Severely ill Ebola patient saved by conventional intensive care

Even severe Ebola virus disease can be successfully treated with routine intensive care, according to a novel case study by researchers from Germany and Karolinska Institutet. The study, which is published in the New England Journal of Medicine (NEJM), provides detailed clinical data that contributes to improved knowledge on how to treat Ebola with existing treatment strategies.

The 36-year old patient contracted Ebola virus disease (EVD) in Sierra Leone, where he worked as an epidemiologist for the World Health Organisation. He was flown to an isolation unit at the University Medical Center Hamburg-Eppendorf in Germany. During his illness, the patient developed several complications, including blood infection (septicaemia), malfunctioning intestines, severe breathing difficulties and encephalopathy with altered mental status and hallucinations. An infection led to severe illness when the amount of virus already was decreasing, suggesting that secondary bacterial infections and sepsis may be an important cause of death in the ongoing outbreak in Afrika.

“The case is a well-documented example of ‘conventional’ intensive care treatment, coordinated by Marylyn Addo and Stefan Schmiedel and their teams, which rescued the patient. Up to my knowledge, this is the best documented case with lots of clinical data and therapy details of a patient suffering from Ebola of the new outbreak, says Thomas Renné at the Department of Molecular Medicine and Surgery, Karolinska Institutet, also affiliated to the Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, and who’s research team participated in the laboratory diagnostics of the patient.

General intensive care

The study describes how the amount of virus particles and virus RNA in blood, saliva, urine and other body fluids changed over time. The case study also shows how a large set of clinical parameters developed for each day. The patient was treated with routine intensive care, including re-hydration, antibiotics and ventilation support when the patient’s breathing was compromised. Eventually, the patient was fully recovered and emitted from the hospital. The researchers conclude that severe EVD can be successfully treated with general intensive care even in the absence of novel Ebola-virus specific therapies.

The current Ebola epidemic is the largest to date and has led to a public health emergency in the region. A high rate of infection among health care personnel has made the situation even worse. Several international health care workers have been evacuated to specialised centres in Europe and the United States.

“This cost and labour intensive treatment is required to offer the best possible therapy especially to those, who get infected while fighting the disease" says Thomas Renné.

Text: Karin Söderlund Leifler

Publication

A Case of Severe Ebola Virus Infection Complicated by Gram-Negative Septicemia
Benno Kreuels, Dominic Wichmann, Petra Emmerich, Jonas Schmidt-Chanasit, Geraldine de Heer, Stefan Kluge, Abdourahmane Sow, Thomas Renné, Stephan Gunther, Ansgar W. Lohse, Marylyn M. Addo, and Stefan Schmiedel
NEJM, online 22 October 2014, doi: 10.1056/NEJMbr1411677