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Kasereka MC, Mukadi-Bamuleka D, Kitenge-Omasumbu R, Edidi-Atani F, Kuamfumu MM, Mulangu S, Tshiani-Mbaya O, Malengera Vicky K, Mbala-Kingebeni P, Ahuka-Mundeke S, Muyembe-Tamfum JJ, Lee BE, Houston S, Mumtaz Z, Hawkes MT. Rhabdomyolysis, Acute Kidney Injury, and Mortality in Ebola Virus Disease: Retrospective Analysis of Cases From the Eastern Democratic Republic of the Congo, 2019. J Infect Dis 2024; 230:e465-e473. [PMID: 38696335 PMCID: PMC11326845 DOI: 10.1093/infdis/jiae224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/13/2024] [Accepted: 04/28/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Skeletal muscle injury in Ebola virus disease (EVD) has been reported, but its association with morbidity and mortality remains poorly defined. METHODS This retrospective study included patients admitted to 2 EVD treatment units over an 8-month period in 2019 during an EVD epidemic in the Democratic Republic of the Congo. RESULTS An overall 333 patients (median age, 30 years; 58% female) had at least 1 creatine kinase (CK) measurement (n = 2229; median, 5/patient [IQR, 1-11]). Among patients, 271 (81%) had an elevated CK level (>380 U/L); 202 (61%) had rhabdomyolysis (CK >1000 IU/L); and 45 (14%) had severe rhabdomyolysis (≥5000 U/L). Among survivors, the maximum CK level was a median 1600 (IQR, 550-3400), peaking 3.4 days after admission (IQR, 2.3-5.5) and decreasing thereafter. Among fatal cases, the CK rose monotonically until death, with a median maximum CK level of 2900 U/L (IQR, 1500-4900). Rhabdomyolysis at admission was an independent predictor of acute kidney injury (adjusted odds ratio, 2.2 [95% CI, 1.2-3.8]; P = .0065) and mortality (adjusted hazard ratio, 1.7 [95% CI, 1.03-2.9]; P = .037). CONCLUSIONS Rhabdomyolysis is associated with acute kidney injury and mortality in patients with EVD. These findings may inform clinical practice by identifying laboratory monitoring priorities and highlighting the importance of fluid management.
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Affiliation(s)
- Masumbuko Claude Kasereka
- Department of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Daniel Mukadi-Bamuleka
- Department of Virology, Institut National de Recherche Biomédicale
- Service of Microbiology, Department of Medical Biology, University of Kinshasa
| | - Richard Kitenge-Omasumbu
- Programme National d'Urgences et Actions Humanitaires, Ministry of Health of the Democratic Republic of the Congo, Kinshasa
| | - François Edidi-Atani
- Department of Virology, Institut National de Recherche Biomédicale
- Service of Microbiology, Department of Medical Biology, University of Kinshasa
| | - Meris Matondo Kuamfumu
- Department of Virology, Institut National de Recherche Biomédicale
- Service of Microbiology, Department of Medical Biology, University of Kinshasa
| | - Sabue Mulangu
- Department of Virology, Institut National de Recherche Biomédicale
- Service of Microbiology, Department of Medical Biology, University of Kinshasa
| | - Olivier Tshiani-Mbaya
- Department of Virology, Institut National de Recherche Biomédicale
- Service of Microbiology, Department of Medical Biology, University of Kinshasa
| | - Kambale Malengera Vicky
- Department of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Department of Virology, Institut National de Recherche Biomédicale
- Service of Microbiology, Department of Medical Biology, University of Kinshasa
| | - Steve Ahuka-Mundeke
- Department of Virology, Institut National de Recherche Biomédicale
- Service of Microbiology, Department of Medical Biology, University of Kinshasa
| | - Jean-Jacques Muyembe-Tamfum
- Department of Virology, Institut National de Recherche Biomédicale
- Service of Microbiology, Department of Medical Biology, University of Kinshasa
| | - Bonita E Lee
- Department of Pediatrics, University of Alberta, Edmonton
| | - Stan Houston
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Zubia Mumtaz
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Michael T Hawkes
- School of Public Health, University of Alberta, Edmonton, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
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Dobbs KR, Lobb A, Dent AE. Ebola virus disease in children: epidemiology, pathogenesis, management, and prevention. Pediatr Res 2024; 95:488-495. [PMID: 37903937 DOI: 10.1038/s41390-023-02873-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 11/01/2023]
Abstract
Ebola disease is a severe disease with extremely high case-fatality rates ranging from 28-100%. Observations made during the 2013-2016 West African epidemic improved our understanding of the clinical course of Ebola disease and accelerated the study of therapeutic and preventative strategies. The epidemic also highlighted the unique challenges associated with providing optimal care for children during Ebola disease outbreaks. In this review, we outline current understanding of Ebola disease epidemiology, pathogenesis, management, and prevention, highlighting data pertinent to the care of children. IMPACT: In this review, we summarize recent advancements in our understanding of Ebola disease epidemiology, clinical presentation, and therapeutic and preventative strategies. We highlight recent data pertinent to the care of children and pregnant women and identify research gaps for this important emerging viral infection in children.
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Affiliation(s)
- Katherine R Dobbs
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
| | - Alyssa Lobb
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Arlene E Dent
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Kjaldgaard L, Claude KM, Mukadi-Bamuleka D, Kitenge-Omasumbu R, Dixit D, Edidi-Atani F, Kuamfumu MM, Bulabula-Penge J, Mambu-Mbika F, Tshiani-Mbaya O, Diaz J, Mulangu S, Legand A, Mbala-Kingebeni P, Formenty P, Ahuka-Mundeke S, Muyembe-Tamfum JJ, Hawkes MT. Virus kinetics and biochemical derangements among children with Ebolavirus disease. EClinicalMedicine 2022; 53:101638. [PMID: 36105872 PMCID: PMC9465268 DOI: 10.1016/j.eclinm.2022.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A paucity of data is available on virologic and biochemical characteristics of paediatric Ebolavirus disease (EVD), compared to adults. METHODS We conducted a retrospective chart review of children (<16 years old) and a comparator group of young adults (16-44 years) from two treatment centres during the 2018-2020 EVD epidemic in Eastern Democratic Republic of the Congo. Statistical methods included chi-squared and Fisher's exact tests (dichotomous and categorical variables), Mann-Whitney U-test (continuous variables), multivariable linear regression (for determinants of admission viral load), linear mixed-effects models (for analysis of longitudinal viral load), and Cox proportional hazard models (to examine risk factors for mortality). FINDINGS We included 73 children and 234 adults admitted from April to October 2019. Paediatric patients commonly had electrolytes imbalances: hypokalaemia in 26/73 (36%), hyperkalaemia in 38/73 (52%), and hyponatraemia in 54/73 (74%). Hypoglycaemia occurred in 20/73 (27%), acute kidney injury in 43/73 (59%), and rhabdomyolysis in 35/73 (48%). Biochemical abnormalities were detected in a similar proportion of children and adults. The viral load (VL, log10 copies/mL) at admission (7.2 versus 6.5, p=0.0001), the peak viral load (7.5 versus 6.7, p=<0.0001), and the time for viraemia clearance (16 days versus 12 days, p=<0.0001) were significantly different in children. The duration of hospital stay was prolonged in children (20 versus 16 days, p=<0.0001). Risk factors for mortality in children were: VL >7.6 log10copies/mL, alanine transaminase >525 U/L, C-reactive protein >100 mg/L, blood urea nitrogen >7.5 mmol/L, rhabdomyolysis, and.acute kidney injury. INTERPRETATION Paediatric EVD patients, like adults, experience multiorgan dysfunction with life-threatening electrolyte imbalances, hypoglycaemia, kidney injury, liver injury, and rhabdomyolysis. Paediatric patients have significantly higher VLs throughout the course of EVD than adults. FUNDING This study was not funded.
