Characteristics and Clinical Management of a Cluster of 3 Patients With Ebola Virus Disease, Including the First Domestically Acquired Cases in the United States.
Characteristics and Clinical Management of a Cluster of 3 Patients With Ebola Virus Disease, Including the First Domestically Acquired Cases in the United States.
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DOI：
10.7326/m15-0530
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发表时间：
2015-07-21
影响因子：
39.2
通讯作者：
Uyeki TM
中科院分区：
文献类型：
--
作者：
Liddell AM;Davey RT Jr;Mehta AK;Varkey JB;Kraft CS;Tseggay GK;Badidi O;Faust AC;Brown KV;Suffredini AF;Barrett K;Wolcott MJ;Marconi VC;Lyon GM 3rd;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
西非已报告26000多例埃博拉病毒病（EVD）病例，死亡率很高。一些患者已被医疗后送至美国和欧洲的医院。关于西非以外EVD患者的临床病程和管理的详细临床数据有限。描述一组EVD患者的临床特征和管理，包括在美国获得的首批埃博拉病毒（EBOV）感染病例。回顾性临床病例系列。2014年9月和10月，三家美国医院。在美国发现的首例输入性EVD病例和在美国护理索引病例患者的重症监护护士中获得的2例继发性EVD病例。临床恢复、EBOV RNA水平、埃博拉病毒血症消退、出院存活或死亡。索引患者具有高EBOV RNA水平，发展为需要重症监护支持的呼吸和肾衰竭，并死亡。两名继发性EBOV感染的患者都有非特异性体征和症状，并发展为中度疾病; EBOV RNA水平为中度，两名患者均痊愈。两名存活患者均接受了多种研究药物（包括恢复期血浆）的非对照治疗，这限制了结果的普遍性。早期诊断、及时启动支持性医疗护理和中度临床疾病可能有助于两名幸存者的成功结局。由于无法确定试验性治疗的潜在获益以及可能导致病情不太严重的患者特异性因素的影响，因此需要对这些干预措施进行对照临床研究，尤其是在高水平支持性医疗护理的背景下。没有。
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. 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. Retrospective clinical case series. Three U.S. hospitals in September and October 2014. 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. Clinical recovery, EBOV RNA level, resolution of Ebola viremia, survival with discharge from hospital, or death. 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. Both surviving patients received uncontrolled treatment with multiple investigational agents, including convalescent plasma, which limits generalizability of the results. 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. None.