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N Engl J Med. 2014 Dec 18;371(25):2394-401. doi: 10.1056/NEJMoa1411677. Epub 2014 Oct 22.

A case of severe Ebola virus infection complicated by gram-negative septicemia.

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From the Division of Tropical Medicine, First Department of Medicine (B.K., A.W.L., M.M.A., S.S.), Department of Intensive Care Medicine (D.W., G.H., S.K.), Institute for Clinical Chemistry and Laboratory Medicine (T.R.), and Infectious Disease Unit for Outpatient Care (S.S.), University Medical Center Hamburg-Eppendorf, the German Center for Infection Research, Hamburg-Borstel-Lübeck (B.K., J.S.-C., S.G., A.W.L., M.M.A., S.S.), the Research Group for Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (B.K.), and the Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research (P.E., J.S.-C., S.G.) - all in Hamburg, Germany; Arboviruses and Hemorrhagic Fever Viruses Unit, Pasteur Institute, and Public Health and Development Institute, Cheikh Anta Diop University - both in Dakar, Senegal (A.S.); Bordeaux Public Health Institute, INSERM Unité 897, Bordeaux University, Bordeaux, France (A.S); the Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm (T.R.); and the Infectious Diseases Unit, Massachusetts General Hospital, Boston (M.M.A.).


Ebola virus disease (EVD) developed in a patient who contracted the disease in Sierra Leone and was airlifted to an isolation facility in Hamburg, Germany, for treatment. During the course of the illness, he had numerous complications, including septicemia, respiratory failure, and encephalopathy. Intensive supportive treatment consisting of high-volume fluid resuscitation (approximately 10 liters per day in the first 72 hours), broad-spectrum antibiotic therapy, and ventilatory support resulted in full recovery without the use of experimental therapies. Discharge was delayed owing to the detection of viral RNA in urine (day 30) and sweat (at the last assessment on day 40) by means of polymerase-chain-reaction (PCR) assay, but the last positive culture was identified in plasma on day 14 and in urine on day 26. This case shows the challenges in the management of EVD and suggests that even severe EVD can be treated effectively with routine intensive care.

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