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Affiliation(s)
- Lindsey Kjaldgaard
- Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
- Member, Women and Children's Research Institute, University of Alberta, Edmonton, AB, Canada
| | | | - Daniel Mukadi-Bamuleka
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Richard Kitenge-Omasumbu
- Programme National d'Urgences et Actions Humanitaires (PNUAH), Ministry of Health of the Democratic Republic of the Congo (DRC), Democratic Republic of the Congo
| | - Devika Dixit
- Department of Medicine, Division of Infectious Diseases, University of Saskatchewan, Saskatoon, SK, Canada
| | - François Edidi-Atani
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Meris Matondo Kuamfumu
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Junior Bulabula-Penge
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Fabrice Mambu-Mbika
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Olivier Tshiani-Mbaya
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Janet Diaz
- World Health Organization (WHO), Geneva, Switzerland
| | - Sabue Mulangu
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | - Anais Legand
- World Health Organization (WHO), Geneva, Switzerland
| | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | | | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
| | | | - Michael T. Hawkes
- Member, Women and Children's Research Institute, University of Alberta, Edmonton, AB, Canada
- Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Distinguished Researcher, Stollery Science Lab, University of Alberta, Edmonton, AB, Canada
- Corresponding author at: Department of Paediatrics, University of Alberta, 3-588D Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada.
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Kahindo CK, Mukuku O, Wembonyama SO, Tsongo ZK. Prevalence and Factors Associated with Acute Kidney Injury in Sub-Saharan African Adults: A Review of the Current Literature. Int J Nephrol 2022; 2022:5621665. [PMID: 35342649 PMCID: PMC8941586 DOI: 10.1155/2022/5621665] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/26/2022] [Accepted: 03/01/2022] [Indexed: 02/05/2023] Open
Abstract
Acute kidney injury (AKI) is a complex condition that can occur in both community and hospital settings and has many aetiologies. These aetiologies may be infectious, toxic, surgical, or related to the different management methods. Although it is a major public health problem worldwide, it must be emphasised that both its incidence and mortality rate appear to be very high in sub-Saharan African (SSA) countries compared to developed countries. The profile of AKI is very different from that of more developed countries. There are no reliable statistics on the incidence of AKI in SSA. Infections (malaria, HIV, diarrhoeal, and other diseases), nephrotoxins, and obstetric and surgical complications are the main aetiologies in Africa. The management of AKI is costly and associated with high rates of prolonged hospitalisation and in-hospital mortality.
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Affiliation(s)
- Charles Kangitsi Kahindo
- Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo
- Clinique Internationnale de Medecine Avancee au Kivu, Goma, Democratic Republic of the Congo
| | - Olivier Mukuku
- Institut Supérieur des Techniques Médicales de Lubumbashi, Lubumbashi, Democratic Republic of the Congo
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Deshwal H, Pradhan D, Mukherjee V. Point-of-care ultrasound in a pandemic: Practical guidance in COVID-19 units. World J Crit Care Med 2021; 10:204-219. [PMID: 34616657 PMCID: PMC8462027 DOI: 10.5492/wjccm.v10.i5.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/05/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has stretched our healthcare system to the brink, highlighting the importance of efficient resource utilization without compromising healthcare provider safety. While advanced imaging is a great resource for diagnostic purposes, the risk of contamination and infection transmission is high and requires extensive logistical planning for intrahospital patient transport, healthcare provider safety, and post-imaging decontamination. This dilemma has necessitated the transition to more bedside imaging. More so than ever, during the current pandemic, the clinical utility and importance of point-of-care ultrasound (POCUS) cannot be overstressed. It allows for safe and efficient beside procedural guidance and provides front line providers with valuable diagnostic information that can be acted upon in real-time for immediate clinical decision-making. The authors have been routinely using POCUS for the management of COVID-19 patients both in the emergency department and in intensive care units turned into “COVID-units.” In this article, we review the nuances of using POCUS in a pandemic situation and maximizing diagnostic output from this bedside technology. Additionally, we review various methods and diagnostic uses of POCUS which can replace conventional imaging and bridge current literature and common clinical practices in critically ill patients. We discuss practical guidance and pertinent review of the literature for the most relevant procedural and diagnostic guidance of respiratory illness, hemodynamic decompensation, renal failure, and gastrointestinal disorders experienced by many patients admitted to COVID-units.
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Affiliation(s)
- Himanshu Deshwal
- Division of Pulmonary, Sleep and Critical Care Medicine, New York University Grossman School of Medicine, New York, NY 10016, United States
| | - Deepak Pradhan
- Division of Pulmonary, Sleep and Critical Care Medicine, New York University Grossman School of Medicine, New York, NY 10016, United States
| | - Vikramjit Mukherjee
- Division of Pulmonary, Sleep and Critical Care Medicine, New York University Grossman School of Medicine, New York, NY 10016, United States
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Alrubaye R, Choudhury H. Severe Rhabdomyolysis in a 35-Year-old Woman with COVID-19 due to SARS-CoV-2 Infection: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926733. [PMID: 32801291 PMCID: PMC7440748 DOI: 10.12659/ajcr.926733] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Rhabdomyolysis is a skeletal muscle injury that has different etiologies and can be a manifestation of coronavirus disease 2019 (COVID-19). Because it is a life-threatening condition, rapid diagnosis is necessary to prevent acute complications. Diagnostic criteria for rhabdomyolysis are elevated serum creatine kinase, liver enzyme levels, and myalgia. Rhabdomyolysis can easily be missed in patients with COVID-19. Herein, we report the case of a female with rhabdomyolysis as a manifestation of acute COVID-19. CASE REPORT A 35-year-old female was found to have rhabdomyolysis associated with COVID-19. Her creatine kinase and liver enzyme levels were significantly elevated. Ringer's lactate infusion was administered at a controlled rate to treat the rhabdomyolysis along with boluses of normal saline, with close monitoring of her oxygen saturation and kidney function. The patient's creatine kinase and liver enzyme levels peaked on Day 2 and then decreased. Her medical condition improved, and she was discharged on Day 4. CONCLUSIONS Our case highlights the need to monitor the creatine kinase level of hospitalized patients with COVID-19. Fluid management can be challenging in patients with rhabdomyolysis due to COVID-19 because of the risk of fluid overload and acute respiratory distress syndrome. Clinicians should be aware that a significant elevation in liver enzyme levels and myalgia can be the presenting features of rhabdomyolysis in patients with COVID-19.
