title: Clinical Management of Ebola Virus Disease in the United States and Europe.
abstract: BACKGROUND
  Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited.
  
  
  METHODS
  We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015.
  
  
  RESULTS
  A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%.
  
  
  CONCLUSIONS
  Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.
authors.affiliation: From the Centers for Disease Control and Prevention (T.M.U., J.G.) and the Division of Infectious Diseases, Emory University School of Medicine (A.K.M.) - both in Atlanta; the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (R.T.D.); Texas Health Presbyterian Hospital Dallas, Dallas (A.M.L.); the Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main (T.W.), the First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg (S.S.), and Leipzig Treatment Center for Highly Contagious Diseases, Klinikum St. Georg, Leipzig (T.G.) - all in Germany; the Division of Infectious Diseases and Laboratory of Virology, Geneva University Hospitals, Geneva (P.V.); the Department of Infection, Royal Free London NHS Foundation Trust, London (M.J.); the Internal Medicine Department, Infectious Diseases Unit Madrid, Hospital La Paz-Carlos III IdiPAZ, Madrid (J.R.A.); New York University School of Medicine-Bellevue Hospital Center, New York (L.E.); University of Nebraska Medical Center, Omaha (A.L.H.); the Departments of Infectious Diseases and Acute Medicine, Oslo University Hospital, Oslo (A.B.B.); Lazzaro Spallanzani National Institute for Infectious Diseases, Rome (G.I.); the Infectious and Tropical Diseases Department, Bégin Military Hospital, Saint-Mandé, France (C.R.); and the Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands (A.I.M.H.).
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Uyeki
authors.forename: Aneesh K
authors.initials: AK
authors.lastname: Mehta
authors.forename: Richard T
authors.initials: RT
authors.lastname: Davey
authors.forename: Allison M
authors.initials: AM
authors.lastname: Liddell
authors.forename: Timo
authors.initials: T
authors.lastname: Wolf
authors.forename: Pauline
authors.initials: P
authors.lastname: Vetter
authors.forename: Stefan
authors.initials: S
authors.lastname: Schmiedel
authors.forename: Thomas
authors.initials: T
authors.lastname: Grünewald
authors.forename: Michael
authors.initials: M
authors.lastname: Jacobs
authors.forename: Jose R
authors.initials: JR
authors.lastname: Arribas
authors.forename: Laura
authors.initials: L
authors.lastname: Evans
authors.forename: Angela L
authors.initials: AL
authors.lastname: Hewlett
authors.forename: Arne B
authors.initials: AB
authors.lastname: Brantsaeter
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ippolito
authors.forename: Christophe
authors.initials: C
authors.lastname: Rapp
authors.forename: Andy I M
authors.initials: AI
authors.lastname: Hoepelman
authors.forename: Julie
authors.initials: J
authors.lastname: Gutman
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003422:Critical Care; D029043:Ebolavirus / Q000235:genetics / Q000302:isolation & purification*; D004573:Electrolytes / Q000627:therapeutic use; D005060:Europe; D005260:Female; D005440:Fluid Therapy; D019142:Hemorrhagic Fever, Ebola / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D000637:Transaminases / Q000097:blood; D014481:United States; D019562:Viral Load
chemical_list: D000900:Anti-Bacterial Agents; D004573:Electrolytes; D012367:RNA, Viral; D000637:Transaminases