Clinical management of ebola virus disease in the United States and Europe

Timothy M. Uyeki, Aneesh K. Mehta, Richard T. Davey, Allison M. Liddell, Timo Wolf, Pauline Vetter, Stefan Schmiedel, Thomas Grünewald, Michael Jacobs, Jose R. Arribas, Laura Evans, Angela L Hewlett, Arne B. Brantsaeter, Giuseppe Ippolito, Christophe Rapp, Andy I M Hoepelman, Julie Gutman

Research output: Contribution to journalArticle

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Abstract

Background Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. METHODS We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015. RESULTS A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renalreplacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%. CONCLUSIONS Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.

Original languageEnglish (US)
Pages (from-to)636-646
Number of pages11
JournalNew England Journal of Medicine
Volume374
Issue number7
DOIs
StatePublished - Feb 18 2016

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Ebola Hemorrhagic Fever
Western Africa
Respiratory Insufficiency
Electrolytes
Renal Insufficiency
Ebolavirus
Oliguria
Anuria
Hypoalbuminemia
Investigational Therapies
Hypokalemia
Nutritional Support
Hypocalcemia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Uyeki, T. M., Mehta, A. K., Davey, R. T., Liddell, A. M., Wolf, T., Vetter, P., ... Gutman, J. (2016). Clinical management of ebola virus disease in the United States and Europe. New England Journal of Medicine, 374(7), 636-646. https://doi.org/10.1056/NEJMoa1504874

Clinical management of ebola virus disease in the United States and Europe. / Uyeki, Timothy M.; Mehta, Aneesh K.; Davey, Richard T.; Liddell, Allison M.; Wolf, Timo; Vetter, Pauline; Schmiedel, Stefan; Grünewald, Thomas; Jacobs, Michael; Arribas, Jose R.; Evans, Laura; Hewlett, Angela L; Brantsaeter, Arne B.; Ippolito, Giuseppe; Rapp, Christophe; Hoepelman, Andy I M; Gutman, Julie.

In: New England Journal of Medicine, Vol. 374, No. 7, 18.02.2016, p. 636-646.

Research output: Contribution to journalArticle

Uyeki, TM, Mehta, AK, Davey, RT, Liddell, AM, Wolf, T, Vetter, P, Schmiedel, S, Grünewald, T, Jacobs, M, Arribas, JR, Evans, L, Hewlett, AL, Brantsaeter, AB, Ippolito, G, Rapp, C, Hoepelman, AIM & Gutman, J 2016, 'Clinical management of ebola virus disease in the United States and Europe', New England Journal of Medicine, vol. 374, no. 7, pp. 636-646. https://doi.org/10.1056/NEJMoa1504874
Uyeki TM, Mehta AK, Davey RT, Liddell AM, Wolf T, Vetter P et al. Clinical management of ebola virus disease in the United States and Europe. New England Journal of Medicine. 2016 Feb 18;374(7):636-646. https://doi.org/10.1056/NEJMoa1504874
Uyeki, Timothy M. ; Mehta, Aneesh K. ; Davey, Richard T. ; Liddell, Allison M. ; Wolf, Timo ; Vetter, Pauline ; Schmiedel, Stefan ; Grünewald, Thomas ; Jacobs, Michael ; Arribas, Jose R. ; Evans, Laura ; Hewlett, Angela L ; Brantsaeter, Arne B. ; Ippolito, Giuseppe ; Rapp, Christophe ; Hoepelman, Andy I M ; Gutman, Julie. / Clinical management of ebola virus disease in the United States and Europe. In: New England Journal of Medicine. 2016 ; Vol. 374, No. 7. pp. 636-646.
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AU - Uyeki, Timothy M.

AU - Mehta, Aneesh K.

AU - Davey, Richard T.

AU - Liddell, Allison M.

AU - Wolf, Timo

AU - Vetter, Pauline

AU - Schmiedel, Stefan

AU - Grünewald, Thomas

AU - Jacobs, Michael

AU - Arribas, Jose R.

AU - Evans, Laura

AU - Hewlett, Angela L

AU - Brantsaeter, Arne B.

AU - Ippolito, Giuseppe

AU - Rapp, Christophe

AU - Hoepelman, Andy I M

AU - Gutman, Julie

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N2 - Background Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. METHODS We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015. RESULTS A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renalreplacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%. CONCLUSIONS Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.

AB - Background Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. METHODS We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015. RESULTS A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renalreplacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%. CONCLUSIONS Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.

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