Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone
Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone
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DOI：
10.1056/nejmoa1411680
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发表时间：
2014-11-27
影响因子：
158.5
通讯作者：
Garry, R. F.
中科院分区：
文献类型：
--
作者：
Schieffelin, J. S.;Shaffer, J. G.;Garry, R. F.
埃博拉病毒病患者的临床和实验室数据有限。塞拉利昂的凯内马政府医院，它有一个现有的基础设施，研究有关病毒性出血热，已收到和照顾病人与EVD自2014年5月在塞拉利昂爆发的开始。METHODS我们审查了可用的流行病学，临床和实验室记录的患者，其中EVD被诊断为2014年5月25日和6月18日之间。我们使用定量逆转录聚合酶链反应测定来评估一个亚组患者中埃博拉病毒（EBOV，扎伊尔种）的载量。在106例诊断为EVD的患者中，87例有已知的结果，44例有详细的临床信息。潜伏期估计为6至12天，病死率为74%。常见的表现包括发热（89%的患者）、头痛（80%）、虚弱（66%）、头晕（60%）、腹泻（51%）、腹痛（40%）和呕吐（34%）。与致死性结局相关的临床和实验室因素包括发热、虚弱、头晕、腹泻和血尿素氮、天冬氨酸转氨酶和肌酐水平升高。探索性分析表明，21岁以下患者的病死率低于45岁以上患者（57%对94%，P = 0.03），并且表现出低于100，000 EBOV拷贝/毫升的患者的病死率低于具有1000万EBOV拷贝/毫升或更多的患者。（33%对94%，P = 0.003）。仅1例患者发生出血。结论塞拉利昂EVD患者的潜伏期和病死率与2014年疫情和以往疫情中观察到的情况相似。虽然出血是罕见的发现，腹泻和其他胃肠道表现是常见的。
BACKGROUNDLimited 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.METHODSWe 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.RESULTSOf 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.CONCLUSIONSThe 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.