Clinical Management of Ebola Virus Disease in the United States and Europe

被引:260
作者
Uyeki, Timothy M. [1 ]
Mehta, Aneesh K. [2 ]
Davey, Richard T., Jr. [3 ]
Liddell, Allison M. [4 ]
Wolf, Timo [5 ]
Vetter, Pauline [8 ]
Schmiedel, Stefan [6 ]
Gruenewald, Thomas [7 ]
Jacobs, Michael [9 ]
Arribas, Jose R. [10 ]
Evans, Laura [11 ]
Hewlett, Angela L. [12 ]
Brantsaeter, Arne B. [13 ,14 ]
Ippolito, Giuseppe [15 ]
Rapp, Christophe [16 ]
Hoepelman, Andy I. M. [17 ]
Rapp, Christophe [16 ]
Hoepelman, Andy I. M. [17 ]
Gutman, Julie [1 ]
机构
[1] Ctr Dis Control & Prevent, Mail Stop A-20,1600 Clifton Rd NE, Atlanta, GA 30329 USA
[2] Emory Univ, Sch Med, Div Infect Dis, Atlanta, GA USA
[3] NIAID, NIH, 9000 Rockville Pike, Bethesda, MD 20892 USA
[4] Texas Hlth Presbyterian Hosp Dallas, Dallas, TX USA
[5] Univ Hosp Frankfurt, Dept Infect Dis, Frankfurt, Germany
[6] Univ Med Ctr Hamburg Eppendorf, Dept Med 1, Hamburg, Germany
[7] Klinikum St Georg, Leipzig Treatment Ctr Highly Contagious Dis, Leipzig, Germany
[8] Univ Hosp Geneva, Div Infect Dis & Lab Virol, Geneva, Switzerland
[9] Royal Free London NHS Fdn Trust, Dept Infect, London, England
[10] Hosp La Paz Carlos III IdiPAZ, Infect Dis Unit Madrid, Dept Internal Med, Madrid, Spain
[11] NYU, Bellevue Hosp Ctr, Sch Med, New York, NY 10016 USA
[12] Univ Nebraska Med Ctr, Omaha, NE USA
[13] Oslo Univ Hosp, Dept Infect Dis, Oslo, Norway
[14] Oslo Univ Hosp, Dept Acute Med, Oslo, Norway
[15] Lazzaro Spallanzani Natl Inst Infect Dis, Rome, Italy
[16] Begin Mil Hosp, Infect & Trop Dis Dept, St Mande, France
[17] Univ Med Ctr Utrecht, Dept Internal Med & Infect Dis, Utrecht, Netherlands
关键词
CONVALESCENT PLASMA; CRITICAL-CARE; PATIENT; FEATURES;
D O I
10.1056/NEJMoa1504874
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. METHODS We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015. RESULTS A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renalreplacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%. CONCLUSIONS Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.
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收藏
页码:636 / 646
页数:11
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