Clinical presentation of patients with ebola virus disease in Conakry, Guinea

Elhadj Ibrahima Bah, Marie Claire Lamah, Tom Fletcher, Shevin T. Jacob, David M. Brett-Major, Amadou Alpha Sall, Nahoko Shindo, William A. Fischer, Francois Lamontagne, Sow Mamadou Saliou, Daniel G. Bausch, Barry Moumié, Tim Jagatic, Armand Sprecher, James V. Lawler, Thierry Mayet, Frederique A. Jacquerioz, María F.Méndez Baggi, Constanza Vallenas, Christophe ClementSimon Mardel, Ousmane Faye, Oumar Faye, Baré Soropogui, Nfaly Magassouba, Lamine Koivogui, Ruxandra Pinto, Robert A. Fowler

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268 Citations (Scopus)

Abstract

Background In March 2014, the World Health Organization was notified of an outbreak of Zaire ebolavirus in a remote area of Guinea. The outbreak then spread to the capital, Conakry, and to neighboring countries and has subsequently become the largest epidemic of Ebola virus disease (EVD) to date. Methods From March 25 to April 26, 2014, we performed a study of all patients with laboratoryconfirmed EVD in Conakry. Mortality was the primary outcome. Secondary outcomes included patient characteristics, complications, treatments, and comparisons between survivors and nonsurvivors. Results Of 80 patients who presented with symptoms, 37 had laboratory-confirmed EVD. Among confirmed cases, the median age was 38 years (interquartile range, 28 to 46), 24 patients (65%) were men, and 14 (38%) were health care workers; among the health care workers, nosocomial transmission was implicated in 12 patients (32%). Patients with confirmed EVD presented to the hospital a median of 5 days (interquartile range, 3 to 7) after the onset of symptoms, most commonly with fever (in 84% of the patients; mean temperature, 38.6°C), fatigue (in 65%), diarrhea (in 62%), and tachycardia (mean heart rate, >93 beats per minute). Of these patients, 28 (76%) were treated with intravenous fluids and 37 (100%) with antibiotics. Sixteen patients (43%) died, with a median time from symptom onset to death of 8 days (interquartile range, 7 to 11). Patients who were 40 years of age or older, as compared with those under the age of 40 years, had a relative risk of death of 3.49 (95% confidence interval, 1.42 to 8.59; P = 0.007). Conclusions Patients with EVD presented with evidence of dehydration associated with vomiting and severe diarrhea. Despite attempts at volume repletion, antimicrobial therapy, and limited laboratory services, the rate of death was 43%.

Original languageEnglish (US)
Pages (from-to)40-47
Number of pages8
JournalNew England Journal of Medicine
Volume372
Issue number1
DOIs
StatePublished - Jan 1 2015

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Ebola Hemorrhagic Fever
Guinea
Disease Outbreaks
Diarrhea
Ebolavirus
Delivery of Health Care
Democratic Republic of the Congo
Mortality
Dehydration
Tachycardia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bah, E. I., Lamah, M. C., Fletcher, T., Jacob, S. T., Brett-Major, D. M., Sall, A. A., ... Fowler, R. A. (2015). Clinical presentation of patients with ebola virus disease in Conakry, Guinea. New England Journal of Medicine, 372(1), 40-47. https://doi.org/10.1056/NEJMoa1411249

Clinical presentation of patients with ebola virus disease in Conakry, Guinea. / Bah, Elhadj Ibrahima; Lamah, Marie Claire; Fletcher, Tom; Jacob, Shevin T.; Brett-Major, David M.; Sall, Amadou Alpha; Shindo, Nahoko; Fischer, William A.; Lamontagne, Francois; Saliou, Sow Mamadou; Bausch, Daniel G.; Moumié, Barry; Jagatic, Tim; Sprecher, Armand; Lawler, James V.; Mayet, Thierry; Jacquerioz, Frederique A.; Baggi, María F.Méndez; Vallenas, Constanza; Clement, Christophe; Mardel, Simon; Faye, Ousmane; Faye, Oumar; Soropogui, Baré; Magassouba, Nfaly; Koivogui, Lamine; Pinto, Ruxandra; Fowler, Robert A.

In: New England Journal of Medicine, Vol. 372, No. 1, 01.01.2015, p. 40-47.

