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Updated: Oct 19 2018

Ebola Virus

  • 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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