Ebola differential diagnosis
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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
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).[1]
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.
- 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.
| 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. |
| 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 demonstrate causative bacteria. |
| Malaria | Presents with acute fever, headache and sometime diarrhea (children). Blood smears must be examined for malaria parasites. Presence of parasites does not exclude concurrent viral infection. Antimalarial must be prescribed in an attempt at therapy. |
| 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 virus. Confirmed history of previous yellow fever vaccination will rule out yellow fever. |
| Others | Viral hepatitis, leptospirosis, rheumatic fever, typhus, and mononucleosis produce signs and symptoms that may be confused with Ebola in the early stages of infection. |
| Table adapted from WHO Guidelines For Epidemic Preparedness And Response: Ebola Haemorrhagic Fever [2] | |