Ebola differential diagnosis: Difference between revisions

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==Overview==
==Overview==
There are other conditions, such as [[Marburg virus]], [[Lassa fever]], [[Typhoid fever]]  and [[Malaria]], that involve hemorrhage and/or high fever as part of their presentation, and therefore resemble Ebola virus disease. The [[clinician]] must first rule out the most likely cause of the fever before consider a viral hemorrhagic fever (VHF).<ref name=CDC>{{cite web | title = Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting  | url = http://www.who.int/csr/resources/publications/ebola/whoemcesr982sec1-4.pdf }}</ref>
Ebola must be differentiated from other diseases that cause hemorrhage and/or high [[fever]] as part of their presentation such as [[Marburg virus]], [[Lassa fever]], [[Typhoid fever]]  and [[Malaria]]. The [[clinician]] must first rule out other more common causes of the [[fever]] before considering a [[viral hemorrhagic fever]] ([[VHF]]) such as Ebola, and the consideration of a [[VHF]] should be based upon epidemiology and demographics as well as sign and symptoms.<ref>{{cite web | title = WHO Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting  | url = http://www.who.int/csr/resources/publications/ebola/whoemcesr982sec1-4.pdf }}</ref> A [[VHF]] such as Ebola, should be suspected in [[febrile]] persons who, within 3 weeks before onset of [[fever]], have either: 1) traveled in the specific local area of a country where [[VHF]] has recently occurred; 2) had direct unprotected contact with blood, other body fluids, secretions, or excretions of a person or animal with VHF; 3) if the patient had any contact with someone who was ill with [[fever]] and [[bleeding]] or who died from an unexplained [[illness]] with [[fever]] and [[bleeding]]; 4) had a possible exposure when working in a laboratory that handles [[hemorrhagic fever]] viruses; 5) If a [[fever]] continues after 3 days of empiric  treatment, and if the patient has [[signs]] such as [[bleeding]] or [[shock]], the [[clinician]] must consider a VHF; 6) if no other cause is found for the patient’s [[signs]] and [[symptoms]], the [[clinician]] must suspect a VHF.


==Differentiating Ebola from other Diseases==
==Differentiating Ebola from other Diseases==
* The [[clinician]] must treat the most likely cause of the fever according to local [[epidemiology]] and the appropriate treatment guidelines.
The table below summarizes the findings that differentiate Ebola from other conditions that cause fever and hemorrhage:
* If the [[fever]] continues after 3 days of recommended treatment, and if the patient has [[signs]] such as [[bleeding]] or [[shock]], the [[clinician]] must consider a VHF.
 
