title: Severe Ebola virus disease with vascular leakage and multiorgan failure: treatment of a patient in intensive care.
abstract: BACKGROUND
  In the current epidemic of Ebola virus disease in western Africa, many aid workers have become infected. Some of these aid workers have been transferred to specialised hospitals in Europe and the USA for intensified treatment, providing the potential for unique insight into the clinical course of Ebola virus disease under optimised supportive measures in isolation units.
  
  
  METHODS
  A 38-year-old male doctor who had contracted an Ebola virus infection in Sierra Leone was airlifted to University Hospital Frankfurt, Germany, on day 5 after disease onset. Within 72 h of admission to the hospital's high-level isolation unit, the patient developed signs of severe multiorgan failure, including lungs, kidneys, and gastrointestinal tract. In addition to clinical parameters, the diagnostic work-up included radiography, ultrasound, pulse contour cardiac output technology, and microbiological and clinical chemistry analyses. Respiratory failure with pulmonary oedema and biophysical evidence of vascular leak syndrome needed mechanical ventilation. The patient received a 3 day treatment course with FX06 (MChE-F4Pharma, Vienna, Austria), a fibrin-derived peptide under clinical development for vascular leak syndrome. After FX06 administration and concurrent detection of Ebola-virus-specific antibodies and a fall in viral load, vascular leak syndrome and respiratory parameters substantially improved. We gave broad-spectrum empiric antimicrobial therapy and the patient needed intermittent renal replacement therapy. The patient fully recovered.
  
  
  RESULTS
  This case report shows the feasibility of delivery of successful intensive care therapy to patients with Ebola virus disease under biosafety level 4 conditions.
  
  
  CONCLUSIONS
  The effective treatment of vascular leakage and multiorgan failure by combination of ventilatory support, antibiotic treatment, and renal replacement therapy can sustain a patient with severe Ebola virus disease until virological remission. FX06 could potentially be a valuable agent in contribution to supportive therapy.
  
  
  BACKGROUND
  University Hospital of Frankfurt.
authors.affiliation: Department of Medicine, Infectious Diseases Unit, University Hospital Frankfurt, Frankfurt/Main, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Wolf
authors.affiliation: Department of Medicine, Infectious Diseases Unit, University Hospital Frankfurt, Frankfurt/Main, Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Kann
authors.affiliation: Institute of Virology and Germany Centre for Infection Research (DZIF), Partner Site Gießen-Marburg-Langen, Philipps University, Marburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Becker
authors.affiliation: Department of Medicine, Infectious Diseases Unit, University Hospital Frankfurt, Frankfurt/Main, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Stephan
authors.affiliation: Department of Medicine, Infectious Diseases Unit, University Hospital Frankfurt, Frankfurt/Main, Germany.
authors.forename: Hans-Reinhardt
authors.initials: HR
authors.lastname: Brodt
authors.affiliation: Department of Medicine, Infectious Diseases Unit, University Hospital Frankfurt, Frankfurt/Main, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: de Leuw
authors.affiliation: Department of Infectious Diseases, Tropical Medicine and Nephrology, Hospital St Georg, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Grünewald
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt/Main, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Vogl
authors.affiliation: Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt/Main, Germany.
authors.forename: Volkhard A J
authors.initials: VA
authors.lastname: Kempf
authors.affiliation: Institute of Medical Virology, University Hospital Frankfurt, Frankfurt/Main, Germany.
authors.forename: Oliver T
authors.initials: OT
authors.lastname: Keppler
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany. Electronic address: kai.zacharowski@kgu.de.
authors.forename: Kai
authors.initials: K
authors.lastname: Zacharowski
mesh_terms: D000328:Adult; D000577:Amides / Q000627:therapeutic use; D000638:Amiodarone / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage; D000998:Antiviral Agents / Q000627:therapeutic use; D001808:Blood Vessels / Q000503:physiopathology*; D003422:Critical Care; D005338:Fibrin Fibrinogen Degradation Products / Q000627:therapeutic use; D019142:Hemorrhagic Fever, Ebola / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D008297:Male; D009102:Multiple Organ Failure / Q000503:physiopathology*; D010356:Patient Isolation / Q000379:methods; D010446:Peptide Fragments / Q000627:therapeutic use; D011654:Pulmonary Edema / Q000209:etiology; D011719:Pyrazines / Q000627:therapeutic use; D013902:Radiography, Thoracic; D051437:Renal Insufficiency / Q000628:therapy; D012131:Respiratory Insufficiency / Q000628:therapy
chemical_list: D000577:Amides; D000890:Anti-Infective Agents; D000998:Antiviral Agents; D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; D011719:Pyrazines; C033786:fibrinogen Bbeta (15-42); C462182:favipiravir; D000638:Amiodarone