Ebola Virus

Epidemiology

  • Western Africa Outbreak Occurred in 2014

Microbiology

  • xxx

Physiology

  • Incubation Period: variable, but can be up to 24 days
  • Transmission: via body fluids

Diagnosis

  • xxx

Clinical Manifestations

General Comments

  • Incubation Period: 6-12 days

Initial Phase

  • General Comments
    • Onset: typically abrupt
  • Anorexia (see Anorexia, [[Anorexia]])
  • Chills
  • Diarrhea (see Diarrhea, [[Diarrhea]])
  • Fever (see Fever, [[Fever]])
  • Headache (see Headache, [[Headache]])
  • Malaise
  • Myalgias (see Myalgias, [[Myalgias]])
  • Nausea/Vomiting (see Nausea and Vomiting, [[Nausea and Vomiting]])
  • Sinus Bradycardia (see Sinus Bradycardia, [[Sinus Bradycardia]])
  • Weakness (see xxxx, [[xxxx]])

Disease Phase

Cardiovascular Manifestations

  • Chest Pain (see Chest Pain, [[Chest Pain]]): may occur in some cases
  • Hypotension/Shock (see Hypotension, [[Hypotension]]): may be exacerbated by dehydration

Dermatologic Manifestations

  • Diffuse, Erythematous, Non-Pruritic Maculopapular Rash (see xxxx, [[xxxx]])
    • Onset: develops by day 5-7 of the illness
    • Distribution: face, neck, trunk, arms (generally easier to see in light-skinned persons)
    • Course of Rash: may desquamate

Gastrointestinal Manifestations

  • General Comments: common
    • Onset: develop within the first few days of illness
  • Abdominal Pain (see Abdominal Pain, [[Abdominal Pain]])
  • Diarrhea (see Diarrhea, [[Diarrhea]]): may be up to 10L per day and result in dehydration
  • Elevated Liver Function Tests (LFT’s)/Transaminitis: due to multifocal hepatic necrosis
  • Nausea/Vomiting (see Nausea and Vomiting, [[Nausea and Vomiting]])

Hematologic manifestations

Hemorrhagic Manifestations

  • General Comments: although disease has been traditionally called “ebola hemorrhagic fever”, major hemorrhage is not seen in the majority of cases
    • However, clinically-significant hemorrhage may occur in the later stages of disease
  • Ecchymoses
  • Gastrointestinal Hemorrhage (see Gastrointestinal Hemorrhage, [[Gastrointestinal Hemorrhage]])
    • Only 6% of Cases Manifest Hematochezia During the Course of Their Illness
  • Mucosal Bleeding
  • Oozing from Venipuncture Sites
  • Petechiae (see Petechiae, [[Petechiae]])

Neurologic Manifestations

  • General Comments
    • Onset: usually develop after day 10 of the illness
  • Meningioencephalitis (see Meningitis, [[Meningitis]] and Encephalitis, [[Encephalitis]])
    • Altered Mental Status (see Delirium, [[Delirium]])
    • Stiff Neck
    • Seizures (see Seizures, [[Seizures]])

Ophthalmologic Manifestations

  • General Comments
    • Onset: develop during the acute phase of the illness or during convalescence
  • Uveitis (see Uveitis, [[Uveitis]])

Renal Manifestations

  • Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]]): may occur during both early and late stages of the disease
  • Electrolyte Abnormalities: due to vomiting and/or diarrhea
  • Proteinuria (see Proteinuria, [[Proteinuria]])

Other Manifestations

  • Conjunctival Injection (see Conjunctival Injection, [[Conjunctival Injection]]): common
  • Dark Red Soft Palate: common
  • Dyspnea (see Dyspnea, [[Dyspnea]]): may occur in some cases
  • Hiccups (see Hiccups, [[Hiccups]]): may occur in some cases
  • Spontaneous Miscarriage: may occur in pregnant females

Convalescent Phase

General Comments

  • Clinical Improvement is Expected to Occur During the Second Week of the Illness
  • Convalescent Phase May Be Prolonged (Lasting >2 Years in Some Cases)

Manifestations During Convalescent Phase

  • Acute Arthralgias (see Arthralgias, [[Arthralgias]]): due to formation of antigen-antibody complexes during recovery
  • Extensive Skin Sloughing/Hair Loss: due to virus-induced necrosis of infected sweat glands and other dermal structures
  • Hearing Loss (see Hearing Loss, [[Hearing Loss]])
  • Retro-Orbital Pain (see Eye Pain, [[Eye Pain]])
  • Uveitis (see Uveitis, [[Uveitis]])
  • Persistent Viral Shedding (in Urine/Semen/Aqueous Fluids): although the clinical importance of this finding is unclear, there have been cases of late onset uveitis and meningitis weeks-months after the initial presentation

Treatment

Supportive Care

  • xxx

XXX

  • xxxx

Prognosis

  • Mortality Rate: 60%

References

  • The 2014 Ebola virus disease outbreak in West Africa. J Gen Virol 2014:95:1619-1624 [MEDLINE]