Research output: Contribution to journalArticle

Bah, EI, Lamah, MC, Fletcher, T, Jacob, ST, Brett-Major, DM, Sall, AA, Shindo, N, Fischer, WA, Lamontagne, F, Saliou, SM, Bausch, DG, Moumié, B, Jagatic, T, Sprecher, A, Lawler, JV, Mayet, T, Jacquerioz, FA, Baggi, MFM, Vallenas, C, Clement, C, Mardel, S, Faye, O, Faye, O, Soropogui, B, Magassouba, N, Koivogui, L, Pinto, R & Fowler, RA 2015, 'Clinical presentation of patients with ebola virus disease in Conakry, Guinea', New England Journal of Medicine, vol. 372, no. 1, pp. 40-47. https://doi.org/10.1056/NEJMoa1411249
Bah EI, Lamah MC, Fletcher T, Jacob ST, Brett-Major DM, Sall AA et al. Clinical presentation of patients with ebola virus disease in Conakry, Guinea. New England Journal of Medicine. 2015 Jan 1;372(1):40-47. https://doi.org/10.1056/NEJMoa1411249
Bah, Elhadj Ibrahima ; Lamah, Marie Claire ; Fletcher, Tom ; Jacob, Shevin T. ; Brett-Major, David M. ; Sall, Amadou Alpha ; Shindo, Nahoko ; Fischer, William A. ; Lamontagne, Francois ; Saliou, Sow Mamadou ; Bausch, Daniel G. ; Moumié, Barry ; Jagatic, Tim ; Sprecher, Armand ; Lawler, James V. ; Mayet, Thierry ; Jacquerioz, Frederique A. ; Baggi, María F.Méndez ; Vallenas, Constanza ; Clement, Christophe ; Mardel, Simon ; Faye, Ousmane ; Faye, Oumar ; Soropogui, Baré ; Magassouba, Nfaly ; Koivogui, Lamine ; Pinto, Ruxandra ; Fowler, Robert A. / Clinical presentation of patients with ebola virus disease in Conakry, Guinea. In: New England Journal of Medicine. 2015 ; Vol. 372, No. 1. pp. 40-47.
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abstract = "Background In March 2014, the World Health Organization was notified of an outbreak of Zaire ebolavirus in a remote area of Guinea. The outbreak then spread to the capital, Conakry, and to neighboring countries and has subsequently become the largest epidemic of Ebola virus disease (EVD) to date. Methods From March 25 to April 26, 2014, we performed a study of all patients with laboratoryconfirmed EVD in Conakry. Mortality was the primary outcome. Secondary outcomes included patient characteristics, complications, treatments, and comparisons between survivors and nonsurvivors. Results Of 80 patients who presented with symptoms, 37 had laboratory-confirmed EVD. Among confirmed cases, the median age was 38 years (interquartile range, 28 to 46), 24 patients (65{\%}) were men, and 14 (38{\%}) were health care workers; among the health care workers, nosocomial transmission was implicated in 12 patients (32{\%}). Patients with confirmed EVD presented to the hospital a median of 5 days (interquartile range, 3 to 7) after the onset of symptoms, most commonly with fever (in 84{\%} of the patients; mean temperature, 38.6°C), fatigue (in 65{\%}), diarrhea (in 62{\%}), and tachycardia (mean heart rate, >93 beats per minute). Of these patients, 28 (76{\%}) were treated with intravenous fluids and 37 (100{\%}) with antibiotics. Sixteen patients (43{\%}) died, with a median time from symptom onset to death of 8 days (interquartile range, 7 to 11). Patients who were 40 years of age or older, as compared with those under the age of 40 years, had a relative risk of death of 3.49 (95{\%} confidence interval, 1.42 to 8.59; P = 0.007). Conclusions Patients with EVD presented with evidence of dehydration associated with vomiting and severe diarrhea. Despite attempts at volume repletion, antimicrobial therapy, and limited laboratory services, the rate of death was 43{\%}.",
author = "Bah, {Elhadj Ibrahima} and Lamah, {Marie Claire} and Tom Fletcher and Jacob, {Shevin T.} and Brett-Major, {David M.} and Sall, {Amadou Alpha} and Nahoko Shindo and Fischer, {William A.} and Francois Lamontagne and Saliou, {Sow Mamadou} and Bausch, {Daniel G.} and Barry Moumi{\'e} and Tim Jagatic and Armand Sprecher and Lawler, {James V.} and Thierry Mayet and Jacquerioz, {Frederique A.} and Baggi, {Mar{\'i}a F.M{\'e}ndez} and Constanza Vallenas and Christophe Clement and Simon Mardel and Ousmane Faye and Oumar Faye and Bar{\'e} Soropogui and Nfaly Magassouba and Lamine Koivogui and Ruxandra Pinto and Fowler, {Robert A.}",
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T1 - Clinical presentation of patients with ebola virus disease in Conakry, Guinea

AU - Bah, Elhadj Ibrahima

AU - Lamah, Marie Claire

AU - Fletcher, Tom

AU - Jacob, Shevin T.