* It is important to review the patient’s history for any contact with someone who was ill with [[fever]] and [[bleeding]] or who died from an unexplained [[illness]] with [[fever]] and [[bleeding]].
* If no other cause is found for the patient’s [[signs]] and [[symptoms]], the [[clinician]] must suspect a VHF.
* Shown below is a table summarizing the typical findings of the differential diagnoses of ebola.
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Shigellosis]] & other bacterial enteric infections'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Shigellosis]] & other bacterial enteric infections'''
| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[diarrhea]], possibly [[Dysentery|bloody]], accompanied by [[fever]], [[nausea]], and sometimes [[toxemia]], [[vomiting]], [[cramps]], and [[tenesmus]]. [[Stool]]s contain [[blood]] and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and [[blood smear]]s, should be made. Presence of [[leucocytosis]] distinguishes bacterial infections.
| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[diarrhea]], possibly [[Dysentery|bloody]], accompanied by [[fever]], [[nausea]], and sometimes [[toxemia]], [[vomiting]], [[cramps]], and [[tenesmus]]. [[Stool]]s contain [[blood]] and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and [[blood smear]]s, should be made. Presence of [[leucocytosis]] distinguishes bacterial infections from [[viral infections]].
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Typhoid fever]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Typhoid fever]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[fever]], [[headache]], [[rash]], gastrointestinal symptoms, with [[lymphadenopathy]], relative [[bradycardia]], [[cough]] and [[leucopenia]] and sometimes [[sore throat]]. [[Blood]] and [[stool culture]] can demonstrate causative bacteria.
| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[fever]], [[headache]], [[rash]], gastrointestinal symptoms, with [[lymphadenopathy]], relative [[bradycardia]], [[cough]] and [[leucopenia]] and sometimes [[sore throat]]. [[Blood]] and [[stool culture]] can confirm the presence of the causative bacteria.
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| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Malaria]]'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Malaria]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with acute [[fever]], [[headache]] and sometime [[diarrhea]] (children). [[Blood smear]]s must be examined for malaria parasites. Presence of [[parasites]] does not exclude concurrent viral infection. [[Antimalarial]] must be prescribed in an attempt at therapy.
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with acute [[fever]], [[headache]] and sometimes [[diarrhea]] (children). A [[blood smear]]s must be examined for malaria parasites. The presence of [[parasites]] does not exclude a concurrent viral infection. An [[antimalarial]] should be prescribed as an [[empiric therapy]]. Although both Malaria and Ebola virus may present with constitutional symptoms and similar lab abnormalities, Malaria is more likely to involve ''paroxysms'' of fever, hypoglycemia, acute respiratory distress syndrome (ARDS), whereas Ebola virus is more likely to involve hemorrhagic sequelae.<ref name=Emergency Physicians Review>{{cite journal| author=| title=Ebola virus outbreak 2014: clinical review for emergency physicians | journal=Annals of Emergency Medicine | year= 2014| volume= | issue= | pages= | pmid= | doi= | pmc= | url=http://www.sciencedirect.com/science/article/pii/S0196064414013961 }} </ref>
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lassa fever]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lassa fever]]'''
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Yellow fever]] and other [[Flaviviridae]] '''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Yellow fever]] and other [[Flaviviridae]] '''
| style="padding: 5px 5px; background: #F5F5F5;" | Present with [[hemorraghe|hemorrhagic]] complications. Epidemiological investigation may reveal a pattern of disease transmission by an insect vector. Virus isolation and serological investigation serves to distinguish these [[virus]]. Confirmed history of previous [[yellow fever]] [[vaccination]] will rule out [[yellow fever]].
| style="padding: 5px 5px; background: #F5F5F5;" | Present with [[hemorrhage|hemorrhagic]] complications. Epidemiological investigation may reveal a pattern of disease transmission by an insect vector. Virus isolation and serological investigation serves to distinguish these [[viruses]]. Confirmed history of previous [[yellow fever]] [[vaccination]] will rule out [[yellow fever]].
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| style="padding: 5px 5px; background: #DCDCDC;" | '''Others'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Others'''
| style="padding: 5px 5px; background: #F5F5F5;" |[[Viral hepatitis]], [[leptospirosis]], [[rheumatic fever]], [[typhus]], and [[mononucleosis]] produce signs and symptoms that may be confused with [[Ebola]] in the early stages of infection.
| style="padding: 5px 5px; background: #F5F5F5;" |[[Viral hepatitis]], [[leptospirosis]], [[dengue fever]], [[rheumatic fever]], [[typhus]], [[acute leukemia]], [[systemic lupus erythematosus]], [[idiopathic thrombocytopenic purpura]], [[thrombotic thrombocytopenic purpura]], [[hemolytic uremic syndrome]], and [[mononucleosis]]
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| style="padding: 5px 5px; background: #FFF;" colspan="2"| <SMALL>Table adapted from WHO Guidelines For Epidemic Preparedness And Response: Ebola Haemorrhagic Fever <ref name="WHO"> {{cite web| title=WHO Guidelines For Epidemic Preparedness And Response: Ebola Haemorrhagic Fever |url= http://apps.who.int/iris/handle/10665/63806 }} </ref></SMALL>
| style="padding: 5px 5px; background: #FFF;" colspan="2"| <SMALL>Table adapted from WHO Guidelines For Epidemic Preparedness And Response: Ebola Haemorrhagic Fever <ref name="WHO"> {{cite web| title=WHO Guidelines For Epidemic Preparedness And Response: Ebola Haemorrhagic Fever |url= http://apps.who.int/iris/handle/10665/63806 }} </ref></SMALL>
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==Differentiating Ebola from Influenza==
Ebola virus should be differentiated from influenza virus since both occur in outbreaks and may present with similar signs and symptoms. The following table provided by the Centers for Disease Control and Prevention (CDC) demonstrates the key differences in transmission, risk factors, and clinical features between Ebola and influenza virus.<ref name="CDC1"> {{cite web| title=Is it Flu or Ebola? |url= http://www.cdc.gov/vhf/ebola/pdf/is-it-flu-or-ebola.pdf}} </ref>
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! style="background: #4479BA; width: 30px;" | {{fontcolor|#FFF|}}
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Influenza (Flu)}}
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Ebola }}
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| style="padding: 5px 5px; background: #DCDCDC;" | '''Cause'''
| style="padding: 5px 5px; background: #F5F5F5;" | The flu is a common, contagious mild/severe respiratory illness caused by infection with [[Influenza causes|influenza virus]].
| style="padding: 5px 5px; background: #F5F5F5;" | Ebola is a rare and deadly disease caused by infection with [[Ebola causes|Ebola virus]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Transmission'''
| style="padding: 5px 5px; background: #F5F5F5;" | [[Influenza pathophysiology|Transmission of influenza virus]] is mainly by droplets during cough, sneeze, or talk. Less commonly, the influenza virus can also spread on surfaces.
| style="padding: 5px 5px; background: #F5F5F5;" | [[Ebola causes|Transmission of Ebola]] is mainly by direct contact with blood or body fluids from:<br>
*A person who is sick or who has died of Ebola<br>
*Objects like needles that have been in contact with the blood or body fluids of a person sick with Ebola<br>
Ebola cannot spread in the air or by water or food.
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Susceptible patients'''
| style="padding: 5px 5px; background: #F5F5F5;" | Anyone can be infected by influenza virus. [[Influenza risk factors|Patients at higher risk]] include young children, elderly, and individuals with co-morbidities
| style="padding: 5px 5px; background: #F5F5F5;" | [[Ebola risk factors|At-risk individuals]] include healthcare providers taking care of Ebola patients and friends/family who have had unprotected direct contact with blood or body fluids of a person sick with Ebola
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Signs and Symptoms'''
| style="padding: 5px 5px; background: #F5F5F5;" |[[Influenza history and symptoms|Signs and symptoms]] usually develop within 2 days following exposure. Symptoms often develop rapidly and simultaneously.<br>
*Fever
*Headache
*Myalgia
*Fatigue
*Cough
*Sore throat
*Runny nose
| style="padding: 5px 5px; background: #F5F5F5;" |[[Ebola history and symptoms|Signs and symptoms of Ebola]] can appear 2 to 21 days following exposure, with an average time of 8-10 days. Symptoms of Ebola often develop over several days and progressively worsen. Early symptoms include:
*Fever
*Headache
*Myalgia
*Fatigue
*Vomiting
*Diarrhea
*Abdominal pain
*Unexplained bleeding or bruising
Late signs and symptoms include:
*Visceral and mucosal hemorrhage
*Neurological impairment
*Convulsions
*Stupor and coma
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<sup>Table adapted from the Centers for Disease Control and Prevention (CDC) - Is it Flu or Ebola?<ref name="CDC1"> {{cite web| title=Is it Flu or Ebola? |url= http://www.cdc.gov/vhf/ebola/pdf/is-it-flu-or-ebola.pdf}} </ref></sup>


