A case of severe Ebola virus infection complicated by gram-negative septicemia

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.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-Infective Agents / therapeutic use*
  • Bacteremia / drug therapy
  • Bacteremia / etiology*
  • Critical Care
  • Diarrhea / etiology
  • Diarrhea / therapy
  • Ebolavirus / genetics
  • Ebolavirus / isolation & purification
  • Fluid Therapy
  • Gram-Negative Bacterial Infections / drug therapy
  • Gram-Negative Bacterial Infections / etiology*
  • Hemorrhagic Fever, Ebola / complications
  • Hemorrhagic Fever, Ebola / therapy*
  • Hepatitis B, Chronic / complications
  • Humans
  • Male
  • Parenteral Nutrition
  • RNA, Viral / blood
  • Sierra Leone
  • Viral Load


  • Anti-Infective Agents
  • RNA, Viral