title: Clinical features of suspected Ebola cases referred to the Moyamba ETC, Sierra Leone: challenges in the later stages of the 2014 outbreak.
abstract: The last ebola virus disease (EVD) outbreak has been the most important since 1976. EVD cases decreased drastically in Sierra Leone at the beginning of 2015. We aim to determine the clinical findings and evolution of patients admitted to an Ebola treatment center (ETC) during the epidemic's late phase.
  
  
  
  We analyze retrospectively data of patients admitted to the Moyamba ETC (December 2014-March 2015). Patients were classified in EVD or non-EVD patients according to the results of Ebola virus real-time reverse transcription polymerase chain reaction (ZAIRE-RT-PCR).
  
  
  
  Seventy-five patients were included, 41.3 % were positive for ZAIRE-RT-PCR. More women (68 % vs 28 %, p = 0.001) were EVD-positive. More EVD patients had previous contact with an Ebola patient (74.2 % vs 36.3 %, p < 0.001). At admission, EVD patients were more likely to have fatigue (96.7 %, p < 0.001), diarrhea (67.7 %, p = 0.002), and muscle pain (61.3 %, p = 0.009); but only objective fevers in 35.5 % of EVD patients. The most reliable criteria for diagnosis were: contact with an Ebola patient plus three WHO symptoms (LR + =3.7, 95 % CI = 1.9-7.3), and positive contact (LR + =2.3, 95 % CI = 1.15-4.20). Only 45.2 % of EVD patients developed fevers during stay, but 75 % developed gastrointestinal symptoms. Non-EVD patients had gastrointestinal problems (33 %), respiratory conditions (26.6 %), and others such as malaria, HIV or tuberculosis with a mortality rate of 11.4 %. vs 58 % in EVD group (p < 0.001).
  
  
  
  More non-EVD patients were admitted in the outbreak's late phases. The low percentage of initial fever highlights the need to emphasize the epidemiological information. EVD patients presented new symptoms getting worse and requiring closer follow-up. Diagnoses of non-EVD patients were diverse with a remarkable mortality, presenting a challenge for the health system.
authors.affiliation: Médicos del Mundo, Madrid, Spain. jarranz@ibsalut.caib.es.|Arquitecte Bennassar Health Center, Palma de Mallorca, Illes Balears, Spain. jarranz@ibsalut.caib.es.|Instituto de Investigación de Palma (IDISPA), Palma de Mallorca, Illes Balears, Spain. jarranz@ibsalut.caib.es.
authors.forename: Javier
authors.identifier: 0000-0003-0728-9751
authors.initials: J
authors.lastname: Arranz
authors.affiliation: Oslo University Hospital, Oslo, Norway.
authors.forename: Karen Marie
authors.initials: KM
authors.lastname: Lundeby
authors.affiliation: Field Epidemiology and Laboratory Training Program Pakistan (FELTP), Islamabad, Pakistan.
authors.forename: Shoaib
authors.initials: S
authors.lastname: Hassan
authors.affiliation: Médicos del Mundo, Madrid, Spain.
authors.forename: Luis Matías
authors.initials: LM
authors.lastname: Zabala Fuentes
authors.affiliation: Médicos del Mundo, Madrid, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: San José Garcés
authors.affiliation: Haukeland University Hospital, Bergen, Norway.
authors.forename: Yngvar Lunde
authors.initials: YL
authors.lastname: Haaskjold
authors.affiliation: St. Olav Hospital, Trondheim, Norway.
authors.forename: Håkon Angell
authors.initials: HA
authors.lastname: Bolkan
authors.affiliation: St. Olav Hospital, Trondheim, Norway.
authors.forename: Kurt Østhuus
authors.initials: KØ
authors.lastname: Krogh
authors.affiliation: Moyamba District Hospital, Moyamba, Moyamba, Sierra Leone.
authors.forename: James
authors.initials: J
authors.lastname: Jongopi
authors.affiliation: St. Olav Hospital, Trondheim, Norway.
authors.forename: Sindre
authors.initials: S
authors.lastname: Mellesmo
authors.affiliation: Haukeland University Hospital, Bergen, Norway.
authors.forename: Ola
authors.initials: O
authors.lastname: Jøsendal
authors.affiliation: Haraldsplass Diaconal Hospital, Bergen, Norway.
authors.forename: Åsmund
authors.initials: Å
authors.lastname: Øpstad
authors.affiliation: Haukeland University Hospital, Bergen, Norway.|University of Bergen, Bergen, Norway.
authors.forename: Erling
authors.initials: E
authors.lastname: Svensen
authors.affiliation: Moyamba District Hospital, Moyamba, Moyamba, Sierra Leone.
authors.forename: Alfred Sandy
authors.initials: AS
authors.lastname: Kamara
authors.affiliation: MRIGlobal, Rockville, MD, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Roberts
authors.affiliation: MRIGlobal, Rockville, MD, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Stamper
authors.affiliation: Sandia National Laboratories, Alburquerque, USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Austin
authors.affiliation: Moyamba District Hospital, Moyamba, Moyamba, Sierra Leone.
authors.forename: Alfredo J
authors.initials: AJ
authors.lastname: Moosa
authors.affiliation: Moyamba District Hospital, Moyamba, Moyamba, Sierra Leone.
authors.forename: Dennis
authors.initials: D
authors.lastname: Marke
authors.affiliation: Stavanger University Hospital, Stavanger, Norway.
authors.forename: Åse
authors.initials: Å
authors.lastname: Berg
authors.affiliation: Haukeland University Hospital, Bergen, Norway.|University of Bergen, Bergen, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Blomberg
authors.affiliation: Médicos del Mundo, Madrid, Spain.|Instituto de Investigación de Palma (IDISPA), Palma de Mallorca, Illes Balears, Spain.|Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Melcior
authors.initials: M
authors.lastname: Riera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology; D004196:Disease Outbreaks; D029043:Ebolavirus / Q000235:genetics; D058872:Epidemics; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology; D005767:Gastrointestinal Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D019142:Hemorrhagic Fever, Ebola / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods; D012017:Referral and Consultation; D012140:Respiratory Tract Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012807:Sierra Leone / Q000453:epidemiology; D055815:Young Adult
keywords: Clinical features of suspected Ebola patients; Diagnostic validation; Ebola virus disease (EVD); Sierra Leone