Severe Ebola virus disease with vascular leakage and multiorgan failure: treatment of a patient in intensive care.

Abstract

BACKGROUND:

In the current epidemic of Ebola virus disease in western Africa, many aid workers have become infected. Some of these aid workers have been transferred to specialised hospitals in Europe and the USA for intensified treatment, providing the potential for unique insight into the clinical course of Ebola virus disease under optimised supportive measures in isolation units.

METHODS:

A 38-year-old male doctor who had contracted an Ebola virus infection in Sierra Leone was airlifted to University Hospital Frankfurt, Germany, on day 5 after disease onset. Within 72 h of admission to the hospital's high-level isolation unit, the patient developed signs of severe multiorgan failure, including lungs, kidneys, and gastrointestinal tract. In addition to clinical parameters, the diagnostic work-up included radiography, ultrasound, pulse contour cardiac output technology, and microbiological and clinical chemistry analyses. Respiratory failure with pulmonary oedema and biophysical evidence of vascular leak syndrome needed mechanical ventilation. The patient received a 3 day treatment course with FX06 (MChE-F4Pharma, Vienna, Austria), a fibrin-derived peptide under clinical development for vascular leak syndrome. After FX06 administration and concurrent detection of Ebola-virus-specific antibodies and a fall in viral load, vascular leak syndrome and respiratory parameters substantially improved. We gave broad-spectrum empiric antimicrobial therapy and the patient needed intermittent renal replacement therapy. The patient fully recovered.

FINDINGS:

This case report shows the feasibility of delivery of successful intensive care therapy to patients with Ebola virus disease under biosafety level 4 conditions.

INTERPRETATION:

The effective treatment of vascular leakage and multiorgan failure by combination of ventilatory support, antibiotic treatment, and renal replacement therapy can sustain a patient with severe Ebola virus disease until virological remission. FX06 could potentially be a valuable agent in contribution to supportive therapy.

FUNDING:

University Hospital of Frankfurt.

• Authors: Timo Wolf, Gerrit Kann, Stephan Becker, Christoph Stephan, Hans-Reinhardt Brodt, Philipp de Leuw, Thomas Grünewald, Thomas Vogl, Volkhard A J Kempf, Oliver T Keppler, Kai Zacharowski
• Journal: Lancet (London, England) (Lancet) Vol. 385 Issue 9976 Pg. 1428-35 (Apr 11 2015) ISSN: 1474-547X [Electronic] England
• PMID: 25534190 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Elsevier Ltd. All rights reserved.

Chemical References

• Amides
• Anti-Infective Agents
• Antiviral Agents
• Fibrin Fibrinogen Degradation Products
• Peptide Fragments
• Pyrazines
• fibrinogen Bbeta (15-42)
• favipiravir
• Amiodarone

Topics

• Adult
• Amides (therapeutic use)
• Amiodarone (therapeutic use)
• Anti-Infective Agents (administration & dosage)
• Antiviral Agents (therapeutic use)
• Blood Vessels (physiopathology)
• Critical Care
• Fibrin Fibrinogen Degradation Products (therapeutic use)
• Hemorrhagic Fever, Ebola (physiopathology, therapy)
• Humans
• Intubation, Intratracheal (methods)
• Male
• Multiple Organ Failure (physiopathology)
• Patient Isolation (methods)
• Peptide Fragments (therapeutic use)
• Pulmonary Edema (etiology)
• Pyrazines (therapeutic use)
• Radiography, Thoracic
• Renal Insufficiency (therapy)
• Respiratory Insufficiency (therapy)