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Affiliation(s)
- Riyadh Alrubaye
- Department of Hospital Medicine, Northeast Georgia Health System, Gainesville, GA, USA
| | - Hasan Choudhury
- Department of Graduate Medical Education, Internal Medicine Residency Program, Northeast Georgia Health System, Gainesville, GA, USA
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Aluisio AR, Perera SM, Yam D, Garbern S, Peters JL, Abel L, Cho DK, Woldemichael D, Kennedy SB, Massaquoi M, Sahr F, Liu T, Levine AC. Association between treatment with oral third-generation cephalosporin antibiotics and mortality outcomes in Ebola virus disease: a multinational retrospective cohort study. Trop Med Int Health 2020; 25:433-441. [PMID: 31912627 PMCID: PMC7176519 DOI: 10.1111/tmi.13369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the association between oral third-generation cephalosporin antibiotic treatment and mortality in Ebola virus disease (EVD). METHODS This retrospective cohort studied EVD-infected patients admitted to five Ebola Treatment Units in Sierra Leone and Liberia during 2014-15. Empiric treatment with cefixime 400 mg once daily for five days was the clinical protocol; however, due to resource variability, only a subset of patients received treatment. Data on sociodemographics, clinical characteristics, malaria status and Ebola viral loads were collected. The primary outcome was mortality compared between cases treated with cefixime within 48 h of admission to those not treated within 48 h. Propensity scores were derived using clinical covariates. Mortality between treated and untreated cases was compared using propensity-matched conditional logistic regression and bootstrapped log-linear regression analyses to calculate an odds ratio (OR) and relative risk (RR), respectively, with associated 95% confidence intervals (CI). RESULTS Of 424 cases analysed, 360 (84.9%) met the cefixime treatment definition. The mean age was 30.5 years and 40.3% were male. Median cefixime treatment duration was 4 days (IQR: 3, 5). Among cefixime-treated patients, mortality was 54.7% (95% CI: 49.6-59.8%) vs. 73.4% (95% CI: 61.5-82.7%) in untreated patients. In conditional logistic regression, mortality likelihood was significantly lower among cases receiving cefixime (OR = 0.48, 95% CI: 0.32-0.71; P = 0.01). In the bootstrap analysis, a non-significant risk reduction was found with cefixime treatment (RR = 0.82, 95% CI: 0.64-1.16, P = 0.11). CONCLUSION Early oral cefixime may be associated with reduced mortality in EVD and warrants further investigation.
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Affiliation(s)
- Adam R. Aluisio
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, USA
| | | | - Derrick Yam
- Center for Statistical Sciences, Department of Biostatistics, Brown University School of Public Health, Providence, USA
| | - Stephanie Garbern
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, USA
| | | | - Logan Abel
- Warren Alpert Medical School of Brown University, Providence, USA
| | - Daniel K. Cho
- Warren Alpert Medical School of Brown University, Providence, USA
| | | | | | | | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Tao Liu
- Center for Statistical Sciences, Department of Biostatistics, Brown University School of Public Health, Providence, USA
| | - Adam C. Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, USA
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Aluisio AR, Yam D, Peters JL, Cho DK, Perera SM, Kennedy SB, Massaquoi M, Sahr F, Smit MA, Liu T, Levine AC. Impact of Intravenous Fluid Therapy on Survival Among Patients With Ebola Virus Disease: An International Multisite Retrospective Cohort Study. Clin Infect Dis 2020; 70:1038-1047. [PMID: 31050703 PMCID: PMC7390355 DOI: 10.1093/cid/ciz344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 04/24/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Intravenous fluid (IVF) is a frequently recommended intervention in Ebola virus disease (EVD), yet its impact on patient outcomes remains unclear. METHODS This retrospective cohort study evaluated patients with EVD admitted to 5 Ebola treatment units (ETUs) in West Africa. The primary outcome was the difference in 28-day survival between cases treated and not treated with IVF. To control for demographic and clinical factors related to both IVF exposure and survival, cases were compared using propensity score matching. To control for time-varying patient and treatment factors over the course of ETU care, a marginal structural proportional hazards model (MSPHM) with inverse probability weighting was used to assess for 28-day survival differences. RESULTS Among 424 EVD-positive cases with data for analysis, 354 (83.5%) were treated with IVF at some point during their ETU admission. Overall, 146 (41.3%) cases treated with IVF survived, whereas 31 (44.9%) cases not treated with any IVF survived (P = .583). Matched propensity score analysis found no significant difference in 28-day survival between cases treated and not treated with IVF during their first 24 and 48 hours of care. Adjusted MSPHM survival analyses also found no significant difference in 28-day survival for cases treated with IVF (27.3%) compared to those not treated with IVF (26.9%) during their entire ETU admission (P = .893). CONCLUSIONS After adjustment for patient- and treatment-specific time-varying factors, there was no significant difference in survival among patients with EVD treated with IVF as compared to those not treated with IVF.
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Affiliation(s)
- Adam R Aluisio
- Department of Emergency Medicine, Brown University Alpert Medical School, Rhode Island
| | - Derrick Yam
- Center for Statistical Sciences, Department of Biostatistics, Brown University School of Public Health, Rhode Island
| | | | | | - Shiromi M Perera
- International Medical Corps, Washington, District of Columbia, Liberia
| | | | | | - Foday Sahr
- Ministry of Defense, Freetown, Sierra Leone
| | - Michael A Smit
- Division of Infectious Diseases, Children’s Hospital Los Angeles, California
| | - Tao Liu
- Center for Statistical Sciences, Department of Biostatistics, Brown University School of Public Health, Rhode Island
| | - Adam C Levine
- Department of Emergency Medicine, Brown University Alpert Medical School, Rhode Island
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Association between multivitamin supplementation and mortality among patients with Ebola virus disease: An international multisite cohort study. Afr J Emerg Med 2020; 10:23-29. [PMID: 32161708 PMCID: PMC7058859 DOI: 10.1016/j.afjem.2019.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Micronutrient supplementation is recommended in Ebola Virus Disease (EVD) care; however, there is limited data on its therapeutic effects. METHODS This retrospective cohort study included patients with EVD admitted to five Ebola Treatment Units (ETU) in Sierra Leone and Liberia during September 2014 to December 2015. A uniform protocol was used to guide ETU care, however, due to supply limitations, only a subset of patients received multivitamins. Data on demographics, clinical characteristics, and laboratory testing was collected. The outcome of interest was facility-based mortality and the primary predictor was multivitamin supplementation initiated within 48 h of admission. The multivitamin formulations included: thiamine, riboflavin, niacin and vitamins A, C, and D3. Propensity score models (PSM) were used to match patients based on covariates associated with multivitamin administration and mortality. Mortality between cases treated and untreated within 48 h of admission were compared using generalized estimating equations to calculate relative risk with bootstrap methods employed to assess statistical significance. RESULTS There were 424 patients with EVD who had sufficient treatment data for analysis, of which 261 (61.6%) had daily multivitamins initiated within 48 h of admission. The mean age of the cohort was 30.5 years and 59.4% were female. In the propensity score matched analysis, mortality was 53.5% among patients receiving multivitamins and 66.2% among patients not receiving multivitamins, resulting in a relative risk for mortality of 0.81 (p = 0.03) for patients receiving multivitamins. CONCLUSION Early multivitamin supplementation was associated with lower overall mortality. Further research on the impact of micronutrient supplementation in EVD is warranted.
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Jacob ST, Crozier I, Fischer WA, Hewlett A, Kraft CS, Vega MADL, Soka MJ, Wahl V, Griffiths A, Bollinger L, Kuhn JH. Ebola virus disease. Nat Rev Dis Primers 2020; 6:13. [PMID: 32080199 PMCID: PMC7223853 DOI: 10.1038/s41572-020-0147-3] [Citation(s) in RCA: 284] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2020] [Indexed: 12/16/2022]
Abstract
Ebola virus disease (EVD) is a severe and frequently lethal disease caused by Ebola virus (EBOV). EVD outbreaks typically start from a single case of probable zoonotic transmission, followed by human-to-human transmission via direct contact or contact with infected bodily fluids or contaminated fomites. EVD has a high case-fatality rate; it is characterized by fever, gastrointestinal signs and multiple organ dysfunction syndrome. Diagnosis requires a combination of case definition and laboratory tests, typically real-time reverse transcription PCR to detect viral RNA or rapid diagnostic tests based on immunoassays to detect EBOV antigens. Recent advances in medical countermeasure research resulted in the recent approval of an EBOV-targeted vaccine by European and US regulatory agencies. The results of a randomized clinical trial of investigational therapeutics for EVD demonstrated survival benefits from two monoclonal antibody products targeting the EBOV membrane glycoprotein. New observations emerging from the unprecedented 2013-2016 Western African EVD outbreak (the largest in history) and the ongoing EVD outbreak in the Democratic Republic of the Congo have substantially improved the understanding of EVD and viral persistence in survivors of EVD, resulting in new strategies toward prevention of infection and optimization of clinical management, acute illness outcomes and attendance to the clinical care needs of patients.
