Characteristics and clinical management of a cluster of 3 patients with Ebola virus disease, including the first domestically acquired cases in the United States

Allison M. Liddell, Richard T. Davey, Aneesh K. Mehta, Jay B. Varkey, Colleen S. Kraft, Gebre K. Tseggay, Oghenetega Badidi, Andrew C. Faust, Katia V. Brown, Anthony F. Suffredini, Kevin Barrett, Mark J. Wolcott, Vincent C. Marconi, G. Marshall Lyon, Gary L. Weinstein, Kenney Weinmeister, Shelby Sutton, Munir Hazbun, César G. Albariño, Zachary ReedDebi Cannon, Ute Ströher, Mark Feldman, Bruce S. Ribner, H. Clifford Lane, Anthony S. Fauci, Timothy M. Uyeki

Research output: Contribution to journalArticle

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Abstract

Background: More than 26 000 cases of Ebola virus disease (EVD) have been reported in western Africa, with high mortality. Several patients have been medically evacuated to hospitals in the United States and Europe. Detailed clinical data are limited on the clinical course and management of patients with EVD outside western Africa. Objective: To describe the clinical characteristics and management of a cluster of patients with EVD, including the first cases of Ebola virus (EBOV) infection acquired in the United States. Design: Retrospective clinical case series. Setting: Three U.S. hospitals in September and October 2014. Patients: First imported EVD case identified in the United States and 2 secondary EVD cases acquired in the United States in critical care nurses who cared for the index case patient. Measurements: Clinical recovery, EBOV RNA level, resolution of Ebola viremia, survival with discharge from hospital, or death. Results: The index patient had high EBOV RNA levels, developed respiratory and renal failure requiring critical care support, and died. Both patients with secondary EBOV infection had nonspecific signs and symptoms and developed moderate illness; EBOV RNA levels were moderate, and both patients recovered. Limitation: Both surviving patients received uncontrolled treatment with multiple investigational agents, including convalescent plasma, which limits generalizability of the results. Conclusion: Early diagnosis, prompt initiation of supportive medical care, and moderate clinical illness likely contributed to successful outcomes in both survivors. The inability to determine the potential benefit of investigational therapies and the effect of patient-specific factors that may have contributed to less severe illness highlight the need for controlled clinical studies of these interventions, especially in the setting of a high level of supportive medical care. Primary Funding Source: None.

Original languageEnglish (US)
Pages (from-to)81-90
Number of pages10
JournalAnnals of Internal Medicine
Volume163
Issue number2
DOIs
StatePublished - Jul 21 2015

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Ebola Hemorrhagic Fever
Ebolavirus
Western Africa
RNA
Critical Care
Investigational Therapies
Viremia
Respiratory Insufficiency
Signs and Symptoms
Renal Insufficiency
Survivors
Early Diagnosis

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Characteristics and clinical management of a cluster of 3 patients with Ebola virus disease, including the first domestically acquired cases in the United States. / Liddell, Allison M.; Davey, Richard T.; Mehta, Aneesh K.; Varkey, Jay B.; Kraft, Colleen S.; Tseggay, Gebre K.; Badidi, Oghenetega; Faust, Andrew C.; Brown, Katia V.; Suffredini, Anthony F.; Barrett, Kevin; Wolcott, Mark J.; Marconi, Vincent C.; Lyon, G. Marshall; Weinstein, Gary L.; Weinmeister, Kenney; Sutton, Shelby; Hazbun, Munir; Albariño, César G.; Reed, Zachary; Cannon, Debi; Ströher, Ute; Feldman, Mark; Ribner, Bruce S.; Lane, H. Clifford; Fauci, Anthony S.; Uyeki, Timothy M.

In: Annals of Internal Medicine, Vol. 163, No. 2, 21.07.2015, p. 81-90.

