1. Clinical, virological, and biological parameters associated with outcomes of Ebola virus infection in Macenta, Guinea
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Vernet, Marie-Astrid, Reynard, Stéphanie, Fizet, Alexandra, Schaeffer, Justine, Pannetier, Delphine, Guedj, Jeremie, Rives, Max, Georges, Nadia, Garcia-Bonnet, Nathalie, Sylla, Aboubacar I., Grovogui, Péma, Kerherve, Jean-Yves, Savio, Christophe, Savio-Coste, Sylvie, Séverac, Marie-Laure, Zloczewski, Philippe, Linares, Sandrine, Harouna, Souley, Abdoul, Bing M'Lebing, Petitjean, Frederic, Samake, Nenefing, Shepherd, Susan, Kinda, Moumouni, Koundouno, Fara Roger, Joxe, Ludovic, Mateo, Mathieu, Lecine, Patrick, Page, Audrey, Tchamdja, Tang Maleki, Schoenhals, Matthieu, Barbe, Solenne, Simon, Bernard, Tran-Minh, Tuan, Longuet, Christophe, L'Hériteau, François, Baize, Sylvain, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur (RIIP), Biologie des Infections Virales Émergentes - Biology of Emerging Viral Infections (UBIVE), Centre International de Recherche en Infectiologie - UMR (CIRI), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut Pasteur [Paris], Laboratoire P4 Jean Mérieux-Inserm [Lyon] (Unité de service 3), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Européen de Recherche en Virologie et Immunologie [Lyon] (Tour Inserm CERVI), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Ministère de la santé, Ministère de la Santé [Conakry, Guinea], Alliance for International medical Action (ALIMA), BIOASTER Microbiology Technology Institute [Lyon], Croix rouge française, Fondation Mérieux, Centre de Coordination de Lutte contre les Infections Nosocomiales PARIS NORD (CCLIN PARIS NORD), Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut Pasteur [Paris] (IP), and Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)
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Adult ,Male ,Adolescent ,viruses ,virus diseases ,Infant ,Hemorrhagic Fever, Ebola ,Middle Aged ,Viral Load ,Ebolavirus ,Prognosis ,[SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology ,Cohort Studies ,Young Adult ,Child, Preschool ,Outcome Assessment, Health Care ,[SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology ,Humans ,[SDV.IMM]Life Sciences [q-bio]/Immunology ,Female ,Guinea ,Survivors ,Clinical Medicine ,Child - Abstract
International audience; BACKGROUND. The pathogenesis of Ebola virus (EBOV) disease (EVD) is poorly characterized. The establishment of well-equipped diagnostic laboratories close to Ebola treatment centers (ETCs) has made it possible to obtain relevant virological and biological data during the course of EVD and to assess their association with the clinical course and different outcomes of the disease. METHODS. We were responsible for diagnosing EBOV infection in patients admitted to two ETCs in forested areas of Guinea. The pattern of clinical signs was recorded, and an etiological diagnosis was established by RT-PCR for EBOV infection or a rapid test for malaria and typhoid fever. Biochemical analyses were also performed. RESULTS. We handled samples from 168 patients between November 29, 2014, and January 31, 2015; 97 patients were found to be infected with EBOV, with Plasmodium falciparum coinfection in 18%. Overall mortality for EVD cases was 58%, rising to 86% if P. falciparum was also present. Viral load was higher in fatal cases of EVD than in survivors, and fatal cases were associated with higher aspartate aminotransferase (AST) and alanine aminotransferase (ALT), C-reactive protein (CRP), and IL-6 levels. Furthermore, regardless of outcome, EVD was characterized by higher creatine kinase (CPK), amylase, and creatinine levels than in febrile patients without EVD, with higher blood urea nitrogen (BUN) levels in fatal cases of EVD only. CONCLUSION. These findings suggest that a high viral load at admission is a marker of poor EVD prognosis. In addition, high AST, ALT, CRP, and IL-6 levels are associated with a fatal outcome of EVD. Damage to the liver and other tissues, with massive rhabdomyolysis and, probably, acute pancreatitis, is associated with EVD and correlated with disease severity. Finally, biochemical analyses provide substantial added value at ETCs, making it possible to improve supportive rehydration and symptomatic care for patients. FUNDING. The French Ministry of Foreign Affairs, the Agence Française de Développement, and Institut Pasteur.
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- 2017