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Affiliation(s)
- Shevin T Jacob
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Global Health Security Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Ian Crozier
- Integrated Research Facility at Fort Detrick, Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research supported by the National Cancer Institute, Frederick, MD, USA
| | - William A Fischer
- Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine, Chapel Hill, NC, USA
| | - Angela Hewlett
- Nebraska Biocontainment Unit, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Colleen S Kraft
- Microbiology Section, Emory Medical Laboratory, Emory University School of Medicine, Atlanta, GA, USA
| | - Marc-Antoine de La Vega
- Department of Microbiology, Immunology & Infectious Diseases, Université Laval, Quebec City, QC, Canada
| | - Moses J Soka
- Partnership for Ebola Virus Disease Research in Liberia, Monrovia Medical Units ELWA-2 Hospital, Monrovia, Liberia
| | - Victoria Wahl
- National Biodefense Analysis and Countermeasures Center, Fort Detrick, Frederick, MD, USA
| | - Anthony Griffiths
- Department of Microbiology and National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, MA, USA
| | - Laura Bollinger
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD, USA
| | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD, USA.
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Chertow DS, Shekhtman L, Lurie Y, Davey RT, Heller T, Dahari H. Modeling Challenges of Ebola Virus-Host Dynamics during Infection and Treatment. Viruses 2020; 12:v12010106. [PMID: 31963118 PMCID: PMC7019702 DOI: 10.3390/v12010106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/10/2019] [Accepted: 01/14/2020] [Indexed: 02/06/2023] Open
Abstract
Mathematical modeling of Ebola virus (EBOV)-host dynamics during infection and treatment in vivo is in its infancy due to few studies with frequent viral kinetic data, lack of approved antiviral therapies, and limited insight into the timing of EBOV infection of cells and tissues throughout the body. Current in-host mathematical models simplify EBOV infection by assuming a single homogeneous compartment of infection. In particular, a recent modeling study assumed the liver as the largest solid organ targeted by EBOV infection and predicted that nearly all cells become refractory to infection within seven days of initial infection without antiviral treatment. We compared our observations of EBOV kinetics in multiple anatomic compartments and hepatocellular injury in a critically ill patient with Ebola virus disease (EVD) with this model's predictions. We also explored the model's predictions, with and without antiviral therapy, by recapitulating the model using published inputs and assumptions. Our findings highlight the challenges of modeling EBOV-host dynamics and therapeutic efficacy and emphasize the need for iterative interdisciplinary efforts to refine mathematical models that might advance understanding of EVD pathogenesis and treatment.
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Affiliation(s)
- Daniel S. Chertow
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA
- Correspondence: ; Tel.: +1-(301)-451-7731
| | - Louis Shekhtman
- The Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA; (L.S.); (H.D.)
- Network Science Institute, Northeastern University, Boston, MA 02115, USA
| | - Yoav Lurie
- Liver Unit, Shaare Zedek Medical Center and the Hebrew University of Jerusalem, Jerusalem 9103102, Israel
| | - Richard T. Davey
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Theo Heller
- Translational Hepatology Unit, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Harel Dahari
- The Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA; (L.S.); (H.D.)
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12
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Clément C, Adhikari NKJ, Lamontagne F. Evidence-Based Clinical Management of Ebola Virus Disease and Epidemic Viral Hemorrhagic Fevers. Infect Dis Clin North Am 2019; 33:247-264. [PMID: 30712765 DOI: 10.1016/j.idc.2018.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The 2014 to 2016 Ebola virus disease outbreak underscored the threat posed by hemorrhagic fevers. Filoviral outbreaks have been identified since 1967, but data collection has remained sparse, limiting current knowledge of these illnesses. Documentation of objective physical signs and laboratory parameters and appropriate clinical management are connected and interdependent. Implementing both is necessary to improve outcomes. Clinical features include severe volume depletion due to diarrhea and vomiting, shock, rhabdomyolysis, and metabolic disturbances. Overt hemorrhage is uncommon. Point-of-care devices and inexpensive electronic equipment enable better monitoring and record keeping in resource-limited settings.
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Affiliation(s)
- Christophe Clément
- Intensive Care Unit, Polyclinique Bordeaux Nord Aquitaine, 15 rue Claude Boucher, Bordeaux 33000, France; Intensive Care Unit, Mamoudzou Hospital, rue de l'Hôpital, Mayotte 97600, France
| | - Neill K J Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Interdepartmental Division of Critical Care, University of Toronto, 209 Victoria Street, 4th Floor, Room 411, Toronto, Ontario M5B 1T8, Canada
| | - François Lamontagne
- Interdepartmental Division of Critical Care, University of Toronto, 209 Victoria Street, 4th Floor, Room 411, Toronto, Ontario M5B 1T8, Canada; Department of Medicine, Université de Sherbrooke, 300112e Avenue Nord, Sherbrooke, Québec J1H 5N4, Canada.
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13
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Rojek AM, Salam A, Ragotte RJ, Liddiard E, Elhussain A, Carlqvist A, Butler M, Kayem N, Castle L, Odondi L', Stepniewska K, Horby PW. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect 2019; 25:1307-1314. [PMID: 31284032 PMCID: PMC7116468 DOI: 10.1016/j.cmi.2019.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/25/2019] [Accepted: 06/28/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Over 28 000 individuals were infected with Ebola virus during the West Africa (2013-2016) epidemic, yet there has been criticism of the lack of robust clinical descriptions of Ebola virus disease (EVD) illness from that outbreak. OBJECTIVES To perform a meta-analysis of published data from the epidemic to describe the clinical presentation, evolution of disease, and predictors of mortality in individuals with EVD. To assess the quality and utility of published data for clinical and public health decision-making. DATA SOURCES Primary articles available in PubMed and published between January 2014 and May 2017. ELIGIBILITY Studies that sequentially enrolled individuals hospitalized for EVD and that reported acute clinical outcomes. METHODS We performed meta-analyses using random-effect models and assessed heterogeneity using the I2 method. We assessed data representativeness by comparing meta-analysis estimates with WHO aggregate data. We examined data utility by examining the availability and compatibility of data sets. RESULTS In all, 3653 articles were screened and 34 articles were included, representing 16 independent cohorts of patients (18 overlapping cohorts) and at least 6168 individuals. The pooled estimate for case fatality rate was 51% (95% CI 46%-56%). However, pooling of estimates for clinical presentation, progression, and predictors of mortality in individuals with EVD were hampered by significant heterogeneity, and inadequate data on clinical progression. Our assessment of data quality found that heterogeneity was largely unexplained, and data availability and compatibility were poor. CONCLUSIONS We have quantified a missed opportunity to generate reliable estimates of the clinical manifestations of EVD during the West Africa epidemic. Clinical data standards and data capture platforms are urgently needed.