Research output: Contribution to journalArticle

Liddell, AM, Davey, RT, Mehta, AK, Varkey, JB, Kraft, CS, Tseggay, GK, Badidi, O, Faust, AC, Brown, KV, Suffredini, AF, Barrett, K, Wolcott, MJ, Marconi, VC, Lyon, GM, Weinstein, GL, Weinmeister, K, Sutton, S, Hazbun, M, Albariño, CG, Reed, Z, Cannon, D, Ströher, U, Feldman, M, Ribner, BS, Lane, HC, Fauci, AS & Uyeki, TM 2015, 'Characteristics and clinical management of a cluster of 3 patients with Ebola virus disease, including the first domestically acquired cases in the United States', Annals of Internal Medicine, vol. 163, no. 2, pp. 81-90. https://doi.org/10.7326/M15-0530
Liddell, Allison M. ; Davey, Richard T. ; Mehta, Aneesh K. ; Varkey, Jay B. ; Kraft, Colleen S. ; Tseggay, Gebre K. ; Badidi, Oghenetega ; Faust, Andrew C. ; Brown, Katia V. ; Suffredini, Anthony F. ; Barrett, Kevin ; Wolcott, Mark J. ; Marconi, Vincent C. ; Lyon, G. Marshall ; Weinstein, Gary L. ; Weinmeister, Kenney ; Sutton, Shelby ; Hazbun, Munir ; Albariño, César G. ; Reed, Zachary ; Cannon, Debi ; Ströher, Ute ; Feldman, Mark ; Ribner, Bruce S. ; Lane, H. Clifford ; Fauci, Anthony S. ; Uyeki, Timothy M. / Characteristics and clinical management of a cluster of 3 patients with Ebola virus disease, including the first domestically acquired cases in the United States. In: Annals of Internal Medicine. 2015 ; Vol. 163, No. 2. pp. 81-90.
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AU - Liddell, Allison M.

AU - Davey, Richard T.

AU - Mehta, Aneesh K.

AU - Varkey, Jay B.

AU - Kraft, Colleen S.

AU - Tseggay, Gebre K.

AU - Badidi, Oghenetega

AU - Faust, Andrew C.

AU - Brown, Katia V.

AU - Suffredini, Anthony F.

AU - Barrett, Kevin

AU - Wolcott, Mark J.

AU - Marconi, Vincent C.

AU - Lyon, G. Marshall

AU - Weinstein, Gary L.

AU - Weinmeister, Kenney

AU - Sutton, Shelby

AU - Hazbun, Munir

AU - Albariño, César G.

AU - Reed, Zachary

AU - Cannon, Debi

AU - Ströher, Ute

AU - Feldman, Mark

AU - Ribner, Bruce S.

AU - Lane, H. Clifford

AU - Fauci, Anthony S.

AU - Uyeki, Timothy M.

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N2 - Background: More than 26 000 cases of Ebola virus disease (EVD) have been reported in western Africa, with high mortality. Several patients have been medically evacuated to hospitals in the United States and Europe. Detailed clinical data are limited on the clinical course and management of patients with EVD outside western Africa. Objective: To describe the clinical characteristics and management of a cluster of patients with EVD, including the first cases of Ebola virus (EBOV) infection acquired in the United States. Design: Retrospective clinical case series. Setting: Three U.S. hospitals in September and October 2014. Patients: First imported EVD case identified in the United States and 2 secondary EVD cases acquired in the United States in critical care nurses who cared for the index case patient. Measurements: Clinical recovery, EBOV RNA level, resolution of Ebola viremia, survival with discharge from hospital, or death. Results: The index patient had high EBOV RNA levels, developed respiratory and renal failure requiring critical care support, and died. Both patients with secondary EBOV infection had nonspecific signs and symptoms and developed moderate illness; EBOV RNA levels were moderate, and both patients recovered. Limitation: Both surviving patients received uncontrolled treatment with multiple investigational agents, including convalescent plasma, which limits generalizability of the results. Conclusion: Early diagnosis, prompt initiation of supportive medical care, and moderate clinical illness likely contributed to successful outcomes in both survivors. The inability to determine the potential benefit of investigational therapies and the effect of patient-specific factors that may have contributed to less severe illness highlight the need for controlled clinical studies of these interventions, especially in the setting of a high level of supportive medical care. Primary Funding Source: None.

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