title: Characteristics and Clinical Management of a Cluster of 3 Patients With Ebola Virus Disease, Including the First Domestically Acquired Cases in the United States.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Retrospective clinical case series.
  
  
  METHODS
  Three U.S. hospitals in September and October 2014.
  
  
  METHODS
  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.
  
  
  METHODS
  Clinical recovery, EBOV RNA level, resolution of Ebola viremia, survival with discharge from hospital, or death.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Both surviving patients received uncontrolled treatment with multiple investigational agents, including convalescent plasma, which limits generalizability of the results.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  None.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Liddell
authors.forename: Richard T
authors.initials: RT
authors.lastname: Davey
authors.forename: Aneesh K
authors.initials: AK
authors.lastname: Mehta
authors.forename: Jay B
authors.initials: JB
authors.lastname: Varkey
authors.forename: Colleen S
authors.initials: CS
authors.lastname: Kraft
authors.forename: Gebre K
authors.initials: GK
authors.lastname: Tseggay
authors.forename: Oghenetega
authors.initials: O
authors.lastname: Badidi
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Faust
authors.forename: Katia V
authors.initials: KV
authors.lastname: Brown
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Suffredini
authors.forename: Kevin
authors.initials: K
authors.lastname: Barrett
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Wolcott
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Marconi
authors.forename: G Marshall
authors.initials: GM
authors.lastname: Lyon
authors.forename: Gary L
authors.initials: GL
authors.lastname: Weinstein
authors.forename: Kenney
authors.initials: K
authors.lastname: Weinmeister
authors.forename: Shelby
authors.initials: S
authors.lastname: Sutton
authors.forename: Munir
authors.initials: M
authors.lastname: Hazbun
authors.forename: César G
authors.initials: CG
authors.lastname: Albariño
authors.forename: Zachary
authors.initials: Z
authors.lastname: Reed
authors.forename: Debi
authors.initials: D
authors.lastname: Cannon
authors.forename: Ute
authors.initials: U
authors.lastname: Ströher
authors.forename: Mark
authors.initials: M
authors.lastname: Feldman
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Ribner
authors.forename: H Clifford
authors.initials: HC
authors.lastname: Lane
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Fauci
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Uyeki
mesh_terms: D000328:Adult; D003422:Critical Care / Q000379:methods*; D042241:Early Diagnosis; D029043:Ebolavirus / Q000235:genetics / Q000378:metabolism; D017809:Fatal Outcome; D005260:Female; D019142:Hemorrhagic Fever, Ebola / Q000175:diagnosis* / Q000628:therapy* / Q000821:virology; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000097:blood; D051437:Renal Insufficiency / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D013781:Texas; D014766:Viremia / Q000175:diagnosis / Q000628:therapy
chemical_list: D012367:RNA, Viral