==References==
==References==
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[[Category:Zoonoses]]
[[Category:Zoonoses]]
[[Category:Hemorrhagic fevers]]
[[Category:Hemorrhagic fevers]]
[[Category:Needs overview]]
 
[[Category:Infectious disease]]
[[Category:Disease]]
[[Category:Disease]]


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Latest revision as of 17:37, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]; Guillermo Rodriguez Nava, M.D. [3]

Overview

Ebola must be differentiated from other diseases that cause hemorrhage and/or high fever as part of their presentation such as Marburg virus, Lassa fever, Typhoid fever and Malaria. The clinician must first rule out other more common causes of the fever before considering a viral hemorrhagic fever (VHF) such as Ebola, and the consideration of a VHF should be based upon epidemiology and demographics as well as sign and symptoms.[1] A VHF such as Ebola, should be suspected in febrile persons who, within 3 weeks before onset of fever, have either: 1) traveled in the specific local area of a country where VHF has recently occurred; 2) had direct unprotected contact with blood, other body fluids, secretions, or excretions of a person or animal with VHF; 3) if the patient had any contact with someone who was ill with fever and bleeding or who died from an unexplained illness with fever and bleeding; 4) had a possible exposure when working in a laboratory that handles hemorrhagic fever viruses; 5) If a fever continues after 3 days of empiric treatment, and if the patient has signs such as bleeding or shock, the clinician must consider a VHF; 6) if no other cause is found for the patient’s signs and symptoms, the clinician must suspect a VHF.