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Affiliation(s)
- A M Rojek
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK.
| | - A Salam
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK; United Kingdom Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - R J Ragotte
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - E Liddiard
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - A Elhussain
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - A Carlqvist
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - M Butler
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - N Kayem
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - L Castle
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - L 'o Odondi
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - K Stepniewska
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK; WorldWide Antimalarial Resistance Network, Oxford, UK
| | - P W Horby
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
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14
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Aluisio AR, Perera SM, Yam D, Garbern S, Peters JL, Abel L, Cho DK, Kennedy SB, Massaquoi M, Sahr F, Brinkmann S, Locks L, Liu T, Levine AC. Vitamin A Supplementation Was Associated with Reduced Mortality in Patients with Ebola Virus Disease during the West African Outbreak. J Nutr 2019; 149:1757-1765. [PMID: 31268140 PMCID: PMC6768816 DOI: 10.1093/jn/nxz142] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/04/2019] [Accepted: 06/03/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Micronutrient supplementation is recommended in Ebola virus disease (EVD); however, there are limited data on therapeutic impacts of specific micronutrients. OBJECTIVE To evaluate the association between vitamin A supplementation and mortality in EVD. METHODS This retrospective cohort included patients with EVD admitted to 5 International Medical Corps Ebola Treatment Units (ETUs) in 2 countries during 2014-2015. Protocolized treatments with micronutrients were used at all ETUs: however, because of resource constraints, only a subset of patients received vitamin A. Standardized data on demographics, clinical characteristics, malaria status, and Ebola viral loads (cycle threshold values) were collected. The outcome of interest was mortality between cases treated with 200,000 IU of vitamin A on care days 1 and/or 2, and those not. Propensity scores based on the first 48 h of care were derived using covariates of age, ETU duration, malaria status, cycle threshold values, and clinical symptoms. Patients were matched 1:1 using nearest neighbors with replacement. Mortality between cases treated and not treated with vitamin A was compared using generalized estimating equations to calculate RR with associated 95% CI. RESULTS There were 424 cases analyzed, of which 330 (77.8%) were treated with vitamin A. The mean age was 30.5 y and 40.3% were men. The most common symptoms were diarrhea (85.6%), anorexia (80.7%), and abdominal pain (76.9%). Mortality proportions among cases treated and not treated with vitamin A were 55.0% and 71.9%, respectively. In the propensity-matched analysis, mortality was significantly lower among cases receiving vitamin A (RR = 0.77, 95% CI: 0.59, 0.99; P = 0.041). In a subgroup analysis of patients treated with multivitamins already containing vitamin A, additional vitamin A supplementation did not impact mortality. CONCLUSION Early vitamin A supplementation was associated with reduced mortality in patients with EVD, and should be further studied and considered for use in future epidemics.
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Affiliation(s)
- Adam R Aluisio
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | | | - Derrick Yam
- Brown University, School of Public Health, Center for Statistical Sciences, Department of Biostatistics, Providence, RI, USA
| | - Stephanie Garbern
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Jillian L Peters
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Logan Abel
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | | | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Lindsey Locks
- Department of Health Sciences, Boston University: Sargent College, Boston, MA, USA
| | - Tao Liu
- Brown University, School of Public Health, Center for Statistical Sciences, Department of Biostatistics, Providence, RI, USA
| | - Adam C Levine
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
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15
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Lanini S, Portella G, Vairo F, Kobinger GP, Pesenti A, Langer M, Kabia S, Brogiato G, Amone J, Castilletti C, Miccio R, Capobianchi MR, Strada G, Zumla A, Di Caro A, Ippolito G. Relationship Between Viremia and Specific Organ Damage in Ebola Patients: A Cohort Study. Clin Infect Dis 2019; 66:36-44. [PMID: 29020340 DOI: 10.1093/cid/cix704] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/07/2017] [Indexed: 12/18/2022] Open
Abstract
Background Pathogenesis of Ebola virus disease remains poorly understood. We used concomitant determination of routine laboratory biomarkers and Ebola viremia to explore the potential role of viral replication in specific organ damage. Methods We recruited patients with detectable Ebola viremia admitted to the EMERGENCY Organizzazione Non Governativa Organizzazione Non Lucrativa di Utilità Sociale (ONG ONLUS) Ebola Treatment Center in Sierra Leone. Repeated measure of Ebola viremia, alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), activated prothrombin time (aPTT), international normalized ratio (INR), creatinine, and blood urea nitrogen (BUN) were recorded. Patients were followed up from admission until death or discharge. Results One hundred patients (49 survivors and 51 nonsurvivors) were included in the analysis. Unadjusted analysis to compare survivors and nonsurvivors provided evidence that all biomarkers were significantly above the normal range and that the extent of these abnormalities was generally higher in nonsurvivors than in survivors. Multivariable mixed-effects models provided strong evidence for a biological gradient (suggestive of a direct role in organ damage) between the viremia levels and either ALT, AST, CPK LDH, aPTT, and INR. In contrast, no direct linear association was found between viremia and either creatinine, BUN, or bilirubin. Conclusions This study provides evidence to support that Ebola virus may have a direct role in muscular damage and imbalance of the coagulation system. We did not find strong evidence suggestive of a direct role of Ebola virus in kidney damage. The role of the virus in liver damage remains unclear, but our evidence suggests that acute severe liver injury is not a typical feature of Ebola virus disease.
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Affiliation(s)
- Simone Lanini
- National Institute for Infectious Diseases "Lazzaro Spallanzani," Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,International Public Health Crisis Group, Milan, Italy
| | | | - Francesco Vairo
- National Institute for Infectious Diseases "Lazzaro Spallanzani," Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,International Public Health Crisis Group, Milan, Italy
| | - Gary P Kobinger
- International Public Health Crisis Group, Milan, Italy.,Research Centre on Infectious Diseases, Faculty of Medicine, Université Laval, Québec, Canada
| | - Antonio Pesenti
- EMERGENCY, Milan, Italy.,Department of Anesthesia, Critical Care Medicine and Emergency, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda-Ospedale Maggiore Policlinico, and Department of Pathophysiology and Transplantation, University of Milan
| | - Martin Langer
- EMERGENCY, Milan, Italy.,Department of Oncology and Onco-Hematology, University of Milan, and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Soccoh Kabia
- Connaught Hospital Tower Hill, Freetown, Sierra Leone
| | | | - Jackson Amone
- Department of Clinical Services, Ministry of Health, Kampala, Uganda
| | - Concetta Castilletti
- National Institute for Infectious Diseases "Lazzaro Spallanzani," Istituto di Ricovero e Cura a Carattere Scientifico , Rome, Italy
| | | | - Maria Rosaria Capobianchi
- National Institute for Infectious Diseases "Lazzaro Spallanzani," Istituto di Ricovero e Cura a Carattere Scientifico , Rome, Italy
| | - Gino Strada
- International Public Health Crisis Group, Milan, Italy.,EMERGENCY, Milan, Italy
| | - Alimuddin Zumla
- International Public Health Crisis Group, Milan, Italy.,Division of Infection and Immunity, University College London, and National Institute for Health Research Biomedical Research Centre at University College London Hospitals NHS Foundation Trust, United Kingdom
| | - Antonino Di Caro
- National Institute for Infectious Diseases "Lazzaro Spallanzani," Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,International Public Health Crisis Group, Milan, Italy
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases "Lazzaro Spallanzani," Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,International Public Health Crisis Group, Milan, Italy
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16
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Reynard S, Journeaux A, Gloaguen E, Schaeffer J, Varet H, Pietrosemoli N, Mateo M, Baillet N, Laouenan C, Raoul H, Mullaert J, Baize S. Immune parameters and outcomes during Ebola virus disease. JCI Insight 2019; 4:125106. [PMID: 30626757 DOI: 10.1172/jci.insight.125106] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/29/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The West African Ebola virus epidemic from 2014-2016 highlighted the lack of knowledge about the pathogenicity of the virus and the factors responsible for outcome. A performant and rapid diagnosis is of crucial importance, as is overcoming the difficulty of providing high-quality patient management during such an extensive outbreak. Here, we propose to study the role of the immune mediators during Ebola virus disease and to define some molecules of importance in the outcome. METHODS Plasma from Guinean patients sampled during the outbreak were analyzed using RT-qPCR, magnetic bead assay, ELISA, and high-quality statistical analyses. We also performed a transcriptomic analysis in leukocytes samples. Therefore, we deeply characterized the immune responses involved in Ebola virus disease. RESULTS We evaluated the immune patterns depending on the outcome of the disease. Survivors presented an efficient and well-balanced immune response, whereas fatalities were characterized by an intense inflammatory response, overexpression of multiple cytokines, and a "chemokine storm." The plasma concentration of most of the parameters tested increased until death. Statistical analyses also allowed us to define a panel of markers highly predictive of outcome. CONCLUSION The immune response observed in fatalities was highly similar to that characterizing septic shock syndrome. Our results suggest that immune responses can play a major pathogenic role during severe Ebola virus infection and argue in favor of therapeutic approaches that act on both viral replication and the induction of shock syndrome. FUNDING French Ministry of Foreign Affairs, the Agence Française de Développement, and the Institut Pasteur.
