title: Clinical, virological, and biological parameters associated with outcomes of Ebola virus infection in Macenta, Guinea.
abstract: BACKGROUND.The pathogenesis of Ebola virus (EBOV) disease (EVD) is poorly characterized. The establishment of well-equipped diagnostic laboratories close to Ebola treatment centers (ETCs) has made it possible to obtain relevant virological and biological data during the course of EVD and to assess their association with the clinical course and different outcomes of the disease.METHODS.We were responsible for diagnosing EBOV infection in patients admitted to two ETCs in forested areas of Guinea. The pattern of clinical signs was recorded, and an etiological diagnosis was established by RT-PCR for EBOV infection or a rapid test for malaria and typhoid fever. Biochemical analyses were also performed.RESULTS.We handled samples from 168 patients between November 29, 2014, and January 31, 2015; 97 patients were found to be infected with EBOV, withPlasmodium falciparumcoinfection in 18%. Overall mortality for EVD cases was 58%, rising to 86% ifP.falciparumwas also present. Viral load was higher in fatal cases of EVD than in survivors, and fatal cases were associated with higher aspartate aminotransferase (AST) and alanine aminotransferase (ALT), C-reactive protein (CRP), and IL-6 levels. Furthermore, regardless of outcome, EVD was characterized by higher creatine kinase (CPK), amylase, and creatinine levels than in febrile patients without EVD, with higher blood urea nitrogen (BUN) levels in fatal cases of EVD only.CONCLUSION.These findings suggest that a high viral load at admission is a marker of poor EVD prognosis. In addition, high AST, ALT, CRP, and IL-6 levels are associated with a fatal outcome of EVD. Damage to the liver and other tissues, with massive rhabdomyolysis and, probably, acute pancreatitis, is associated with EVD and correlated with disease severity. Finally, biochemical analyses provide substantial added value at ETCs, making it possible to improve supportive rehydration and symptomatic care for patients.FUNDING.The French Ministry of Foreign Affairs, the Agence Française de Développement, and Institut Pasteur.
authors.affiliation: Centre Pasteur du Cameroun, Yaounde, Cameroon.
authors.forename: Marie-Astrid
authors.initials: MA
authors.lastname: Vernet
authors.affiliation: Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France.|Centre International de Recherche en Infectiologie, Université de Lyon, INSERM, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS UMR5308, Lyon, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Reynard
authors.affiliation: Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France.|Centre International de Recherche en Infectiologie, Université de Lyon, INSERM, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS UMR5308, Lyon, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Fizet
authors.affiliation: Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France.|Centre International de Recherche en Infectiologie, Université de Lyon, INSERM, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS UMR5308, Lyon, France.
authors.forename: Justine
authors.initials: J
authors.lastname: Schaeffer
authors.affiliation: Laboratoire P4 Jean Mérieux - INSERM (US003), Lyon, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Pannetier
authors.affiliation: INSERM, Infection, Antimicrobials, Modelling, Evolution, UMR 1137, Université Paris Diderot, Paris, France.|Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France.
authors.forename: Jeremie
authors.initials: J
authors.lastname: Guedj
authors.affiliation: Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France.
authors.forename: Max
authors.initials: M
authors.lastname: Rives
authors.affiliation: Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Georges
authors.affiliation: Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Garcia-Bonnet
authors.affiliation: Ministère de la Santé, Conakry, République de Guinée.
authors.forename: Aboubacar I
authors.initials: AI
authors.lastname: Sylla
authors.affiliation: Ministère de la Santé, Conakry, République de Guinée.
authors.forename: Péma
authors.initials: P
authors.lastname: Grovogui
authors.affiliation: Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Kerherve
authors.affiliation: Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Savio
authors.affiliation: Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Savio-Coste
authors.affiliation: Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: de Séverac
authors.affiliation: Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Zloczewski
authors.affiliation: Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Linares
authors.affiliation: Alliance for International Medical Action, Montreuil, France.
authors.forename: Souley
authors.initials: S
authors.lastname: Harouna
authors.affiliation: Alliance for International Medical Action, Montreuil, France.
authors.forename: Bing M'Lebing
authors.initials: BM
authors.lastname: Abdoul
authors.affiliation: Alliance for International Medical Action, Montreuil, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Petitjean
authors.affiliation: Alliance for International Medical Action, Montreuil, France.
authors.forename: Nenefing
authors.initials: N
authors.lastname: Samake
authors.affiliation: Alliance for International Medical Action, Montreuil, France.
authors.forename: Susan
authors.initials: S
authors.lastname: Shepherd
authors.affiliation: Alliance for International Medical Action, Montreuil, France.
authors.forename: Moumouni
authors.initials: M
authors.lastname: Kinda
authors.affiliation: Alliance for International Medical Action, Montreuil, France.
authors.forename: Fara Roger
authors.initials: FR
authors.lastname: Koundouno
authors.affiliation: Alliance for International Medical Action, Montreuil, France.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Joxe
authors.affiliation: Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France.|Centre International de Recherche en Infectiologie, Université de Lyon, INSERM, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS UMR5308, Lyon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Mateo
authors.affiliation: Bioaster, Lyon, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lecine
authors.affiliation: Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France.|Centre International de Recherche en Infectiologie, Université de Lyon, INSERM, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS UMR5308, Lyon, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Page
authors.affiliation: Etablissement de Préparation et de Réponse aux Urgences Sanitaires, Ministère de la Santé, Paris, France.
authors.forename: Tang Maleki
authors.initials: TM
authors.lastname: Tchamdja
authors.affiliation: Centre Pasteur du Cameroun, Yaounde, Cameroon.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Schoenhals
authors.affiliation: Alliance for International Medical Action, Montreuil, France.
authors.forename: Solenne
authors.initials: S
authors.lastname: Barbe
authors.affiliation: Croix-Rouge Française, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Simon
authors.affiliation: Croix-Rouge Française, Paris, France.
authors.forename: Tuan
authors.initials: T
authors.lastname: Tran-Minh
authors.affiliation: Fondation Mérieux, Lyon, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Longuet
authors.affiliation: CClin Paris-Nord, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: L'Hériteau
authors.affiliation: Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France.|Centre International de Recherche en Infectiologie, Université de Lyon, INSERM, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS UMR5308, Lyon, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Baize
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D029043:Ebolavirus; D005260:Female; D016701:Guinea / Q000453:epidemiology; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology / Q000503:physiopathology* / Q000821:virology*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D017741:Survivors; D019562:Viral Load; D055815:Young Adult