151
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Acute respiratory distress syndrome after convalescent plasma use: treatment of a patient with Ebola virus disease contracted in Madrid, Spain. THE LANCET RESPIRATORY MEDICINE 2015; 3:554-62. [DOI: 10.1016/s2213-2600(15)00180-0] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 02/01/2023]
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152
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Velásquez GE, Aibana O, Ling EJ, Diakite I, Mooring EQ, Murray MB. Time From Infection to Disease and Infectiousness for Ebola Virus Disease, a Systematic Review. Clin Infect Dis 2015; 61:1135-40. [PMID: 26129757 DOI: 10.1093/cid/civ531] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/19/2015] [Indexed: 11/13/2022] Open
Abstract
We systematically reviewed the literature to estimate the incubation and latent periods of Ebola virus disease. We found limited epidemiological data from individuals with discrete 1-day exposures. Available data suggest that the incubation and latent periods may differ, and mathematical models may be improved by distinguishing between the two periods.
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Affiliation(s)
- Gustavo E Velásquez
- Divisions of Infectious Diseases Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Omowunmi Aibana
- Global Health Equity, Brigham and Women's Hospital Division of Infectious Diseases, Miriam Hospital, Providence, Rhode Island
| | | | - Ibrahim Diakite
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Eric Q Mooring
- Department of Epidemiology Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health
| | - Megan B Murray
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts Department of Epidemiology Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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153
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Management of Microbiological Samples in a Confirmed Case of Ebola Virus Disease: Constraints and Limitations. J Clin Microbiol 2015; 53:3396-400. [PMID: 26109444 DOI: 10.1128/jcm.01142-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In light of the recent Ebola virus outbreak, it has to be realized that besides medical treatment, precise algorithms for the management of complicating microbial infections are mandatory for Ebola virus disease (EVD) patients. While the necessity of such diagnostics is apparent, practical details are much less clear. Our approach, established during the treatment of an EVD patient at the University Hospital in Frankfurt am Main, Germany, provides a roadmap for reliable and safe on-site microbiological testing.
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154
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Treating the Host Response to Ebola Virus Disease with Generic Statins and Angiotensin Receptor Blockers. mBio 2015; 6:e00716. [PMID: 26106080 PMCID: PMC4479704 DOI: 10.1128/mbio.00716-15] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Treatments targeting the Ebola virus may eventually be shown to work, but they will not have an impact on overall Ebola mortality in West Africa. Endothelial dysfunction is responsible for the fluid and electrolyte imbalances seen in Ebola patients. Because inexpensive generic statins and angiotensin receptor blockers restore endothelial barrier integrity, they can be used to treat the host response in these patients. In Sierra Leone, approximately 100 Ebola patients were treated with this combination, and reports indicate that survival was greatly improved.
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155
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Bordes J, Karkowski L, Cournac JM, Gagnon N, Billhot M, Rousseau C, De Greslan T, Cellarier G. Dyspnea and Risk of Death in Ebola Infected Patients: Is Lung Really Involved? Clin Infect Dis 2015; 61:852. [PMID: 26063724 DOI: 10.1093/cid/civ441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julien Bordes
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Intensive Care and Anesthesia Department, Sainte Anne Military Teaching Hospital, Toulon
| | - Ludovic Karkowski
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Internal Medicine Department, Legouest Military Teaching Hospital, Metz
| | - Jean Marie Cournac
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Internal Medicine Department, Percy Military Teaching Hospital, Paris
| | - Nicolas Gagnon
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Intensive Care and Anesthesia Department, Legouest Military Teaching Hospital, Metz
| | - Magali Billhot
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Internal Medicine Department, Val de Grâce Military Teaching Hospital, Paris
| | - Claire Rousseau
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Internal Medicine Department, Clermont Tonnerre Military Teaching Hospital, Brest
| | - Thierry De Greslan
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Neurology Department, Val de Grâce Military Teaching Hospital, Paris
| | - Gilles Cellarier
- Ebola Treatment Center for Healthcare Workers, French Military Health Service, Conakry, Guinea Cardiology Department, Sainte Anne Military Teaching Hospital, Toulon, France
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156
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Torabi-Parizi P. Critical care management of two patients with Ebola: a biocontainment unit demystified. Crit Care Med 2015; 43:1326-7. [PMID: 25978155 PMCID: PMC4435824 DOI: 10.1097/ccm.0000000000001009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Parizad Torabi-Parizi
- Critical Care Medicine Department Clinical Center, National Institutes of Health Bethesda, MD, USA
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157
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Nguyen C, Kaku S, Tutera D, Kuschner WG, Barr J. Viral Respiratory Infections of Adults in the Intensive Care Unit. J Intensive Care Med 2015; 31:427-41. [PMID: 25990273 DOI: 10.1177/0885066615585944] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/16/2015] [Indexed: 12/12/2022]
Abstract
Viral lower respiratory tract infections (LRTIs) are an underappreciated cause of critical illness in adults. Recent advances in viral detection techniques over the past decade have demonstrated viral LRTIs are associated with rates of morbidity, mortality, and health care utilization comparable to those of seen with bacterial community acquired and nosocomial pneumonias. In this review, we describe the relationship between viral LRTIs and critical illness, as well as discuss relevant clinical features and management strategies for the more prevalent respiratory viral pathogens.