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Affiliation(s)
- Stéphanie Reynard
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Centre International de Recherche en Infectiologie, Université Lyon I, INSERM, CNRS, ENS Lyon, Lyon, France
| | - Alexandra Journeaux
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Centre International de Recherche en Infectiologie, Université Lyon I, INSERM, CNRS, ENS Lyon, Lyon, France
| | - Emilie Gloaguen
- Infection Antimicrobials Modelling Evolution, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Justine Schaeffer
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Centre International de Recherche en Infectiologie, Université Lyon I, INSERM, CNRS, ENS Lyon, Lyon, France
| | - Hugo Varet
- Institut Pasteur, Hub Bioinformatique et Biostatistique, Centre de Bioinformatique, Biostatistique et Biologie Intégrative, C3BI, USR 3756 IP CNRS, Paris, France
| | - Natalia Pietrosemoli
- Institut Pasteur, Hub Bioinformatique et Biostatistique, Centre de Bioinformatique, Biostatistique et Biologie Intégrative, C3BI, USR 3756 IP CNRS, Paris, France
| | - Mathieu Mateo
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Centre International de Recherche en Infectiologie, Université Lyon I, INSERM, CNRS, ENS Lyon, Lyon, France
| | - Nicolas Baillet
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Centre International de Recherche en Infectiologie, Université Lyon I, INSERM, CNRS, ENS Lyon, Lyon, France
| | - Cédric Laouenan
- Infection Antimicrobials Modelling Evolution, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France
| | - Hervé Raoul
- Laboratoire P4 Jean Mérieux-INSERM, INSERM, Lyon, France
| | - Jimmy Mullaert
- Infection Antimicrobials Modelling Evolution, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Sylvain Baize
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Centre International de Recherche en Infectiologie, Université Lyon I, INSERM, CNRS, ENS Lyon, Lyon, France
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17
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Amissah-Arthur MB, Poller B, Tunbridge A, Adebajo A. Musculoskeletal manifestations of Ebola virus. Rheumatology (Oxford) 2017; 57:28-31. [PMID: 28379487 DOI: 10.1093/rheumatology/kex082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Indexed: 02/06/2023] Open
Abstract
The 2014 West African Ebola virus disease outbreak shocked the world as it swept through the region leaving Guinea, Liberia and Sierra Leone struggling to gain control. As the largest Ebola virus disease outbreak to date, there are more survivors in its wake than ever before, with a spectrum of health problems requiring management. Here we review various musculoskeletal manifestations of the virus that can occur both during and after the infection, and consider possible pathogenesis.
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Affiliation(s)
| | - Bozena Poller
- Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital
| | - Anne Tunbridge
- Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital
| | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
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18
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Mérens A, Bigaillon C, Delaune D. Ebola virus disease: Biological and diagnostic evolution from 2014 to 2017. Med Mal Infect 2017; 48:83-94. [PMID: 29224715 DOI: 10.1016/j.medmal.2017.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
The Ebola virus disease outbreak observed in West Africa from March 2014 to June 2016 has led to many fundamental and applied research works. Knowledge of this virus has substantially increased. Treatment of many patients in epidemic countries and a few imported cases in developed countries led to developing new diagnostic methods and to adapt laboratory organization and biosafety precautions to perform conventional biological analyses. Clinical and biological monitoring of patients infected with Ebola virus disease helped to determine severity criteria and bad prognosis markers. It also contributed to showing the possibility of viral sanctuaries in patients and the risk of transmission after recovery. After a summary of recent knowledge of environmental and clinical viral persistence, we aimed to present new diagnostic methods and other biological tests that led to highlighting the pathophysiological consequences of Ebola virus disease and its prognostic markers. We also aimed to describe our lab experience in the care of Ebola virus-infected patients, especially technical and logistical changes between 2014 and 2017.
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Affiliation(s)
- A Mérens
- Laboratoire de biologie, hôpital d'instruction des Armées-Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - C Bigaillon
- Laboratoire de biologie, hôpital d'instruction des Armées-Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - D Delaune
- Laboratoire de biologie, hôpital d'instruction des Armées-Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
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19
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Irenge LM, Dindart JM, Gala JL. Biochemical testing in a laboratory tent and semi-intensive care of Ebola patients on-site in a remote part of Guinea: a paradigm shift based on a bleach-sensitive point-of-care device. Clin Chem Lab Med 2017; 55:1881-1890. [PMID: 28306518 DOI: 10.1515/cclm-2016-0456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 02/04/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND During the West Africa Ebola virus disease (EVD) outbreak, a Belgian laboratory was deployed for supporting the Ebola treatment unit (ETU) of N'Zerekore, Guinea. Besides diagnosis of EVD and malaria, biochemical parameters were tested and used to guide supportive treatment of EVD. METHODS To preserve analytes stability, lithium-heparin blood samples were analyzed using the i-STAT® point-of-care testing (POCT) handheld device without the viral inactivation step. To mitigate the risk of Ebola virus transmission, assays were performed inside a portable glovebox with strict biosafety procedures. RESULTS Providing the medical staff with real-time biochemical data modified their therapeutic attitude, shifting from empiric to a semi-intensive laboratory-guided treatment of hydro-electrolytic disturbances, metabolic acidosis and/or impaired kidney function. As illustrated with representative EVD cases (n=8), optimized supportive treatment with intravenous fluid therapy and electrolyte replacement often helped correct these abnormalities. However, the harsh operating conditions, especially the use of bleach decontamination inside the glovebox, caused several technical failures and the final breakdown of the POCT device. CONCLUSIONS POCT availability resulted in a paradigm shift in laboratory practice and care delivery at the N'Zerekore ETU. We conclude that there is urgent need for novel well-designed and validated POCT devices usable by non-expert operators in high ambient temperature and limited space. These devices should withstand regular and thorough decontamination by the personnel working on-site with life-threatening pathogens and be compatible with high biosafety level procedures. Such specific users' requirements need a European validation and standardization process of proposed solutions led by the EU Standardization Committee (CEN).
