Arranz Javier, Lundeby Karen Marie, Hassan Shoaib, Zabala Fuentes Luis Matías, San José Garcés Pedro, Haaskjold Yngvar Lunde, Bolkan Håkon Angell, Krogh Kurt Østhuus, Jongopi James, Mellesmo Sindre, Jøsendal Ola, Øpstad Åsmund, Svensen Erling, Kamara Alfred Sandy, Roberts David P, Stamper Paul D, Austin Paula, Moosa Alfredo J, Marke Dennis, Berg Åse, Blomberg Bjørn, Riera Melcior
Médicos del Mundo, Madrid, Spain.
Arquitecte Bennassar Health Center, Palma de Mallorca, Illes Balears, Spain.
BMC Infect Dis. 2016 Jun 22;16:308. doi: 10.1186/s12879-016-1609-9.
The last ebola virus disease (EVD) outbreak has been the most important since 1976. EVD cases decreased drastically in Sierra Leone at the beginning of 2015. We aim to determine the clinical findings and evolution of patients admitted to an Ebola treatment center (ETC) during the epidemic's late phase.
We analyze retrospectively data of patients admitted to the Moyamba ETC (December 2014-March 2015). Patients were classified in EVD or non-EVD patients according to the results of Ebola virus real-time reverse transcription polymerase chain reaction (ZAIRE-RT-PCR).
Seventy-five patients were included, 41.3 % were positive for ZAIRE-RT-PCR. More women (68 % vs 28 %, p = 0.001) were EVD-positive. More EVD patients had previous contact with an Ebola patient (74.2 % vs 36.3 %, p < 0.001). At admission, EVD patients were more likely to have fatigue (96.7 %, p < 0.001), diarrhea (67.7 %, p = 0.002), and muscle pain (61.3 %, p = 0.009); but only objective fevers in 35.5 % of EVD patients. The most reliable criteria for diagnosis were: contact with an Ebola patient plus three WHO symptoms (LR + =3.7, 95 % CI = 1.9-7.3), and positive contact (LR + =2.3, 95 % CI = 1.15-4.20). Only 45.2 % of EVD patients developed fevers during stay, but 75 % developed gastrointestinal symptoms. Non-EVD patients had gastrointestinal problems (33 %), respiratory conditions (26.6 %), and others such as malaria, HIV or tuberculosis with a mortality rate of 11.4 %. vs 58 % in EVD group (p < 0.001).
More non-EVD patients were admitted in the outbreak's late phases. The low percentage of initial fever highlights the need to emphasize the epidemiological information. EVD patients presented new symptoms getting worse and requiring closer follow-up. Diagnoses of non-EVD patients were diverse with a remarkable mortality, presenting a challenge for the health system.
最近一次埃博拉病毒病（EVD）疫情是自1976年以来最为严重的一次。2015年初，塞拉利昂的EVD病例急剧减少。我们旨在确定在疫情后期入住埃博拉治疗中心（ETC）的患者的临床症状及病情发展情况。
我们回顾性分析了莫扬巴ETC（2014年12月至2015年3月）收治患者的数据。根据埃博拉病毒实时逆转录聚合酶链反应（扎伊尔型RT-PCR）结果，将患者分为EVD患者和非EVD患者。
共纳入75例患者，41.3%的患者扎伊尔型RT-PCR检测呈阳性。EVD阳性患者中女性更多（68%对28%，p = 0.001）。更多的EVD患者此前接触过埃博拉患者（74.2%对36.3%，p < 0.001）。入院时，EVD患者更易出现疲劳（96.7%，p < 0.001）、腹泻（67.7%，p = 0.002）和肌肉疼痛（61.3%，p = 0.009）；但仅有35.5%的EVD患者有客观发热症状。最可靠的诊断标准为：接触过埃博拉患者且伴有世界卫生组织定义的三种症状（LR+ = 3.7，95%CI = 1.9 - 7.3），以及有阳性接触史（LR+ = 2.3，95%CI = 1.15 - 4.20）。仅45.2%的EVD患者在住院期间出现发热，但75%的患者出现胃肠道症状。非EVD患者有胃肠道问题（33%）、呼吸道疾病（26.6%）以及其他疾病，如疟疾、艾滋病毒或结核病，死亡率为11.4%。而EVD组的死亡率为58%（p < 0.001）。
在疫情后期，收治的非EVD患者更多。初始发热比例较低，这凸显了强调流行病学信息的必要性。EVD患者出现了新的症状，且病情加重，需要更密切的随访。非EVD患者的诊断多样，死亡率较高，这给卫生系统带来了挑战。
