title: Acute respiratory distress syndrome after convalescent plasma use: treatment of a patient with Ebola virus disease contracted in Madrid, Spain.
abstract: BACKGROUND
  In the current epidemic of Ebola virus disease, health-care workers have been transferred to Europe and the USA for optimised supportive care and experimental treatments. We describe the clinical course of the first case of Ebola virus disease contracted outside of Africa, in Madrid, Spain.
  
  
  METHODS
  Herein we report clinical, laboratory, and virological findings of the treatment of a female nurse assistant aged 44 years who was infected with Ebola virus around Sept 25-26, 2014, while caring for a Spanish missionary with confirmed Ebola virus disease who had been medically evacuated from Sierra Leone to La Paz-Carlos III University Hospital, Madrid. We also describe the use of experimental treatments for Ebola virus disease in this patient.
  
  
  RESULTS
  The patient was symptomatic for 1 week before first hospital admission on Oct 6, 2014. We used supportive treatment with intravenous fluids, broad-spectrum antibiotics, and experimental treatments with convalescent plasma from two survivors of Ebola virus disease and high-dose favipiravir. On day 10 of illness, she had acute respiratory distress syndrome, possibly caused by transfusion-related acute lung injury, which was managed without mechanical ventilation. Discharge was delayed because of the detection of viral RNA in several bodily fluids despite clearance of viraemia. The patient was discharged on day 34 of illness. At the time of discharge, the patient had possible subacute post-viral thyroiditis. None of the people who had contact with the patient before and after admission became infected with Ebola virus.
  
  
  CONCLUSIONS
  This report emphasises the uncertainties about the efficacy of experimental treatments for Ebola virus disease. Clinicians should be aware of the possibility of transfusion-related acute lung injury when using convalescent plasma for the treatment of Ebola virus disease.
  
  
  BACKGROUND
  La Paz-Carlos III University Hospital.
authors.affiliation: Department of Internal Medicine, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Mora-Rillo
authors.affiliation: Department of Internal Medicine, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Arsuaga
authors.affiliation: Department of Internal Medicine, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain.
authors.forename: Germán
authors.initials: G
authors.lastname: Ramírez-Olivencia
authors.affiliation: Department of Internal Medicine, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: de la Calle
authors.affiliation: Department of Clinical Pharmacology, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain.
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Borobia
authors.affiliation: Arbovirus Laboratory, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Paz
authors.initials: P
authors.lastname: Sánchez-Seco
authors.affiliation: Department of Internal Medicine, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Lago
authors.affiliation: Department of Critical Care, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Figueira
authors.affiliation: Department of Laboratory Medicine, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Fernández-Puntero
authors.affiliation: Department of Haematology, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain.
authors.forename: Aurora
authors.initials: A
authors.lastname: Viejo
authors.affiliation: Arbovirus Laboratory, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Anabel
authors.initials: A
authors.lastname: Negredo
authors.affiliation: Department of Occupational Health, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain.
authors.forename: Concepción
authors.initials: C
authors.lastname: Nuñez
authors.affiliation: Department of Critical Care, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Flores
authors.affiliation: Department of Clinical Pharmacology, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain.
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Carcas
authors.affiliation: Department of Haematology, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Jiménez-Yuste
authors.affiliation: Arbovirus Laboratory, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Fátima
authors.initials: F
authors.lastname: Lasala
authors.affiliation: Department of Critical Care, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain.
authors.forename: Abelardo
authors.initials: A
authors.lastname: García-de-Lorenzo
authors.affiliation: Department of Internal Medicine, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Arnalich
authors.affiliation: Department of Internal Medicine, La Paz-Carlos III University Hospital, IdiPAZ, Madrid, Spain. Electronic address: joser.arribas@salud.madrid.org.
authors.forename: Jose R
authors.initials: JR
authors.lastname: Arribas
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology; D000328:Adult; D000577:Amides / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D019142:Hemorrhagic Fever, Ebola / Q000628:therapy*; D006801:Humans; D009728:Nursing Assistants; D009784:Occupational Diseases / Q000209:etiology* / Q000628:therapy; D010356:Patient Isolation; D010949:Plasma; D011719:Pyrazines / Q000627:therapeutic use; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000628:therapy; D013030:Spain; D015163:Superinfection / Q000209:etiology; D065227:Transfusion Reaction; D019562:Viral Load
chemical_list: D000577:Amides; D000998:Antiviral Agents; D011719:Pyrazines; C462182:favipiravir