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20
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Rojek A, Horby P, Dunning J. Insights from clinical research completed during the west Africa Ebola virus disease epidemic. THE LANCET. INFECTIOUS DISEASES 2017; 17:e280-e292. [PMID: 28461209 PMCID: PMC5856335 DOI: 10.1016/s1473-3099(17)30234-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/05/2016] [Accepted: 02/09/2017] [Indexed: 12/27/2022]
Abstract
The west Africa Ebola virus disease (EVD) epidemic was extraordinary in scale. Now that the epidemic has ended, it is a relevant time to examine published studies with direct relevance to clinical care and, more broadly, to examine the implications of the clinical research response mounted. Clinically relevant research includes literature detailing risk factors for and clinical manifestations of EVD, laboratory and other investigation findings in patients, experimental vaccine and therapeutic clinical trials, and analyses of survivor syndrome. In this Review, we discuss new insights from patient-oriented research completed during the west Africa epidemic, identify ongoing knowledge gaps, and suggest priorities for future research.
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Affiliation(s)
- Amanda Rojek
- Epidemic Diseases Research Group Oxford (ERGO), Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Peter Horby
- Epidemic Diseases Research Group Oxford (ERGO), Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jake Dunning
- Epidemic Diseases Research Group Oxford (ERGO), Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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21
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Vernet MA, Reynard S, Fizet A, Schaeffer J, Pannetier D, Guedj J, Rives M, Georges N, Garcia-Bonnet N, Sylla AI, Grovogui P, Kerherve JY, Savio C, Savio-Coste S, de Séverac ML, Zloczewski P, Linares S, Harouna S, Abdoul BM, Petitjean F, Samake N, Shepherd S, Kinda M, Koundouno FR, Joxe L, Mateo M, Lecine P, Page A, Tchamdja TM, Schoenhals M, Barbe S, Simon B, Tran-Minh T, Longuet C, L'Hériteau F, Baize S. Clinical, virological, and biological parameters associated with outcomes of Ebola virus infection in Macenta, Guinea. JCI Insight 2017; 2:e88864. [PMID: 28352651 DOI: 10.1172/jci.insight.88864] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
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. FUNDING. The French Ministry of Foreign Affairs, the Agence Française de Développement, and Institut Pasteur.
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Affiliation(s)
| | - Stéphanie Reynard
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France.,Centre International de Recherche en Infectiologie, Université de Lyon, INSERM, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS UMR5308, Lyon, France
| | - Alexandra Fizet
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France.,Centre International de Recherche en Infectiologie, Université de Lyon, INSERM, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS UMR5308, Lyon, France
| | - Justine Schaeffer
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France.,Centre International de Recherche en Infectiologie, Université de Lyon, INSERM, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS UMR5308, Lyon, France
| | | | - Jeremie Guedj
- INSERM, Infection, Antimicrobials, Modelling, Evolution, UMR 1137, Université Paris Diderot, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France
| | - Max Rives
- Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France
| | - Nadia Georges
- Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France
| | - Nathalie Garcia-Bonnet
- Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France
| | | | - Péma Grovogui
- Ministère de la Santé, Conakry, République de Guinée
| | - Jean-Yves Kerherve
- Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France
| | - Christophe Savio
- Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France
| | - Sylvie Savio-Coste
- Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France
| | - Marie-Laure de Séverac
- Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France
| | - Philippe Zloczewski
- Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France
| | - Sandrine Linares
- Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France
| | - Souley Harouna
- Alliance for International Medical Action, Montreuil, France
| | | | | | - Nenefing Samake
- Alliance for International Medical Action, Montreuil, France
| | - Susan Shepherd
- Alliance for International Medical Action, Montreuil, France
| | - Moumouni Kinda
- Alliance for International Medical Action, Montreuil, France
| | | | - Ludovic Joxe
- Alliance for International Medical Action, Montreuil, France
| | - Mathieu Mateo
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France.,Centre International de Recherche en Infectiologie, Université de Lyon, INSERM, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS UMR5308, Lyon, France
| | | | - Audrey Page
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France.,Centre International de Recherche en Infectiologie, Université de Lyon, INSERM, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS UMR5308, Lyon, France
| | - Tang Maleki Tchamdja
- Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France
| | | | - Solenne Barbe
- Alliance for International Medical Action, Montreuil, France
| | | | | | | | | | - Sylvain Baize
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France.,Centre International de Recherche en Infectiologie, Université de Lyon, INSERM, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS UMR5308, Lyon, France
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22
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Smit MA, Michelow IC, Glavis-Bloom J, Wolfman V, Levine AC. Characteristics and Outcomes of Pediatric Patients With Ebola Virus Disease Admitted to Treatment Units in Liberia and Sierra Leone: A Retrospective Cohort Study. Clin Infect Dis 2017; 64:243-249. [PMID: 28011610 PMCID: PMC5241778 DOI: 10.1093/cid/ciw725] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/24/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The clinical and virologic characteristics of Ebola virus disease (EVD) in children have not been thoroughly documented. METHODS Consecutive children aged <18 years with real-time polymerase chain reaction (RT-PCR)-confirmed EVD were enrolled retrospectively in 5 Ebola treatment units in Liberia and Sierra Leone in 2014/2015. Data collection and medical management were based on standardized International Medical Corps protocols. We performed descriptive statistics, multivariate logistic regression, and Kaplan-Meier survival analyses. RESULTS Of 122 children enrolled, the median age was 7 years and one-third were aged <5 years. The female-to-male ratio was 1.3. The most common clinical features at triage and during hospitalization were fever, weakness, anorexia, and diarrhea, although 21% of patients were initially afebrile and 6 patients remained afebrile. Bleeding was rare at presentation (5%) and manifested subsequently in fewer than 50%. The overall case fatality rate was 57%. Factors associated with death in bivariate analyses were age <5 years, bleeding at any time during hospitalization, and high viral load. After adjustment with logistic regression modeling, the odds of death were 14.8-fold higher if patients were aged <5 years, 5-fold higher if the patient had any evidence of bleeding, and 5.2-fold higher if EVD RT-PCR cycle threshold value was ≤20. Plasmodium parasitemia had no impact on EVD outcomes. CONCLUSIONS Age <5 years, bleeding, and high viral loads were poor prognostic indicators of children with EVD. Research to understand mechanisms of these risk factors and the impact of dehydration and electrolyte imbalance will improve health outcomes.
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Affiliation(s)
- Michael A Smit
- Warren Alpert Medical School, and
- Department of Pediatrics, Division of Infectious Diseases, Brown University, Providence, Rhode Island; and
| | - Ian C Michelow
- Warren Alpert Medical School, and
- Department of Pediatrics, Division of Infectious Diseases, Brown University, Providence, Rhode Island; and
| | | | | | - Adam C Levine
- Warren Alpert Medical School, and
- International Medical Corps, Los Angeles, California
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23
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Baseler L, Chertow DS, Johnson KM, Feldmann H, Morens DM. The Pathogenesis of Ebola Virus Disease. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2017; 12:387-418. [DOI: 10.1146/annurev-pathol-052016-100506] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Laura Baseler
- Department of Veterinary Medicine and Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Daniel S. Chertow
- Critical Care Medicine Department, Clinical Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892
| | - Karl M. Johnson
- Founder, Special Pathogens Branch, Centers for Disease Control and Prevention, Placitas, New Mexico 87043
| | - Heinz Feldmann
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana 59840
| | - David M. Morens
- Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892;
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24
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[Ebola virus disease: Clinical presentation, prognosis and treatment]. Rev Med Interne 2016; 38:181-187. [PMID: 27717513 DOI: 10.1016/j.revmed.2016.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 07/30/2016] [Indexed: 01/01/2023]
Abstract
The clinical spectrum of Ebola virus disease (EVD) ranges from very serious forms with organ failure and death within days to paucisymptomatic forms and perhaps even asymptomatic. The authors propose a focus on the clinical manifestations of EVD, on prognosis and on therapeutic aspects (excluding resuscitation). This work extracts from the literature the main data gathered during the 2014-2015 epidemic that raged in Guinea Conakry and Sierra Leone. These two countries, even if they are separated by a border, are one and the same population base. The characteristics of the epidemic in Liberia have not been analyzed. The authors have treated EVD patients in the health workers treatment center of Conakry and enrich this work about their personal experience.
