The challenges of managing the Ebola virus disease in the epidemic field

Abstract

Since August 2018, the Democratic Republic of the Congo (DRC) has experienced the most devastating and prolonged outbreak of Ebola virus disease (EVD) in its history, with more than 3320 cases and 2220 deaths in the North Kivu and Ituri provinces (7th December 2019). The management of a patient with EVD must take into account: the sensitive geopolitical context in this area of armed conflicts, ethnic and cultural considerations, drastic precautionary measures imposed on caregivers, as well as specific diagnostic and therapeutic limitations. The therapeutic strategies are mainly based on the optimized and early management of patients in Ebola treatment centres (ETC and the allocation of promising targeted therapeutics aimed to abolish the expansion of the infectious process). The main objective remains the performance of the level of supportive care and refers to a massive liquid filling with monitoring and compensation of hydro-electrolytic losses that are the paramount of typical EVD. Controlling early vascular filling is mandatory in order to prevent a bad outcome and to establish indication for up-graduation of levels of care, such as renal replacement therapy, invasive ventilation or the use of inotropic drugs, which are challenging to achieve in the context of the field. We report the case of a hospitalized patient with a severe form of MVE in the CTE of Béni (North Kivu), DRC during the ongoing 2018 outbreak.