Critical Care for Multiple Organ Failure Secondary to Ebola Virus Disease in the United States.

Ebola virus disease (EVD) is a severe illness primarily characterized by fever, fatigue, diarrhea, and vomiting. It was first identified in 1976 with several small, limited outbreaks occurring between 1976 and 2012 (1, 2). Since December 2013, a complex and wide-ranging outbreak of EVD centered in West Africa has primarily affected Guinea, Liberia, and Sierra Leone. As of March 11, 2015, the current outbreak has resulted in approximately 24,282 confirmed and suspected cases with 9,976 deaths globally (3). For the first time in history, there has been both local and distant spread of EVD in West Africa—to neighboring nations (including Mali, Nigeria, and Senegal)—and to resource-rich nations in Europe and North America through multiple mechanisms, including repatriation of infected healthcare workers (HCW), index cases traveling to resource-rich nations, and local spread through contacts with infected HCW (4). Limited laboratory and other resources in the affected West African nations have hampered a more detailed understanding of the clinical phenotypes of EVD. Several recently published case series demonstrate that there is a wide spectrum of severity of illness in EVD ranging from mild-to-moderate symptoms largely confined to the gastrointestinal system (copious watery diarrhea, vomiting, abdominal pain, and acute hepatitis) to the development of organ failure and death (5–7). Reported mortality rates in West Africa during the current outbreak have ranged from 40% to 70%, which is notably improved from previous outbreaks where mortality rates approached 90% (3, 8). With the arrival of EVD to resource-rich nations, a more detailed description of the natural history of both mild and severe EVD is beginning to emerge with several patients in the United States and Europe developing critical illness requiring advanced life support with mechanical ventilation and renal replacement therapy (RRT) (9–12). As in previous outbreaks, both severity of illness and mortality risk appear to be associated with both viral load at presentation and peak viral load (5, 13). Here, we report the spectrum of critical illness, organ failure, laboratory data, and interventions on three patients with severe EVD in the United States.