BACKGROUND: Infection with Ebola virus (EBOV) results in a life-threatening disease, with reported mortality rates between 50%-70%. The factors that determine patient survival are poorly understood; however, clinical observations indicate that EBOV viremia may be associated with fatal outcome. We conducted a study of the kinetics of Zaire EBOV viremia in patients with EBOV disease (EVD) who were managed at an Ebola Treatment Centre in Sierra Leone during the recent West African outbreak. METHODS: Data from 84 EVD patients (38 survivors, 46 nonsurvivors) were analyzed, and EBOV viremia was quantified between 2 and 13 days after symptom onset. Time since symptom onset and clinical outcome were used as independent variables to compare EBOV viral kinetics in survivors and nonsurvivors. RESULTS: In all patients, EBOV viremia kinetics was a quadratic function of time; however, EBOV viremia was 0.94 logarithm (log) copies per ml (cp/ml) (P = 0.011) higher in nonsurvivors than in survivors from day 2 after the onset of symptoms. Survivors reached peak viremia levels at an earlier time after symptom onset than nonsurvivors (day 5 versus day 7) and had lower mean peak viremia levels compared with nonsurvivors (7.46 log cp/ml; 95% CI, 7.17-7.76 vs. 8.60 log cp/ml; 95% CI, 8.27-8.93). Before reaching peak values, EBOV viremia similarly increased both in survivors and nonsurvivors; however, the decay of viremia after the peak was much stronger in survivors than in nonsurvivors. CONCLUSION: Our results demonstrate that plasma concentrations of EBOV are markedly different between survivors and nonsurvivors at very early time points after symptom onset and may be predicative of outcome. Further studies focused on the early phase of the disease will be required to identify the causal and prognostic factors that determine patient outcome. FUNDING: Italian Ministry of Health; Italian Ministry of Foreign Affairs; EMERGENCY's private donations; and Royal Engineers for DFID-UK.
RCT Entities:
BACKGROUND: Infection with Ebola virus (EBOV) results in a life-threatening disease, with reported mortality rates between 50%-70%. The factors that determine patient survival are poorly understood; however, clinical observations indicate that EBOV viremia may be associated with fatal outcome. We conducted a study of the kinetics of Zaire EBOV viremia in patients with EBOV disease (EVD) who were managed at an Ebola Treatment Centre in Sierra Leone during the recent West African outbreak. METHODS: Data from 84 EVD patients (38 survivors, 46 nonsurvivors) were analyzed, and EBOV viremia was quantified between 2 and 13 days after symptom onset. Time since symptom onset and clinical outcome were used as independent variables to compare EBOV viral kinetics in survivors and nonsurvivors. RESULTS: In all patients, EBOV viremia kinetics was a quadratic function of time; however, EBOV viremia was 0.94 logarithm (log) copies per ml (cp/ml) (P = 0.011) higher in nonsurvivors than in survivors from day 2 after the onset of symptoms. Survivors reached peak viremia levels at an earlier time after symptom onset than nonsurvivors (day 5 versus day 7) and had lower mean peak viremia levels compared with nonsurvivors (7.46 log cp/ml; 95% CI, 7.17-7.76 vs. 8.60 log cp/ml; 95% CI, 8.27-8.93). Before reaching peak values, EBOV viremia similarly increased both in survivors and nonsurvivors; however, the decay of viremia after the peak was much stronger in survivors than in nonsurvivors. CONCLUSION: Our results demonstrate that plasma concentrations of EBOV are markedly different between survivors and nonsurvivors at very early time points after symptom onset and may be predicative of outcome. Further studies focused on the early phase of the disease will be required to identify the causal and prognostic factors that determine patient outcome. FUNDING: Italian Ministry of Health; Italian Ministry of Foreign Affairs; EMERGENCY's private donations; and Royal Engineers for DFID-UK.
