Ebola history and symptoms: Difference between revisions

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__NOTOC__
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{{Ebola}}
{{Ebola}}
{{CMG}}; {{AE}} {{MJM}}; {{GRN}}
{{CMG}}; {{AE}} {{MJM}}; {{GRN}}; {{YD}}
==Overview==
==Overview==
Ebola causes a variety of [[symptoms]] which may include [[fever]], [[chills]] [[vomiting]], [[diarrhea]], generalized [[pain]] or [[malaise]], and sometimes [[internal bleeding|internal]] and [[hemorrhage|external bleeding]], that follow an [[incubation period]] of 2-21 days.  These [[symptoms]] are common to all [[species]] of ''[[Ebola virus]]'', but the different [[species]] may present with differences in the severity of [[symptoms]].
Patients who present with fever and have a recent travel to endemic countries, particularly to West Africa including Sierra Leone,Liberia, Guinea, and Nigeria, should be suspected to have Ebola virus infection. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Incubation period ranges from 2 to 21 days prior to development of symptoms. The majority of symptomatic patients have fatal outcomes. Patients often initially develop flu-like or malaria-like symptoms before multisystem organ failure and bleeding diasthesis take place.


==History==
==History==
Ebola infection commonly occurs from direct contact with the [[virus]] through [[mucosal]] surfaces, cuts on the [[skin]], or [[parenterally]].
Ebola hemorrhagic fever should be suspected in patients with acute febrile illness, hemorrhagic symptoms, and a history of travel to an endemic area. As such, patients who present with fever and have a recent travel to endemic countries, particularly to [[West Africa]] including [[Sierra Leone]], [[Liberia]], [[Guinea]], and [[Nigeria]], should be suspected to have Ebola virus infection. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Exposure to Ebola virus include direct contact, exposure to blood or body fluids of infected patients, processing of blood or body fluids of a patient with suspected or confirmed Ebola virus infection, and contact with a dead body without appropriate [[Ebola primary prevention|personal protective equipment]] in an endemic country. Other important clues during history-taking include: duration and character of fever and other constitutional symptoms, presence of systemic manifestations, appearance of any hemorrhagic symptoms, and presence of sick contacts and their symptoms.
The risk of [[infection]] is increased when there is contact with patients or cadavers [[infected]] with the [[virus]]. Once [[infection]] occurs, it commonly takes 2 - 21 days for [[symptoms]] to develop. Patients who have fatal [[outcome]]s, often develop earlier [[symptoms]], dying between the 6th and 16th day of disease from [[shock]] and [[multiorgan failure]].
Although different [[species]] of [[Ebola virus]] have different clinical manifestations, a common progression of [[symptoms]] includes 2 phases:<ref name="pmid9988156">{{cite journal| author=Ndambi R, Akamituna P, Bonnet MJ, Tukadila AM, Muyembe-Tamfum JJ, Colebunders R| title=Epidemiologic and clinical aspects of the Ebola virus epidemic in Mosango, Democratic Republic of the Congo, 1995. | journal=J Infect Dis | year= 1999 | volume= 179 Suppl 1 | issue=  | pages= S8-10 | pmid=9988156 | doi=10.1086/514297 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9988156  }} </ref><ref name="pmid9988155">{{cite journal| author=Bwaka MA, Bonnet MJ, Calain P, Colebunders R, De Roo A, Guimard Y et al.| title=Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo: clinical observations in 103 patients. | journal=J Infect Dis | year= 1999 | volume= 179 Suppl 1 | issue=  | pages= S1-7 | pmid=9988155 | doi=10.1086/514308 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9988155  }} </ref><ref name="pmid21084112">{{cite journal| author=Feldmann H, Geisbert TW| title=Ebola haemorrhagic fever. | journal=Lancet | year= 2011 | volume= 377 | issue= 9768 | pages= 849-62 | pmid=21084112 | doi=10.1016/S0140-6736(10)60667-8 | pmc=PMC3406178 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21084112  }} </ref>


* Phase 1 - characterized by general [[symptoms]], such as: [[fever]], [[chills]], [[asthenia]] and [[headache]].
==Early Symptoms==
Incubation period ranges from 2 to 21 days. The majority of symptomatic patients have fatal [[outcome]]s. Patients often initially develop flu-like or malaria-like symptoms before [[multisystem organ failure]] and [[bleeding diasthesis]] take place.
====Constitutional symptoms====
*[[Fever]] and [[chills]] are the most common presenting features of Ebola virus infection
*[[Headache]]
*[[Weight loss]]
*[[Anorexia]]
*[[Asthenia]]


After phase 1, there is a pseudoremission phase, in which patients' clinical status improve for 24 - 48 hours.
====Skin====
* Characteristic [[maculopapular]], non-[[pruritic]] [[rash]] with [[erythema]]. Skin rash typically appears within 5-7 days of disease onset and has a [[centripetal]] distribution.
* [[Desquamation]]


* Phase 2 - characterized by severe [[symptoms]], such as neuropsychiatric changes and hemorrhagic manifestations.
====Musculoskeletal====
*[[Arthralgia]]
*[[Myalgia]]


