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