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Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone

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Schieffelin, John S., Shaffer, Jeffrey G., Goba, Augustine, Gbakie, Michael, Gire, Stephen K., Colubri, Andres, Sealfon, Rachel S.G., Kanneh, Lansana, Moigboi, Alex, Momoh, Mambu, Fullah, Mohammed, Moses, Lina M., Brown, Bethany L., Andersen, Kristian G., Winnicki, Sarah, Schaffner, Stephen F., Park, Daniel J., Yozwiak, Nathan L., Jiang, Pan-Pan, Kargbo, David, Jalloh, Simbirie, Fonnie, Mbalu, Sinnah, Vandi, French, Issa, Kovoma, Alice, Kamara, Fatima K., Tucker, Veronica, Konuwa, Edwin, Sellu, Josephine, Mustapha, Ibrahim, Foday, Momoh, Yillah, Mohamed, Kanneh, Franklyn, Saffa, Sidiki, Massally, James L.B., Boisen, Matt L., Branco, Luis M., Vandi, Mohamed A., Grant, Donald S., Happi, Christian, Gevao, Sahr M., Fletcher, Tom E., Fowler, Robert A., Bausch, Daniel G., Sabeti, Pardis C., Khan, S. Humarr and Garry, Robert F. (2014) 'Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone'. New England Journal of Medicine, Vol 371, Issue 22, pp. 2092-2100.

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Abstract

Background

Limited clinical and laboratory data are available on patients with Ebola virus disease (EVD). The Kenema Government Hospital in Sierra Leone, which had an existing infrastructure for research regarding viral hemorrhagic fever, has received and cared for patients with EVD since the beginning of the outbreak in Sierra Leone in May 2014.

Methods

We reviewed available epidemiologic, clinical, and laboratory records of patients in whom EVD was diagnosed between May 25 and June 18, 2014. We used quantitative reverse-transcriptase–polymerase-chain-reaction assays to assess the load of Ebola virus (EBOV, Zaire species) in a subgroup of patients.

Results

Of 106 patients in whom EVD was diagnosed, 87 had a known outcome, and 44 had detailed clinical information available. The incubation period was estimated to be 6 to 12 days, and the case fatality rate was 74%. Common findings at presentation included fever (in 89% of the patients), headache (in 80%), weakness (in 66%), dizziness (in 60%), diarrhea (in 51%), abdominal pain (in 40%), and vomiting (in 34%). Clinical and laboratory factors at presentation that were associated with a fatal outcome included fever, weakness, dizziness, diarrhea, and elevated levels of blood urea nitrogen, aspartate aminotransferase, and creatinine. Exploratory analyses indicated that patients under the age of 21 years had a lower case fatality rate than those over the age of 45 years (57% vs. 94%, P=0.03), and patients presenting with fewer than 100,000 EBOV copies per milliliter had a lower case fatality rate than those with 10 million EBOV copies per milliliter or more (33% vs. 94%, P=0.003). Bleeding occurred in only 1 patient.

Conclusions

The incubation period and case fatality rate among patients with EVD in Sierra Leone are similar to those observed elsewhere in the 2014 outbreak and in previous outbreaks. Although bleeding was an infrequent finding, diarrhea and other gastrointestinal manifestations were common. (Funded by the National Institutes of Health and others.)

Item Type: Article
Additional Information: “From New England Journal of Medicine, Schieffelin, J.S. et al, Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone, Volume 371., Page No.2092-2100 Copyright © 2014. Massachusetts Medical Society. Reprinted with permission.
Subjects: WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Viral Hemorrhagic Fevers. Other Virus Diseases > WC 534 Viral hemorrhagic fevers
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1056/NEJMoa1411680
Depositing User: Lynn Roberts-Maloney
Date Deposited: 16 Jun 2015 10:29
Last Modified: 06 Feb 2018 13:10
URI: http://archive.lstmed.ac.uk/id/eprint/5210

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