic Republic of Congo and resulted in high survival rate [68]. Another therapeutic called ZMapp, cocktail of three monoclonal antibodies also proved to be superior to standard care for Ebola Virus Disease treatment [71].…”

Intensivmedizinisches Back-up bei infektiologischen Katastrophen

“…Erforderlich sind bei diesen Patienten vor allem das Monitoring der Vitalparameter, Labortestungen, intravenöse Flüssigkeitsgabe, die Applikation von vasoaktiven Medikamenten und Sauerstoff, Beatmung und Nierenersatztherapie (Abb. 2 ; [ 16 ]). Die Sterblichkeit in Westafrika betrug zwischen 39 und 70 %.…”

“…Dass die Überlebensrate durch moderne Intensivmedizin deutlich verbessert wird, zeigen die Erfahrungen bei Patienten, die während der Epidemie in andere Industriestaaten evakuiert wurden. So betrug die Sterblichkeit bei in Europa und in den USA behandelten Patienten nur 18,5 % [ 16 , 17 ]. Der hierfür notwendige klinische und materielle Aufwand ist in den Endemieländern nicht zu leisten.…”