Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone.
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Date
2014
Authors
Journal Title
Journal ISSN
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Publisher
New England Journal of Medicine
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.)