Differentiating Ebola from other Diseases

The table below summarizes the findings that differentiate Ebola from other conditions that cause fever and hemorrhage:

Disease Findings
Shigellosis & other bacterial enteric infections Presents with diarrhea, possibly bloody, accompanied by fever, nausea, and sometimes toxemia, vomiting, cramps, and tenesmus. Stools contain blood and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and blood smears, should be made. Presence of leucocytosis distinguishes bacterial infections from viral infections.
Typhoid fever Presents with fever, headache, rash, gastrointestinal symptoms, with lymphadenopathy, relative bradycardia, cough and leucopenia and sometimes sore throat. Blood and stool culture can confirm the presence of the causative bacteria.
Malaria Presents with acute fever, headache and sometimes diarrhea (children). A blood smears must be examined for malaria parasites. The presence of parasites does not exclude a concurrent viral infection. An antimalarial should be prescribed as an empiric therapy. Although both Malaria and Ebola virus may present with constitutional symptoms and similar lab abnormalities, Malaria is more likely to involve paroxysms of fever, hypoglycemia, acute respiratory distress syndrome (ARDS), whereas Ebola virus is more likely to involve hemorrhagic sequelae.
Lassa fever Disease onset is usually gradual, with fever, sore throat, cough, pharyngitis, and facial edema in the later stages. Inflammation and exudation of the pharynx and conjunctiva are common.
Yellow fever and other Flaviviridae Present with hemorrhagic complications. Epidemiological investigation may reveal a pattern of disease transmission by an insect vector. Virus isolation and serological investigation serves to distinguish these viruses. Confirmed history of previous yellow fever vaccination will rule out yellow fever.
Others Viral hepatitis, leptospirosis, dengue fever, rheumatic fever, typhus, acute leukemia, systemic lupus erythematosus, idiopathic thrombocytopenic purpura, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, and mononucleosis
Table adapted from WHO Guidelines For Epidemic Preparedness And Response: Ebola Haemorrhagic Fever [2]

Differentiating Ebola from Influenza

Ebola virus should be differentiated from influenza virus since both occur in outbreaks and may present with similar signs and symptoms. The following table provided by the Centers for Disease Control and Prevention (CDC) demonstrates the key differences in transmission, risk factors, and clinical features between Ebola and influenza virus.[3]

Influenza (Flu) Ebola
Cause The flu is a common, contagious mild/severe respiratory illness caused by infection with influenza virus. Ebola is a rare and deadly disease caused by infection with Ebola virus
Transmission Transmission of influenza virus is mainly by droplets during cough, sneeze, or talk. Less commonly, the influenza virus can also spread on surfaces. Transmission of Ebola is mainly by direct contact with blood or body fluids from:
  • A person who is sick or who has died of Ebola
  • Objects like needles that have been in contact with the blood or body fluids of a person sick with Ebola

Ebola cannot spread in the air or by water or food.

Susceptible patients Anyone can be infected by influenza virus. Patients at higher risk include young children, elderly, and individuals with co-morbidities At-risk individuals include healthcare providers taking care of Ebola patients and friends/family who have had unprotected direct contact with blood or body fluids of a person sick with Ebola
Signs and Symptoms Signs and symptoms usually develop within 2 days following exposure. Symptoms often develop rapidly and simultaneously.
  • Fever
  • Headache
  • Myalgia
  • Fatigue
  • Cough
  • Sore throat
  • Runny nose
Signs and symptoms of Ebola can appear 2 to 21 days following exposure, with an average time of 8-10 days. Symptoms of Ebola often develop over several days and progressively worsen. Early symptoms include:
  • Fever
  • Headache
  • Myalgia
  • Fatigue
  • Vomiting
  • Diarrhea
  • Abdominal pain
  • Unexplained bleeding or bruising

Late signs and symptoms include:

  • Visceral and mucosal hemorrhage
  • Neurological impairment
  • Convulsions
  • Stupor and coma

Table adapted from the Centers for Disease Control and Prevention (CDC) - Is it Flu or Ebola?[3]

References

  1. "WHO Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting" (PDF).
  2. "WHO Guidelines For Epidemic Preparedness And Response: Ebola Haemorrhagic Fever".
  3. 3.0 3.1 "Is it Flu or Ebola?" (PDF).

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