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Snapshot
  • A 32-year-old medical assistant presents to a clinic in Uganda with fevers, generalized myalgias, and headaches. She reports also having nausea and blood-tinged vomiting. She had traveled to Uganda to volunteer at a hospital and has been working there for a month. She reports that the team had treated several patients for presumed flu, but laboratory testing revealed Ebola. On physical exam, she has a petechial rash on her chest. Appropriate isolation precautions are taken.
Introduction
  • Classification
    • ebola virus
      • an enveloped, linear, non-segmented, negative-sense, single-stranded RNA virus
      • filovirus with a helical capsid
      • transmission via direct contact with infected human body fluids (including post-mortem)
      • reservoirs are humans or infected animals (bats, pigs, or primates)
      • causes hemorrhagic fever
  • Epidemiology
    • incidence
      • most common in Africa
    • risk factors
      • travel to endemic countries
      • occupational exposure
      • sick contacts
  • Pathogenesis
    • the virus targets endothelial cells, hepatocytes, phagocytes, and dendritic cells
    • after an incubation period up to 21 days, the virus will disseminate via the lymphatics and cause multiorgan failure
  • Prevention
    • vaccines are under development
  • Prognosis
    • high mortality rate
Presentation
  • Symptoms
    • flu-like symptoms
      • high fever
      • myalgia
      • headache
    • nausea and vomiting
      • may have hematemesis
    • diarrhea
      • may have melena
  • Physical exam
    • petechial rash
    • can be hemorrhagic if the disease progresses to disseminated intravascular coagulopathy (DIC) and shock
      • bleeding from puncture sites
      • conjunctival injection
Studies
  • Labs
    • thrombocytopenia
    • hepatic transaminitis
    • detection of viral RNA on reverse-transcriptase polymerase chain reaction (RT-PCR)
  • Making the diagnosis
    • diagnosis based on clinical presentation and detection of viral RNA on RT-PCR
Differential
  • Yellow fever
    • distinguishing factors
      • presents with jaundice and scleral icterus with minor hemorrhage
      • transmission via mosquitoes
  • Dengue fever
    • distinguishing factors
      • also presents with hemorrhage
      • blanching confluent erythematous maculopapular rash with lymphadenopathy
      • transmission via mosquitoes
Treatment
  • Management approach
    • immediate isolation of the patient
    • mainstay of treatment is supportive
  • Conservative
    • supportive care
      • indication
        • all patients
      • modalities
        • correct electrolyte abnormalities
        • hydration of blood transfusion
        • reversal of coagulopathy
Complications
  • Death
  • Bacteremia

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