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Ebola FactsOctober 14, 2014
Symptoms of Ebola• Initial symptoms are nonspecific - may include fever, chills, myalgias, and malaise.• Patients can progress to develop gastrointestinal symptoms:
– severe watery diarrhea, nausea, vomiting, abdominal pain• Other symptoms:
– chest pain, shortness of breath, headache or confusion, conjunctival injection, hiccups, seizures, and cerebral edema
• Bleeding not universally present but can manifest later as petechiae, ecchymosis/ bruising, or oozing. Frank hemorrhage less common.
• Some develop diffuse erythematous maculopapular rash that can desquamate. • Most common symptoms reported during current outbreak:
– fever (87%)– fatigue (76%)– vomiting (68%)– diarrhea (66%)– loss of appetite (65%)
• Patients with fatal disease develop more severe clinical signs early during infection and die between days 6 - 16 of complications (mean of 7.5 days).
• In non-fatal cases, patients may have fever for several days and improve, around day 6. • The case fatality proportion in West Africa is about 71%
Source: Centers for Disease Control and Prevention. http://www.cdc.gov/vhf/ebola/hcp/clinician-information-us-healthcare-settings.html
Diagnosis of Ebola
Timeline of Infection Diagnostic tests available
Within a few days after symptoms begin
•Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing•IgM ELISA•Polymerase chain reaction (PCR)•Virus isolation
Later in disease course or after recovery •IgM and IgG antibodies
Retrospectively in deceased patients•Immunohistochemistry testing•PCR•Virus isolation
• Diagnosing Ebola can be difficult at first since early symptoms, such as fever, are nonspecific to Ebola infection.
• However, if a person has the early symptoms and has had contact with Ebola they should be isolated and public health professionals notified.
• Samples from the patient can then be collected and tested to confirm infection.
Source: Centers for Disease Control and Prevention http://www.cdc.gov/vhf/ebola/diagnosis/index.html
Source: http://www.cdc.gov/vhf/ebola/pdf/checklist-patients-evaluated-us-evd.pdf
Treatment of Ebola• There are no approved treatments available for EVD. • Clinical management focus - supportive care of complications:
– hypovolemia, electrolyte abnormalities, hematologic abnormalities, refractory shock, hypoxia, hemorrhage, septic shock, multi-organ failure, and DIC.
• Recommended care includes:– volume repletion– maintenance of blood pressure (with vasopressors if needed)– maintenance of oxygenation– pain control– nutritional support– treating secondary bacterial infections and pre-existing comorbidities
• Among patients from West Africa, large volumes of intravenous fluids have often been required to correct dehydration due to diarrhea and vomiting.
• Several investigational therapeutics for Ebola virus disease are in development. There are no approved vaccines available for EVD. Several investigational Ebola vaccines are in development, and Phase I trials are underway for some vaccine candidates.
Source: Centers for Disease Control and Prevention. http://www.cdc.gov/vhf/ebola/hcp/clinician-information-us-healthcare-settings.html
Source: http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf
References• Baize S. et al. Emergence of Zaire Ebola Virus Disease in Guinea -
Prepminary Report. N Engl J Med. 2014 Apr 16. epub• Feldmann H , Geisbert TW. Ebola Haemorrhagic Fever. Lancet.
2011 Mar 5;377(9768):849-62.• Fowler RA, Fletcher T, Fischer WA, et al. Caring for Critically Ill
Patients with Ebola Virus Disease: Perspectives from West Africa. Am J Respir Crit Care Med. 2014 Aug 25. Epub
• Kortepeter MG, Bausch DG, Bray M. Basic Cpnical and Laboratory Features of Filoviral Hemorrhagic Fever. J Infect Dis. 2011 Nov;204 Suppl 3:S810-6
• WHO Ebola Response Team. Ebola Virus Disease in West Africa –The First 9 Months of the Epidemic and Forward Projections. N EngJ Med. 2014 Sept 23. Epub
Source: http://www.cdc.gov/vhf/ebola/index.html
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