Severe Ebola virus case with multiple complications effectively treated with routine intensive care

The patient had been cured of an Ebola infection. As disclosed in a case report by doctors and epidemiologists from the UKE hospital, the Bernhard Nocht Institute (BNI), and the German Center for Infection Research (DZIF) that has been published in the New England Journal of Medicine (NEJM), the patient experienced severe complications, even as blood tests showed that the virus itself was diminishing.

Septicaemia in addition to the serious loss of fluid resulting from the Ebola virus necessitated further intensive care measures.

The patient had worked for the World Health Organization (WHO) as an epidemiologist in an Ebola treatment center in Sierra Leone. The most likely source of infection was close contact with a colleague who had shown symptoms of Ebola and died 10 days before the onset of the patient’s symptoms.

On day 10 of his infection, the patient was transferred to the UKE hospital’s special isolation facility in Hamburg for treatment. From the beginning, the patient’s condition was challenging. “The fluid balance was greatly disturbed; the digestive system was already under attack. Maximal supportive measures were initiated, with a primary goal of restoring volume and electrolyte balance.

In the first 72 hours high-volume intravenous fluid replacement of up to 10 liters per day was necessary to stabilize cardiocirculatory values”, explains Dr. Benno Kreuels, physician at the First Department of Medicine, University Medical Center Hamburg-Eppendorf (UKE), and first author of the NEJM publication.

Typical symptoms of an Ebola infection, such as diarrhea and vomiting, were successfully treated after a few days. On day 13, however, the patient’s condition deteriorated again due to severe septicaemia, which was caused by gram-negative and multi-resistant bacteria. The patient’s chance of survival, which was threatened at this time by severe encephalopathy and increasingly impaired respiratory function, could be secured with a broad-spectrum antibiotic therapy and non-invasive ventilatory support.

„The patient fully recovered thanks to intensive care measures. Routine intensive care treatment and the quick initiation of intravenous rehydration seem to be particularly important for survival in Ebola patients, as long as no sufficiently effective and safe Ebola-specific therapies are available,” concludes Dr. Stefan Schmiedel, tropical medicine expert at the First Department of Medicine who led the patient’s course of treatment.

In agreement with local and national health authorities, the patient was discharged from the hospital on the fortieth day after the onset of his infection. At this time, all cultures of bodily fluid samples (blood, saliva, conjunctival swab, stool, urine, or sweat) had been free from infectious virus particles for at least 20 days. „Thanks to our close monitoring, we were able to learn much about the virus and the course of viral disease. For example, we were able to isolate infectious Ebola virus particles from urine days after plasma samples showed no signs of the virus”, explains Prof. Dr. Marylyn Addo, physician and head of the tropical medicine division at the First Department of Medicine, who also holds the DZIF professorship for Emerging Infections.

Prof. Dr. Ansgar Lohse, head of the First Department of Medicine at the University Medical Center Hamburg-Eppendorf (UKE), underscores Germany’s responsibility in the struggle against Ebola: „The most important measure in fighting the Ebola epidemic is certainly an improved health care system on site. But it is also important that we open our highly specialized isolation units to international health care workers who put their lives at risk to help the sick in regions where Ebola is epidemic. In this way, we can provide support to West Africa. In addition, this case shows how much can be learned by careful clinical and scientific observation of a single case, and – in agreement with our patient – we are now glad to share this knowledge.

Publication: Kreuels B, Wichmann D, Emmerich P, Schmidt-Chanasit J, de Heer G, Kluge S, Abdourahmane S, Renné T, Günther S, Lohse AW, Addo MM, Schmiedel S. (2014). A case of severe Ebola virus infection complicated by gram-negative septicemia. New England Journal of Medicine (online first release on October 22, 2014; DOI: 10.1056/NEJMbr1411677).