AU - Brett-Major, David M.

AU - Sall, Amadou Alpha

AU - Shindo, Nahoko

AU - Fischer, William A.

AU - Lamontagne, Francois

AU - Saliou, Sow Mamadou

AU - Bausch, Daniel G.

AU - Moumié, Barry

AU - Jagatic, Tim

AU - Sprecher, Armand

AU - Lawler, James V.

AU - Mayet, Thierry

AU - Jacquerioz, Frederique A.

AU - Baggi, María F.Méndez

AU - Vallenas, Constanza

AU - Clement, Christophe

AU - Mardel, Simon

AU - Faye, Ousmane

AU - Faye, Oumar

AU - Soropogui, Baré

AU - Magassouba, Nfaly

AU - Koivogui, Lamine

AU - Pinto, Ruxandra

AU - Fowler, Robert A.

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N2 - Background In March 2014, the World Health Organization was notified of an outbreak of Zaire ebolavirus in a remote area of Guinea. The outbreak then spread to the capital, Conakry, and to neighboring countries and has subsequently become the largest epidemic of Ebola virus disease (EVD) to date. Methods From March 25 to April 26, 2014, we performed a study of all patients with laboratoryconfirmed EVD in Conakry. Mortality was the primary outcome. Secondary outcomes included patient characteristics, complications, treatments, and comparisons between survivors and nonsurvivors. Results Of 80 patients who presented with symptoms, 37 had laboratory-confirmed EVD. Among confirmed cases, the median age was 38 years (interquartile range, 28 to 46), 24 patients (65%) were men, and 14 (38%) were health care workers; among the health care workers, nosocomial transmission was implicated in 12 patients (32%). Patients with confirmed EVD presented to the hospital a median of 5 days (interquartile range, 3 to 7) after the onset of symptoms, most commonly with fever (in 84% of the patients; mean temperature, 38.6°C), fatigue (in 65%), diarrhea (in 62%), and tachycardia (mean heart rate, >93 beats per minute). Of these patients, 28 (76%) were treated with intravenous fluids and 37 (100%) with antibiotics. Sixteen patients (43%) died, with a median time from symptom onset to death of 8 days (interquartile range, 7 to 11). Patients who were 40 years of age or older, as compared with those under the age of 40 years, had a relative risk of death of 3.49 (95% confidence interval, 1.42 to 8.59; P = 0.007). Conclusions Patients with EVD presented with evidence of dehydration associated with vomiting and severe diarrhea. Despite attempts at volume repletion, antimicrobial therapy, and limited laboratory services, the rate of death was 43%.

AB - Background In March 2014, the World Health Organization was notified of an outbreak of Zaire ebolavirus in a remote area of Guinea. The outbreak then spread to the capital, Conakry, and to neighboring countries and has subsequently become the largest epidemic of Ebola virus disease (EVD) to date. Methods From March 25 to April 26, 2014, we performed a study of all patients with laboratoryconfirmed EVD in Conakry. Mortality was the primary outcome. Secondary outcomes included patient characteristics, complications, treatments, and comparisons between survivors and nonsurvivors. Results Of 80 patients who presented with symptoms, 37 had laboratory-confirmed EVD. Among confirmed cases, the median age was 38 years (interquartile range, 28 to 46), 24 patients (65%) were men, and 14 (38%) were health care workers; among the health care workers, nosocomial transmission was implicated in 12 patients (32%). Patients with confirmed EVD presented to the hospital a median of 5 days (interquartile range, 3 to 7) after the onset of symptoms, most commonly with fever (in 84% of the patients; mean temperature, 38.6°C), fatigue (in 65%), diarrhea (in 62%), and tachycardia (mean heart rate, >93 beats per minute). Of these patients, 28 (76%) were treated with intravenous fluids and 37 (100%) with antibiotics. Sixteen patients (43%) died, with a median time from symptom onset to death of 8 days (interquartile range, 7 to 11). Patients who were 40 years of age or older, as compared with those under the age of 40 years, had a relative risk of death of 3.49 (95% confidence interval, 1.42 to 8.59; P = 0.007). Conclusions Patients with EVD presented with evidence of dehydration associated with vomiting and severe diarrhea. Despite attempts at volume repletion, antimicrobial therapy, and limited laboratory services, the rate of death was 43%.

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