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Affiliation(s)
- Christopher Nguyen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Shawn Kaku
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Dominic Tutera
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ware G Kuschner
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA Pulmonary Section, Medicine Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Juliana Barr
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
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158
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Schmiedel S, Kreuels B. [Ebola virus disease in West Africa and Germany : clinical presentation, management and practical experience with medevacuated patients in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:679-85. [PMID: 25963641 DOI: 10.1007/s00103-015-2162-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ebolaviruses are the causative pathogens of a severe form of viral haemorrhagic fever with cytokine induced shock and multi-organ failure and a high case fatality rate in humans (50-90 %, more than 70 % in the beginning of the current outbreak), designated Ebola haemorrhagic fever or Ebola virus disease (EVD). Ebola is endemic in regions of Central and West Africa. Ebolavirus Zaire (EBOV) is the most aggressive Ebola virus species and is causing the current epidemic. Currently, beginning in late 2013, an unprecedented epidemic with several thousand cases and deaths (as per WHO report 24.12.2014: 19,497 documented cases, 7588 death, 2352 cases in past 3 weeks) is unfolding in Guinea, Liberia and Sierra Leone, and spreading to other countries in Africa, Europe and the USA, where isolated cases have occurred. Ebola transmission occurs exclusively through direct contact with body fluids through mucosal surfaces, skin abrasions, or by parenteral introduction-an aerolised transmission has not been reported so far. Infections in healthcare personnel have not only occurred after needle stick injuries but also after unsafe doffing procedures of personal protection equipment (PPE). The protection of healthcare personnel caring for Ebola patients, therefore, requires that high standards in the use of PPE are mandatory. In high-income countries the management and treatment of EVD patients in specialized centres is recommended. Using negative pressure rooms and positive pressure suits may provide additional safety. Due to the high degree of training and monitoring needed to prevent occupational risks, treatment of EVD patients in non-specialized hospitals should not take place.
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Affiliation(s)
- Stefan Schmiedel
- Bernhard-Nocht-Klinik für Tropenmedizin, I. Medizinische Klinik und Poliklinik & Ambulanzzentrum Infektiologie, Universitätsklinikum Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland,
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159
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Kraft CS, Hewlett AL, Koepsell S, Winkler AM, Kratochvil CJ, Larson L, Varkey JB, Mehta AK, Lyon GM, Friedman-Moraco RJ, Marconi VC, Hill CE, Sullivan JN, Johnson DW, Lisco SJ, Mulligan MJ, Uyeki TM, McElroy AK, Sealy T, Campbell S, Spiropoulou C, Ströher U, Crozier I, Sacra R, Connor MJ, Sueblinvong V, Franch HA, Smith PW, Ribner BS. The Use of TKM-100802 and Convalescent Plasma in 2 Patients With Ebola Virus Disease in the United States. Clin Infect Dis 2015; 61:496-502. [PMID: 25904375 DOI: 10.1093/cid/civ334] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/21/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The current West Africa Ebola virus disease (EVD) outbreak has resulted in multiple individuals being medically evacuated to other countries for clinical management. METHODS We report two patients who were transported from West Africa to the United States for treatment of EVD. Both patients received aggressive supportive care measures, as well as an investigational therapeutic (TKM-100802) and convalescent plasma. RESULTS While one patient experienced critical illness with multi-organ failure requiring mechanical ventilation and renal replacement therapy, both patients recovered without serious long-term sequelae to date. CONCLUSIONS It is unclear what role the experimental drug and convalescent plasma had in the recovery of these patients. Prospective clinical trials are needed to delineate the role of investigational therapies in the care of patients with EVD.
