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

Article Article scientifique Article Clinical Management of Ebola Virus Disease in the United States and Europe eng 2016 author Uyeki Timothy M author Mehta Aneesh K author Davey Richard T (Jr) author Liddell Allison M author Wolf Timo author Vetter Pauline 673142 author Schmiedel Stefan author Grünewald Thomas author Jacobs Michael author Arribas Jose R author Evans Laura author Hewlett Angela L author Brantsaeter Arne B author Ippolito Giuseppe author Rapp Christophe author Hoepelman Andy I M author Gutman Julie Working Group of the U.S.–European Clinical Network on Clinical Management of Ebola Virus Disease Patients in the U.S. and Europe collaborator Kaiser Laurent 28229 Département de médecine (DEMED) collaborator Schibler Manuel 96444 Département de médecine (DEMED) collaborator Pugin Jérôme 69624 Décanat et administration de la faculté de médecine (ADMED) collaborator Ginet Claude 697458 collaborator Dayer Julie-Anne 583248 collaborator Genevois Emilie 875158 collaborator Csaki Huttner Angela 788122 Département de médecine (DEMED) collaborator Siegrist Claire-Anne 26816 Décanat et administration de la faculté de médecine (ADMED) collaborator Waldvogel Abramowski Sophie 87692 Département de médecine (DEMED) collaborator Samii Kaveh 24652 636-646 10.1056/NEJMoa1504874 26886522 0028-4793 PMC4972324 https://www.nejm.org/doi/10.1056/NEJMoa1504874 Background: Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. Methods: We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015. Results: A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%. Conclusions: Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived. Adult Aged Anti-Bacterial Agents/therapeutic use Combined Modality Therapy Critical Care Ebolavirus/genetics/isolation & purification Electrolytes/therapeutic use Europe Female Fluid Therapy Hemorrhagic Fever Ebola/complications/mortality/therapy Humans Length of Stay Male Middle Aged RNA Viral/blood Respiration Artificial Severity of Illness Index Transaminases/blood United States Viral Load Dewey 616 Dewey 617 56 Département de médecine 221 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false 400 Virologie clinique 668 New England Journal of Medicine 374 7 bb42bbfc-a949-40b7-b315-d101750024e7 Article (Accepted version) Public Clinical_Management_Ebola_Virus_Disease_United_StatesandEurope.pdf 331925 application/pdf db852969-79b7-469c-9cc0-cb4536ce85bc Article (Published version) Restricted NEJMoa1504874.pdf 434806 application/pdf efd8b614d9e41e7ccc9f2a351050ea053f8e0577f2acdcf0b408f5db60d2cb81 271aa23e-b5b9-4903-ab5e-830031477281 Appendix Public nejmoa1504874_appendix.pdf 2205131 application/pdf 51de899001dd292bad78ab51da0faaa8b1e59039fe4ea0ad9211c88952231a83 openAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

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