title: Clinical illness and outcomes in patients with Ebola in Sierra Leone.
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.).
authors.affiliation: The authors' affiliations are listed in the Appendix.
authors.forename: John S
authors.initials: JS
authors.lastname: Schieffelin
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Shaffer
authors.forename: Augustine
authors.initials: A
authors.lastname: Goba
authors.forename: Michael
authors.initials: M
authors.lastname: Gbakie
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Gire
authors.forename: Andres
authors.initials: A
authors.lastname: Colubri
authors.forename: Rachel S G
authors.initials: RS
authors.lastname: Sealfon
authors.forename: Lansana
authors.initials: L
authors.lastname: Kanneh
authors.forename: Alex
authors.initials: A
authors.lastname: Moigboi
authors.forename: Mambu
authors.initials: M
authors.lastname: Momoh
authors.forename: Mohammed
authors.initials: M
authors.lastname: Fullah
authors.forename: Lina M
authors.initials: LM
authors.lastname: Moses
authors.forename: Bethany L
authors.initials: BL
authors.lastname: Brown
authors.forename: Kristian G
authors.initials: KG
authors.lastname: Andersen
authors.forename: Sarah
authors.initials: S
authors.lastname: Winnicki
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Schaffner
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Park
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Yozwiak
authors.forename: Pan-Pan
authors.initials: PP
authors.lastname: Jiang
authors.forename: David
authors.initials: D
authors.lastname: Kargbo
authors.forename: Simbirie
authors.initials: S
authors.lastname: Jalloh
authors.forename: Mbalu
authors.initials: M
authors.lastname: Fonnie
authors.forename: Vandi
authors.initials: V
authors.lastname: Sinnah
authors.forename: Issa
authors.initials: I
authors.lastname: French
authors.forename: Alice
authors.initials: A
authors.lastname: Kovoma
authors.forename: Fatima K
authors.initials: FK
authors.lastname: Kamara
authors.forename: Veronica
authors.initials: V
authors.lastname: Tucker
authors.forename: Edwin
authors.initials: E
authors.lastname: Konuwa
authors.forename: Josephine
authors.initials: J
authors.lastname: Sellu
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Mustapha
authors.forename: Momoh
authors.initials: M
authors.lastname: Foday
authors.forename: Mohamed
authors.initials: M
authors.lastname: Yillah
authors.forename: Franklyn
authors.initials: F
authors.lastname: Kanneh
authors.forename: Sidiki
authors.initials: S
authors.lastname: Saffa
authors.forename: James L B
authors.initials: JL
authors.lastname: Massally
authors.forename: Matt L
authors.initials: ML
authors.lastname: Boisen
authors.forename: Luis M
authors.initials: LM
authors.lastname: Branco
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Vandi
authors.forename: Donald S
authors.initials: DS
authors.lastname: Grant
authors.forename: Christian
authors.initials: C
authors.lastname: Happi
authors.forename: Sahr M
authors.initials: SM
authors.lastname: Gevao
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Fletcher
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fowler
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Bausch
authors.forename: Pardis C
authors.initials: PC
authors.lastname: Sabeti
authors.forename: S Humarr
authors.initials: SH
authors.lastname: Khan
authors.forename: Robert F
authors.initials: RF
authors.lastname: Garry
mesh_terms: D015746:Abdominal Pain; D000328:Adult; D000818:Animals; D003967:Diarrhea; D029043:Ebolavirus / Q000235:genetics* / Q000302:isolation & purification; D058872:Epidemics; D005260:Female; D005334:Fever; D019142:Hemorrhagic Fever, Ebola / Q000150:complications / Q000453:epidemiology* / Q000628:therapy / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012807:Sierra Leone / Q000453:epidemiology; D019562:Viral Load; D014839:Vomiting