A Case of Severe Ebola Virus Infection Complicated by Gram-Negative Septicemia
Benno Kreuels, M.D., Dominic Wichmann, M.D., Petra Emmerich, Ph.D., Jonas Schmidt-Chanasit, M.D., Geraldine de Heer, M.D., Stefan Kluge, M.D., Abdourahmane Sow, M.D., Thomas Renn?, M.D., Ph.D., Stephan G?nther, M.D., Ansgar W. Lohse, M.D., Marylyn M. Addo, M.D., Ph.D., and Stefan Schmiedel, M.D.
October 22, 2014DOI: 10.1056/NEJMoa1411677
Since December 2013, a Zaire ebolavirus (EBOV) epidemic of unprecedented scale has ravaged West Africa, with a focus on Guinea, Sierra Leone, and Liberia.1-4 The current epidemic has led to a public health emergency in the region, exacerbated by high rates of infection among health care personnel. A substantial number of fatal cases are among health care workers.2 Several international health care workers have been evacuated to specialized centers in Europe and the United States. The patient transferred to our isolation unit worked for the World Health Organization (WHO) as an epidemiologist in Sierra Leone and was airlifted at the request of the WHO. Brief descriptions of the unit for the treatment of highly contagious infections (UTHCI) and the measures of infection control, which were similar to those used in biosafety level 4 laboratories, are included in the Supplementary Appendix, available with the full text of this article at NEJM.org.
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On the basis of the patient's history, the most likely source of infection was contact with a colleague who had had symptoms of EVD and died 10 days before the onset of symptoms in our patient. The patient and his colleague shared an office for meetings and used the same restroom facilities until 3 days before the colleague died.
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The patient's medical history was notable for asymptomatic, chronic hepatitis B virus infection (viral DNA level, as assessed by means of PCR, 11,000 IU per milliliter, with no evidence of liver dysfunction)....