Authors: S Baize; E M Leroy; M C Georges-Courbot; M Capron; J Lansoud-Soukate; P Debré; S P Fisher-Hoch; J B McCormick; A J Georges Journal: Nat Med Date: 1999-04 Impact factor: 53.440
Authors: Benno Kreuels; Dominic Wichmann; Petra Emmerich; Jonas Schmidt-Chanasit; Geraldine de Heer; Stefan Kluge; Abdourahmane Sow; Thomas Renné; Stephan Günther; Ansgar W Lohse; Marylyn M Addo; Stefan Schmiedel Journal: N Engl J Med Date: 2014-10-22 Impact factor: 91.245
Authors: John S Schieffelin; Jeffrey G Shaffer; Augustine Goba; Michael Gbakie; Stephen K Gire; Andres Colubri; Rachel S G Sealfon; Lansana Kanneh; Alex Moigboi; Mambu Momoh; Mohammed Fullah; Lina M Moses; Bethany L Brown; Kristian G Andersen; Sarah Winnicki; Stephen F Schaffner; Daniel J Park; Nathan L Yozwiak; Pan-Pan Jiang; David Kargbo; Simbirie Jalloh; Mbalu Fonnie; Vandi Sinnah; Issa French; Alice Kovoma; Fatima K Kamara; Veronica Tucker; Edwin Konuwa; Josephine Sellu; Ibrahim Mustapha; Momoh Foday; Mohamed Yillah; Franklyn Kanneh; Sidiki Saffa; James L B Massally; Matt L Boisen; Luis M Branco; Mohamed A Vandi; Donald S Grant; Christian Happi; Sahr M Gevao; Thomas E Fletcher; Robert A Fowler; Daniel G Bausch; Pardis C Sabeti; S Humarr Khan; Robert F Garry Journal: N Engl J Med Date: 2014-10-29 Impact factor: 91.245
Authors: Anita K McElroy; Bobbie R Erickson; Timothy D Flietstra; Pierre E Rollin; Stuart T Nichol; Jonathan S Towner; Christina F Spiropoulou Journal: J Infect Dis Date: 2014-02-12 Impact factor: 5.226
Authors: Jonathan S Towner; Pierre E Rollin; Daniel G Bausch; Anthony Sanchez; Sharon M Crary; Martin Vincent; William F Lee; Christina F Spiropoulou; Thomas G Ksiazek; Mathew Lukwiya; Felix Kaducu; Robert Downing; Stuart T Nichol Journal: J Virol Date: 2004-04 Impact factor: 5.103
Authors: John C Kash; Kathie-Anne Walters; Jason Kindrachuk; David Baxter; Kelsey Scherler; Krisztina B Janosko; Rick D Adams; Andrew S Herbert; Rebekah M James; Spencer W Stonier; Matthew J Memoli; John M Dye; Richard T Davey; Daniel S Chertow; Jeffery K Taubenberger Journal: Sci Transl Med Date: 2017-04-12 Impact factor: 17.956
Authors: Richard T Davey; Lori Dodd; Michael A Proschan; James Neaton; Jacquie Neuhaus Nordwall; Joseph S Koopmeiners; John Beigel; John Tierney; H Clifford Lane; Anthony S Fauci; Moses B F Massaquoi; Foday Sahr; Denis Malvy Journal: N Engl J Med Date: 2016-10-13 Impact factor: 91.245
Authors: Pritimoy Das; Hossain M S Sazzad; Mohammad Abdul Aleem; M Ziaur Rahman; Mahmudur Rahman; Simon J Anthony; W Ian Lipkin; Emily S Gurley; Stephen P Luby; John J Openshaw Journal: Philos Trans R Soc Lond B Biol Sci Date: 2019-08-12 Impact factor: 6.237
Authors: Emily Speranza; Paula Ruibal; Julia R Port; Feng Feng; Lia Burkhardt; Adam Grundhoff; Stephan Günther; Lisa Oestereich; Julian A Hiscox; John H Connor; César Muñoz-Fontela Journal: J Infect Dis Date: 2018-11-22 Impact factor: 5.226
Authors: Kyle Rosenke; Jennifer Adjemian; Vincent J Munster; Andrea Marzi; Darryl Falzarano; Clayton O Onyango; Melvin Ochieng; Bonventure Juma; Robert J Fischer; Joseph B Prescott; David Safronetz; Victor Omballa; Collins Owuor; Thomas Hoenen; Allison Groseth; Cynthia Martellaro; Neeltje van Doremalen; Galina Zemtsova; Joshua Self; Trenton Bushmaker; Kristin McNally; Thomas Rowe; Shannon L Emery; Friederike Feldmann; Brandi N Williamson; Sonja M Best; Tolbert G Nyenswah; Allen Grolla; James E Strong; Gary Kobinger; Fatorma K Bolay; Kathryn C Zoon; Jorgen Stassijns; Ruggero Giuliani; Martin de Smet; Stuart T Nichol; Barry Fields; Armand Sprecher; Moses Massaquoi; Heinz Feldmann; Emmie de Wit Journal: Clin Infect Dis Date: 2016-08-15 Impact factor: 9.079
Authors: Pauline Vetter; William A Fischer; Manuel Schibler; Michael Jacobs; Daniel G Bausch; Laurent Kaiser Journal: J Infect Dis Date: 2016-07-20 Impact factor: 5.226