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25
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Arranz J, Lundeby KM, Hassan S, Zabala Fuentes LM, San José Garcés P, Haaskjold YL, Bolkan HA, Krogh KØ, Jongopi J, Mellesmo S, Jøsendal O, Øpstad Å, Svensen E, Kamara AS, Roberts DP, Stamper PD, Austin P, Moosa AJ, Marke D, Berg Å, Blomberg B, Riera M. Clinical features of suspected Ebola cases referred to the Moyamba ETC, Sierra Leone: challenges in the later stages of the 2014 outbreak. BMC Infect Dis 2016; 16:308. [PMID: 27334891 PMCID: PMC4916532 DOI: 10.1186/s12879-016-1609-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 06/01/2016] [Indexed: 12/13/2022] Open
Abstract
Background The last ebola virus disease (EVD) outbreak has been the most important since 1976. EVD cases decreased drastically in Sierra Leone at the beginning of 2015. We aim to determine the clinical findings and evolution of patients admitted to an Ebola treatment center (ETC) during the epidemic’s late phase. Methods We analyze retrospectively data of patients admitted to the Moyamba ETC (December 2014-March 2015). Patients were classified in EVD or non-EVD patients according to the results of Ebola virus real-time reverse transcription polymerase chain reaction (ZAIRE-RT-PCR). Results Seventy-five patients were included, 41.3 % were positive for ZAIRE-RT-PCR. More women (68 % vs 28 %, p = 0.001) were EVD-positive. More EVD patients had previous contact with an Ebola patient (74.2 % vs 36.3 %, p < 0.001). At admission, EVD patients were more likely to have fatigue (96.7 %, p < 0.001), diarrhea (67.7 %, p = 0.002), and muscle pain (61.3 %, p = 0.009); but only objective fevers in 35.5 % of EVD patients. The most reliable criteria for diagnosis were: contact with an Ebola patient plus three WHO symptoms (LR + =3.7, 95 % CI = 1.9–7.3), and positive contact (LR + =2.3, 95 % CI = 1.15–4.20). Only 45.2 % of EVD patients developed fevers during stay, but 75 % developed gastrointestinal symptoms. Non-EVD patients had gastrointestinal problems (33 %), respiratory conditions (26.6 %), and others such as malaria, HIV or tuberculosis with a mortality rate of 11.4 %. vs 58 % in EVD group (p < 0.001). Conclusions More non-EVD patients were admitted in the outbreak’s late phases. The low percentage of initial fever highlights the need to emphasize the epidemiological information. EVD patients presented new symptoms getting worse and requiring closer follow-up. Diagnoses of non-EVD patients were diverse with a remarkable mortality, presenting a challenge for the health system.
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Affiliation(s)
- Javier Arranz
- Médicos del Mundo, Madrid, Spain. .,Arquitecte Bennassar Health Center, Palma de Mallorca, Illes Balears, Spain. .,Instituto de Investigación de Palma (IDISPA), Palma de Mallorca, Illes Balears, Spain.
| | | | - Shoaib Hassan
- Field Epidemiology and Laboratory Training Program Pakistan (FELTP), Islamabad, Pakistan
| | | | | | | | | | | | - James Jongopi
- Moyamba District Hospital, Moyamba, Moyamba, Sierra Leone
| | | | | | | | - Erling Svensen
- Haukeland University Hospital, Bergen, Norway.,University of Bergen, Bergen, Norway
| | | | | | | | | | | | - Dennis Marke
- Moyamba District Hospital, Moyamba, Moyamba, Sierra Leone
| | - Åse Berg
- Stavanger University Hospital, Stavanger, Norway
| | - Bjørn Blomberg
- Haukeland University Hospital, Bergen, Norway.,University of Bergen, Bergen, Norway
| | - Melcior Riera
- Médicos del Mundo, Madrid, Spain.,Instituto de Investigación de Palma (IDISPA), Palma de Mallorca, Illes Balears, Spain.,Hospital Son Espases, Palma de Mallorca, Spain
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26
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Dubost C, Pasquier P, Kearns K, Ficko C, Rapp C, Wolff M, Richard JC, Diehl JL, Le Tulzo Y, Mérat S. Preparation of an intensive care unit in France for the reception of a confirmed case of Ebola virus infection. Anaesth Crit Care Pain Med 2015; 34:349-55. [PMID: 26620545 PMCID: PMC7104235 DOI: 10.1016/j.accpm.2015.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/18/2015] [Accepted: 10/20/2015] [Indexed: 11/25/2022]
Abstract
The current Ebola Virus Disease (EVD) outbreak in West Africa is a major challenge for the worldwide medical community. On April 29th 2015, the World Health Organization (WHO) declared 26,277 infected cases; among them, 10,884 have deceased. The epidemic is still ongoing, particularly in Sierra Leone. It is now clear that northern countries will be implicated in the care of EVD patients, both in the field and back at home. Because of the severity of EVD, a fair amount of patients may require intensive care. It is highly probable that intensive care would be able to significantly reduce the mortality linked with EVD. The preparation of a modern Intensive Care Unit (ICU) to treat an EVD patient in good conditions requires time and specific equipment. The cornerstone of this preparation includes two main goals: treating the patient and protecting healthcare providers. Staff training is time consuming and must be performed far in advance of patient arrival. To be efficient, preparation should be planned at a national level with help from public authorities, as was the case in France during the summer of 2014. Due to the severity of the disease, the high risk of transmission and scarce knowledge on EVD treatment, our propositions are necessarily original and innovative. Our review includes four topics: a brief report on the actual outbreak, where to receive and hospitalize the patients, the specific organization of the ICU and finally ethical aspects.
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Affiliation(s)
- Clément Dubost
- Anaesthesiology and intensive care medicine, Begin Military Hospital, 69, avenue de Paris, 94163 Saint-Mande, France.
| | - Pierre Pasquier
- Anaesthesiology and intensive care medicine, Begin Military Hospital, 69, avenue de Paris, 94163 Saint-Mande, France.
| | - Kévin Kearns
- Anaesthesiology and intensive care medicine, Begin Military Hospital, 69, avenue de Paris, 94163 Saint-Mande, France.
| | - Cécile Ficko
- Anaesthesiology and intensive care medicine, Begin Military Hospital, 69, avenue de Paris, 94163 Saint-Mande, France.
| | - Christophe Rapp
- Infectious disease, Begin Military Hospital, 69, avenue de Paris, 94163 Saint-Mande, France.
| | - Michel Wolff
- Intensive care medicine, Bichat University Hospital Bichat, 46, rue Henri-Huchard, 75877 Paris, France.
| | - Jean-Christophe Richard
- Intensive care medicine, hôpital de la Croix-Rousse, 93, grande rue de la Croix-Rousse, 69317 Lyon, France.
| | - Jean-Luc Diehl
- Intensive care medicine, European Hospital Georges-Pompidou, 20, rue Leblanc, 75908 Paris, France.
| | - Yves Le Tulzo
- Intensive care medicine, University Hospital of Rennes Pointchaillou, 33053 Rennes, France.
| | - Stéphane Mérat
- Anaesthesiology and intensive care medicine, Begin Military Hospital, 69, avenue de Paris, 94163 Saint-Mande, France.
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