Ebola virus disease

Background

• Viral hemorrhagic fever
• reservoir is not known (?bats)

2014 Outbreak Details

• No confirmed cases diagnosed via US transmission as of 9/10/14
• Outbreak includes
  • Cities of:
    • Port Harcourt, Nigeria
    • Lagos, Nigeria
    • Dakar, Senegal
  • Countries of:
    • Guinea
    • Liberia
    • Sierra Leone

Communicable Transmission

• Transmission can occur via direct contact with blood and body fluids (urine, saliva, semen, feces, vomit) in contact with mucous membranes or via instruments such as needles

Clinical Features

• Severe, often fatal (40-65%) hemorrhagic fever
• Incubation period: 2-21 days (most commonly days 8-10)
• Common symptoms:
  • Influenza-like Illness: fever, headaches, myalgias, malaise, diarrhea, vomiting, abdominal pain, anorexia
  • Hemorrhagic symptoms: unexplained bleeding/bruising

Differential Diagnosis

1. Ebola Hemorrhagic Fever
2. Lassa Fever- transmitted via rats
3. LCMV- Lymphocytic Choriomeningitis Virus- not usually fatal
4. Hanta Virus Pulmonary Syndrome- Endemic to United States
5. Marburg Hemorrhagic Fever- Last known 2008 (Uganda)

Workup

Persons under Investigation (PUI)

• Obtain a travel history for all persons presenting with fever
• Consider Ebola in any person who presents within 21 days of traveling to an epidemic area
  • Persons who have been in an outbreak area during the prior 21 days should be isolated with standard, contact, and droplet precautions during evaluation
• Immediately to the PUIs to local health authorities or CDD
  • Los Angeles repots to Acute Communicable Disease Control Program (ACDC) at 213-240-7941 (nights/weekends: 213-974-1234)
  • Special diagnostic testing requires consultation

Diagnostics

A few days after infectious symptoms begin, ELISA IgM, PCR or virus isolation are possible. Later in the disease or during recovery, IgM or IgG can be tested.

Management

• Isolated with standard, contact and droplet precautions
  • Isolate in a single room with the door closed
  • Limit entry and maintain a log of people who enter the room
  • Use standard, contact, and droplet precautions
• Test and treat for other possible causes of Fever in Travelers while evaluating for Ebola
  • CDC has guidance for safe specimen handling
• Supportive care
  • Currently no non-experimental medications directed at the Ebola virus, although newer medications are under evaluation

Disposition

Admit, isolation, possible ICU for serologic results and clinical observation/supportive care.

See Also

• Fever in Travelers
• Viral Hemorrhagic Fevers

Sources

cdc.gov/ebola cdc.gov- viral hemorrhagic fevers