严重埃博拉病毒感染合并革兰氏阴性菌败血症病例报告。
A case of severe Ebola virus infection complicated by gram-negative septicemia.
机构信息
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.).
出版信息
N Engl J Med. 2014 Dec 18;371(25):2394-401. doi: 10.1056/NEJMoa1411677. Epub 2014 Oct 22.
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.
埃博拉病毒病（EVD）发生在一名从塞拉利昂感染该病的患者身上，他被空运到德国汉堡的隔离设施接受治疗。在病程中，他出现了许多并发症，包括败血症、呼吸衰竭和脑病。重症支持治疗包括大剂量液体复苏（前 72 小时每天约 10 升）、广谱抗生素治疗和通气支持，最终成功治愈，未使用实验性疗法。由于聚合酶链反应（PCR）检测到尿（第 30 天）和汗（第 40 天最后一次评估）中的病毒 RNA，患者的出院时间被推迟，但最后一次阳性培养是在第 14 天的血浆和第 26 天的尿液中确定的。该病例显示了埃博拉病毒病管理方面的挑战，并表明即使是严重的埃博拉病毒病也可以通过常规重症监护得到有效治疗。
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