Ebola virus disease

Background

Ebola is a viral infection that causes severe, often fatal (40-65%) hemorrhagic fever with outbreaks in Uganda (2011,2012) Republic of Congo (2012) and Guinea, Liberia, Sierra Leone, and Nigeria in 2014. The viral reservoir is not known though thought to be animal in nature. Once a human is infected, 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. Two known United States healthcare workers were infected in Liberia and transported to Atlanta for treatment.

Clinical Features

Symptoms begin as soon as 2 days after infection most commonly days 8-10 though up to 21 days. Common symptoms include fevers, headaches, myalgias, malaise, diarrhea, vomiting, abdominal pain and anorexia. Hemorrhagic symptoms include 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

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

Care is supportive as there is no anti-viral medications directed at the Ebola virus. Since it is contagious, when a patient is suspected of possible Ebola infection, isolation is required until serological testing results. Notify public health.

Disposition

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

Sources

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