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Affiliation(s)
- Colleen S Kraft
- Department of Pathology and Laboratory Medicine Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Angela L Hewlett
- Division of Infectious Diseases, Department of Internal Medicine
| | | | | | | | | | - Jay B Varkey
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Aneesh K Mehta
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - G Marshall Lyon
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Rachel J Friedman-Moraco
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | | | - James N Sullivan
- Division of Critical Care, Department of Anesthesiology, University of Nebraska Medical Center, Omaha
| | - Daniel W Johnson
- Division of Critical Care, Department of Anesthesiology, University of Nebraska Medical Center, Omaha
| | - Steven J Lisco
- Division of Critical Care, Department of Anesthesiology, University of Nebraska Medical Center, Omaha
| | - Mark J Mulligan
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Timothy M Uyeki
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anita K McElroy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tara Sealy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Ute Ströher
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ian Crozier
- World Health Organization, Kenema Hospital, Sierra Leone
| | - Richard Sacra
- University of Massachusetts Medical School, Worcester
| | - Michael J Connor
- Division of Pulmonary, Allergy and Critical Care Division of Renal Medicine, Department of Medicine, Emory University, Atlanta, Georgia
| | | | - Harold A Franch
- Division of Renal Medicine, Department of Medicine, Emory University, Atlanta, Georgia
| | - Philip W Smith
- Division of Infectious Diseases, Department of Internal Medicine
| | - Bruce S Ribner
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
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160
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Lanini S, Zumla A, Ioannidis JPA, Di Caro A, Krishna S, Gostin L, Girardi E, Pletschette M, Strada G, Baritussio A, Portella G, Apolone G, Cavuto S, Satolli R, Kremsner P, Vairo F, Ippolito G. Are adaptive randomised trials or non-randomised studies the best way to address the Ebola outbreak in west Africa? THE LANCET. INFECTIOUS DISEASES 2015; 15:738-45. [PMID: 25881871 PMCID: PMC7129402 DOI: 10.1016/s1473-3099(15)70106-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The Ebola outbreak that has devastated parts of west Africa represents an unprecedented challenge for research and ethics. Estimates from the past three decades emphasise that the present effort to contain the epidemic in the three most affected countries (Guinea, Liberia, and Sierra Leone) has been insufficient, with more than 24 900 cases and about 10 300 deaths, as of March 25, 2015. Faced with such an exceptional event and the urgent response it demands, the use of randomised controlled trials (RCT) for Ebola-related research might be both unethical and infeasible and that potential interventions should be assessed in non-randomised studies on the basis of compassionate use. However, non-randomised studies might not yield valid conclusions, leading to large residual uncertainty about how to interpret the results, and can also waste scarce intervention-related resources, making them profoundly unethical. Scientifically sound and rigorous study designs, such as adaptive RCTs, could provide the best way to reduce the time needed to develop new interventions and to obtain valid results on their efficacy and safety while preserving the application of ethical precepts. We present an overview of clinical studies registered at present at the four main international trial registries and provide a simulation on how adaptive RCTs can behave in this context, when mortality varies simultaneously in either the control or the experimental group.
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Affiliation(s)
- Simone Lanini
- National institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy.
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London, London, UK; National Institute for Health Research Biomedical Research Centre, UCL Hospitals National Health Service Foundation Trust, London, UK
| | - John P A Ioannidis
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Antonino Di Caro
- National institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Sanjeev Krishna
- Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Lawrence Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA
| | - Enrico Girardi
- National institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Michel Pletschette
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | | | - Aldo Baritussio
- Department of Medical and Surgical Sciences, University of Padua, Padua, Italy
| | | | | | - Silvio Cavuto
- IRCCS Arcispedale S Maria Nuova, Reggio Emilia, Italy
| | | | - Peter Kremsner
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany; Centre de Recherches Medicales de Lambarene, Lambarene, Gabon
| | - Francesco Vairo
- National institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Giuseppe Ippolito
- National institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
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161
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Roca A, Afolabi MO, Saidu Y, Kampmann B. Ebola: a holistic approach is required to achieve effective management and control. J Allergy Clin Immunol 2015; 135:856-867. [PMID: 25843598 PMCID: PMC4382328 DOI: 10.1016/j.jaci.2015.02.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/12/2015] [Accepted: 02/17/2015] [Indexed: 01/07/2023]
Abstract
The current Ebola outbreak in West Africa has already caused substantial mortality and dire human and economic consequences. It continues to represent an alarming public health threat in the region and beyond and jeopardizes the provision of health care and other services in the affected countries. The scale of the epidemic has accelerated research efforts for diagnostics, treatment, and prevention galvanized through increased availability of funding. Our knowledge relating to the virus, disease pathogenesis, risk factors, dynamics of transmission, and epidemic control is increasing, and sociocultural factors have emerged as critical determinants for the success and failure of control efforts. However, there is a long way to go. In this review we summarize the current knowledge, examine the sociocultural context in West Africa, and outline priority areas for future research.
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Affiliation(s)
- Anna Roca
- The Medical Research Unit (MRC), Fajara, The Gambia
| | | | - Yauba Saidu
- The Medical Research Unit (MRC), Fajara, The Gambia
| | - Beate Kampmann
- The Medical Research Unit (MRC), Fajara, The Gambia; Imperial College London, London, United Kingdom.
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162
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Büttner S, Koch B, Dolnik O, Eickmann M, Freiwald T, Rudolf S, Engel J, Becker S, Ronco C, Geiger H. Extracorporeal Virus Elimination for the Treatment of Severe Ebola Virus Disease - First Experience with Lectin Affinity Plasmapheresis. Blood Purif 2015; 38:286-91. [DOI: 10.1159/000375229] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 11/19/2022]
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