Wednesday, October 29, 2014

Ebola vs excellent medical care

Mark Reiff sent me a couple of ebola-links, and the New England Journal of Medicine report was particularly interesting. The patient described isn’t exactly typical: he nearly died of a secondary infection as well, but he had top of the line medical care all along the way after he arrived in Hamburg. Among other things he got about 10 liters of plasma every day for a while (8-13) since he was losing 8 via diarrhea! There was no way he’d have survived without heroic treatment.

Grab a dictionary and have a look at the article.

One thing that was pretty startling is Figure 2, showing the levels of viral RNA detected in various body fluids. The blood levels decrease for a while and then drop like a stone—maybe the result of flushing by the plasma? The levels in urine track the projected decline in blood levels A report from the earlier outbreak in Congo found nothing in urine, but evidently their tests weren’t sensitive enough yet. Sweat levels drop too—and then rise with the onset of the secondary infection and then decline more slowly! At day 63 when the report was written the levels had dropped to undetectability. And of course we’ve heard the reports that viral RNA was found in semen 60 days after infection.

I take this to mean that the virus is holed up in some tissues: skin for one. And that someone can be infectious to touch for a while after they’ve recovered from the disease. The latter seems to conflict with earlier work, but the patient was atypical. Without the heroic treatment he wouldn’t have survived to touch people; maybe the typical survivor isn’t hit as hard. Or maybe not.

Still, something to keep in mind. (Texan99 seems to have been right about high performance medical treatment.)

1 comment:

jaed said...

about 10 liters of plasma every day
maybe the result of flushing by the plasma

Saline or Ringer's, surely, not plasma?