Ebola history and symptoms: Difference between revisions

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==History==
==History==
* The early [[symptoms]] of a [[VHF]] such as Ebola include high [[fever]] and [[headache]]. These are also [[symptoms]] of many [[infections]] seen at the health facility
Ebola infection commonly occurs from direct contact with the [[virus]] through [[mucosal]] surfaces, cuts on the [[skin]], or [[parenterally]]. Recent contact with
* Most patients who present with [[fever]] '''do not have a [[VHF]]'''. Their [[fever]] is more often caused by [[malaria]], [[typhoid fever]], [[dysentery]],severe [[bacterial]] [[infection]] or other [[fever]]-producing illness usually seen in the area
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 have earlier [[symptoms]], dying between the 6th and 16th day of disease from [[shock]] and [[multiorgan failure]].
* When a patient presents with [[fever]], exclude other causes of [[fever]]. For example, do a [[malaria]] smear or take a [[stool culture]] as soon as possible
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>
** Treat the most likely cause of the [[fever]] according to the appropriate treatment guidelines
 
** If the [[fever]] continues after 3 days of recommended treatment, and if the patient shows evidence of [[bleeding]] or [[shock]], consider a [[VHF]]
* Phase 1 - characterized by general symptoms, such as: fever, chills, asthenia and headache.
** 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 these [[symptoms]].
 
** If no other cause is found for the patient’s [[signs]] and [[symptoms]], suspect a [[VHF]]. Begin [[VHF]] Isolation Precautions.<ref name=WHOAF>{{cite web | title = Infection Control for Viral Hemorrhagic Fevers in the African Health Care
After phase 1, there is a pseudoremission phase, in which patients' clinical status improve for 24 - 48 hours.
Setting  | url = http://www.who.int/csr/resources/publications/ebola/whoemcesr982sec1-4.pdf }}</ref>
 
* Fewer than 50 percent of patients will not develop any [[hemorrhage]].
* Phase 2 - characterized by severe symptoms, such as neuropsychiatric changes and hemorrhagic manifestations. Generally,
* A history of contact with another infected individual should be elicited particularly in the setting of an outbreak.
 
Patients who only manifest phase 1 symptoms have better survival rates 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==

Revision as of 17:45, 16 July 2014

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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]

Overview

Ebola causes a variety of symptoms which may include fever, chills vomiting, diarrhea, generalized pain or malaise, and sometimes internal and 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.

History

Ebola infection commonly occurs from direct contact with the virus through mucosal surfaces, cuts on the skin, or parenterally. Recent contact with 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 outcomes, often have 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:[1][2][3]

  • Phase 1 - characterized by general symptoms, such as: fever, chills, asthenia and headache.

After phase 1, there is a pseudoremission phase, in which patients' clinical status improve for 24 - 48 hours.

  • Phase 2 - characterized by severe symptoms, such as neuropsychiatric changes and hemorrhagic manifestations. Generally,

Patients who only manifest phase 1 symptoms have better survival rates 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.[3][4]

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

Skin

Respiratory

Gastrointestinal

Vascular

Neurological

Osteoarticular

Phase 2

Generally preceded by a short pseudoremission period, which lasts about 24 - 48 hours

Haemorrhagic manifestations

Nonpsychiatric abnormalities

References

  1. Ndambi R, Akamituna P, Bonnet MJ, Tukadila AM, Muyembe-Tamfum JJ, Colebunders R (1999). "Epidemiologic and clinical aspects of the Ebola virus epidemic in Mosango, Democratic Republic of the Congo, 1995". J Infect Dis. 179 Suppl 1: S8–10. doi:10.1086/514297. PMID 9988156.
  2. Bwaka MA, Bonnet MJ, Calain P, Colebunders R, De Roo A, Guimard Y; et al. (1999). "Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo: clinical observations in 103 patients". J Infect Dis. 179 Suppl 1: S1–7. doi:10.1086/514308. PMID 9988155.
  3. 3.0 3.1 Feldmann H, Geisbert TW (2011). "Ebola haemorrhagic fever". Lancet. 377 (9768): 849–62. doi:10.1016/S0140-6736(10)60667-8. PMC 3406178. PMID 21084112.
  4. Sureau PH (1989). "Firsthand clinical observations of hemorrhagic manifestations in Ebola hemorrhagic fever in Zaire". Rev Infect Dis. 11 Suppl 4: S790–3. PMID 2749110.

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