Patients who only manifest phase 1 symptoms have better [[survival rate]]s than those who develop phase 2 symptoms. Without treatment, patients' clinical status may deteriorate to the point of [[shock]] and [[multiorgan failure]]. The fatal cases usually occur within the first two weeks of [[symptoms]].<ref name="pmid21084112">{{cite journal| author=Feldmann H, Geisbert TW| title=Ebola haemorrhagic fever. | journal=Lancet | year= 2011 | volume= 377 | issue= 9768 | pages= 849-62 | pmid=21084112 | doi=10.1016/S0140-6736(10)60667-8 | pmc=PMC3406178 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21084112  }} </ref><ref name="pmid2749110">{{cite journal| author=Sureau PH| title=Firsthand clinical observations of hemorrhagic manifestations in Ebola hemorrhagic fever in Zaire. | journal=Rev Infect Dis | year= 1989 | volume= 11 Suppl 4 | issue=  | pages= S790-3 | pmid=2749110 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2749110  }} </ref>
If a patient with [[fever]], who is being treated for a different condition, remains [[febrile]] after 3 days, and if [[bleeding]] or [[shock]] occur, then [[VHF]] should be considered.
==Symptoms==
* [[Symptoms]] are varied and often appear suddenly.
===Phase 1===
[[Incubation period]] - duration approximately 2 - 21 days, followed by an abrupt onset of [[symptoms]], which include:
====General====
* [[Fever]]
* [[Chills]]
* [[Malaise]]
====Skin====
* [[Rash]]
* [[Erythema]]
* [[Desquamation]]
====Respiratory====
====Respiratory====
* [[Chest pain]]
* [[Sore throat]]
* [[Shortness of breath]]
* [[Cough]]
* [[Cough]]
* [[Sore throat]]
* [[Nasal discharge]]
* [[Nasal discharge]]
====Gastrointestinal====  
====Gastrointestinal====  
* [[Loss of appetite]]
* [[Abdominal pain]]
* [[Nausea]]
* [[Nausea]]
* [[Dysphagia|Trouble swallowing]]
* [[Vomiting]]
* [[Vomiting]]
* [[Abdominal pain]] - often related with true [[pancreatitis]]
* [[Diarrhea]], which may be bloody even in the early phase of the disease
* [[Diarrhea]]  
 
====Vascular====
====Ophthalmological====
* [[Conjunctival injection|Red eye]]
* [[Eye pain]]
* [[Edema]]
* [[Conjunctivitis]]
 
====Hemorrhagic disease====
*Epistaxis
*Mucosal bleeding
 
==Late Symptoms==
====Respiratory====
*[[Dyspnea]]
 
====Cardiovascular====
*[[Chest pain]]
 
====Gastrointestinal====
*[[Abdominal pain]] that may be related to pancreatitis, intestinal wall swelling, or mesenteric lymphadenopathy
*[[Abdominal distention]]
 
====Neurological====
====Neurological====
* [[Headache]]
* [[Hiccups]], which classically herald worse outcomes and death
* [[Confusion]]
* [[Confusion]]
* [[Tinnitus]]
* [[Tinnitus]]
====Osteoarticular====
* [[Hearing loss]]
* [[Myalgia|Muscle pain]]
* [[Dysphagia]]
* [[Arthralgia|Joint pain]]
*[[Convulsions]]
* [[Back pain]]


===Phase 2===
===Hemorrhagic Disease===
Generally preceded by a short pseudoremission period, which lasts about 24 - 48 hours
* [[Jaundice]]
====Haemorrhagic manifestations====
* [[Petechiae]]
* [[Petechiae|Small red spots on the body]]
* [[Ecchymoses]]
* [[Ecchymoses|Bruises]]
* [[Epistaxis]]
* [[Epistaxis|Nasal bleeding]]
* [[Mucosal bleeding]]
* [[Mucosal bleeding]]
* [[Hematemesis|Bloody vomiting]]
* [[Hematemesis]]
* [[Melena|Bloody stools]]
* [[Melena]]
* [[Hematuria|Bloody urine]]
* [[Hematuria]]
* Uncontroled [[bleeding]] from venepuncture sites
* [[Vaginal bleeding]]
 
* Uncontrolled [[bleeding]] from venipuncture sites
====Nonpsychiatric abnormalities====
*[[Hemorrhagic shock]]
* [[Convulsions]]


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


{{WH}}
{{WH}}
{{WS}}
{{WS}}

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: Michael Maddaleni, B.S.; Guillermo Rodriguez Nava, M.D. [2]; Yazan Daaboul, M.D.

Overview

Patients who present with fever and have a recent travel to endemic countries, particularly to West Africa including Sierra Leone,Liberia, Guinea, and Nigeria, should be suspected to have Ebola virus infection. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Incubation period ranges from 2 to 21 days prior to development of symptoms. The majority of symptomatic patients have fatal outcomes. Patients often initially develop flu-like or malaria-like symptoms before multisystem organ failure and bleeding diasthesis take place.

History

Ebola hemorrhagic fever should be suspected in patients with acute febrile illness, hemorrhagic symptoms, and a history of travel to an endemic area. As such, patients who present with fever and have a recent travel to endemic countries, particularly to West Africa including Sierra Leone, Liberia, Guinea, and Nigeria, should be suspected to have Ebola virus infection. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Exposure to Ebola virus include direct contact, exposure to blood or body fluids of infected patients, processing of blood or body fluids of a patient with suspected or confirmed Ebola virus infection, and contact with a dead body without appropriate personal protective equipment in an endemic country. Other important clues during history-taking include: duration and character of fever and other constitutional symptoms, presence of systemic manifestations, appearance of any hemorrhagic symptoms, and presence of sick contacts and their symptoms.

Early Symptoms

Incubation period ranges from 2 to 21 days. The majority of symptomatic patients have fatal outcomes. Patients often initially develop flu-like or malaria-like symptoms before multisystem organ failure and bleeding diasthesis take place.

Constitutional symptoms

Skin

Musculoskeletal

Respiratory

Gastrointestinal

Ophthalmological

Hemorrhagic disease

  • Epistaxis
  • Mucosal bleeding

Late Symptoms

Respiratory

Cardiovascular

Gastrointestinal

Neurological

Hemorrhagic Disease

References

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