Clinical, virological, and biological parameters associated with outcomes of Ebola virus infection in Macenta, Guinea

被引：57

作者：

Vernet, Marie-Astrid ^{[1
]}

Reynard, Stephanie ^{[2
,3
]}

Fizet, Alexandra ^{[2
,3
]}

Schaeffer, Justine ^{[2
,3
]}

Pannetier, Delphine ^{[4
]}

Guedj, Jeremie ^{[5
,6
]}

Rives, Max ^{[7
]}

Georges, Nadia ^{[7
]}

Garcia-Bonnet, Nathalie ^{[7
]}

Sylla, Aboubacar I. ^{[8
]}

Grovogui, Pema ^{[8
]}

Kerherve, Jean-Yves ^{[7
]}

Savio, Christophe ^{[7
]}

Savio-Coste, Sylvie ^{[7
]}

de Severac, Marie-Laure ^{[7
]}

Zloczewski, Philippe ^{[7
]}

Linares, Sandrine ^{[7
]}

Harouna, Souley ^{[9
]}

Abdoul, Bing M'Lebing ^{[9
]}

Petitjean, Frederic ^{[9
]}

Samake, Nenefing ^{[9
]}

Shepherd, Susan ^{[9
]}

Kinda, Moumouni ^{[9
]}

Koundouno, Fara Roger ^{[9
]}

Joxe, Ludovic ^{[9
]}

Mateo, Mathieu ^{[2
,3
]}

Lecine, Patrick ^{[10
]}

Page, Audrey ^{[2
,3
]}

Tchamdja, Tang Maleki ^{[7
]}

Schoenhals, Matthieu ^{[1
]}

Barbe, Solenne ^{[9
]}

Simon, Bernard ^{[11
]}

Tuan Tran-Minh ^{[11
]}

Longuet, Christophe ^{[12
]}

L'Heriteau, Francois ^{[13
]}

Baize, Sylvain ^{[2
,3
]}

机构：

[1] Ctr Pasteur Cameroun, Yaounde, Cameroon

[2] Inst Pasteur, Unite Biol Infect Virales Emergentes, 21 Ave Tony Garnier, F-69365 Lyon 07, France

[3] Univ Lyon 1, Ecole Normale Super Lyon, Ctr Int Rech Infectiol, INSERM,U1111,CNRS UMR5308, Lyon, France

[4] Lab P4 Jean Merieux INSERM US003, Lyon, France

[5] Univ Paris Diderot, INSERM, UMR 1137, Infect,Antimicrobials,Modelling,Evolut, Paris, France

[6] Hop Bichat Claude Bernard, AP HP, Paris, France

[7] Minist Sante, Etab Preparat & Reponse Urgences Sanit, Paris, France

[8] Minist Sante, Conakry, Guinea

[9] Alliance Int Med Act, Montreuil, France

[10] Bioaster, Lyon, France

[11] Croix Rouge Francaise, Paris, France

[12] Fdn Merieux, Lyon, France

[13] CClin Paris Nord, Paris, France

来源：

JCI INSIGHT | 2017年 / 2卷 / 06期

关键词：

SIERRA-LEONE; DISEASE; RHABDOMYOLYSIS; MORTALITY; MANAGEMENT; RESPONSES; KINETICS; SURVIVAL; FEATURES; FAILURE;

D O I：

10.1172/jci.insight.88864

中图分类号：

R-3 [医学研究方法]; R3 [基础医学];

学科分类号：

1001 ;

摘要：

BACKGROUND. The pathogenesis of Ebola virus (EBOV) disease (EVD) is poorly characterized. The establishment of well-equipped diagnostic laboratories close to Ebola treatment centers (ETCs) has made it possible to obtain relevant virological and biological data during the course of EVD and to assess their association with the clinical course and different outcomes of the disease. METHODS. We were responsible for diagnosing EBOV infection in patients admitted to two ETCs in forested areas of Guinea. The pattern of clinical signs was recorded, and an etiological diagnosis was established by RT-PCR for EBOV infection or a rapid test for malaria and typhoid fever. Biochemical analyses were also performed. RESULTS. We handled samples from 168 patients between November 29, 2014, and January 31, 2015; 97 patients were found to be infected with EBOV, with Plasmodium falciparum coinfection in 18%. Overall mortality for EVD cases was 58%, rising to 86% if P. falciparum was also present. Viral load was higher in fatal cases of EVD than in survivors, and fatal cases were associated with higher aspartate aminotransferase (AST) and alanine aminotransferase (ALT), C-reactive protein (CRP), and IL-6 levels. Furthermore, regardless of outcome, EVD was characterized by higher creatine kinase (CPK), amylase, and creatinine levels than in febrile patients without EVD, with higher blood urea nitrogen (BUN) levels in fatal cases of EVD only. CONCLUSION. These findings suggest that a high viral load at admission is a marker of poor EVD prognosis. In addition, high AST, ALT, CRP, and IL-6 levels are associated with a fatal outcome of EVD. Damage to the liver and other tissues, with massive rhabdomyolysis and, probably, acute pancreatitis, is associated with EVD and correlated with disease severity. Finally, biochemical analyses provide substantial added value at ETCs, making it possible to improve supportive rehydration and symptomatic care for patients.

引用

页数：14

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