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Ebola hemorrhagic fever should be suspected in patients with acute febrile illness, hemorrhagic symptoms, and a history of travel to an endemic area. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Travel to endemic countries particularly in West Africa including Sierra Leone, Liberia, Guinea, and Nigeria is important to note. Other exposure to Ebola virus including direct contact, or exposure to blood or body fluids of infected patients, processing 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 questions include: duration of fever, systemic manifestations, and appearance of any hemorrhagic symptoms. | Ebola hemorrhagic fever should be suspected in patients with acute febrile illness, hemorrhagic symptoms, and a history of travel to an endemic area. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Travel to endemic countries particularly in West Africa including Sierra Leone, Liberia, Guinea, and Nigeria is important to note. Other exposure to Ebola virus including direct contact, or exposure to blood or body fluids of infected patients, processing 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 questions include: duration of fever, systemic manifestations, and appearance of any hemorrhagic symptoms. | ||
== | ==Symptoms== | ||
Incubation period ranges from 2 to 21 days. The majority of symptomatic patients have fatal [[outcome]]s, often initially develop initially flu-like or malaria-like symptoms before multisystem organ failure and bleeding diasthesis take place. Symptoms onset often correlates with outcomes, where patients with fatal outcomes usually have early symptoms, while patients with non-fatal outcomes have delayed onset of symptoms.<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>. Classically, patients' symptoms may be distinguished by non-specific mild to moderate symptoms early in the course of the disease, followed by a phase of pseudoremission in the minority of patients, and eventually advanced disease characterized by hemorrhagic and neurological complications that eventually lead to multiorgan failure, coma, and death. Notably, not all patients follow the classical sequence of the clinical disease. | |||
* | ===Early Symptoms=== | ||
====Constitutional symptoms==== | |||
*Fever and chills are the most common presenting features of Ebola virus infection | |||
*Headache | |||
====Skin==== | ====Skin==== | ||
* Characteristic maculopapular, non-pruritic [[rash]] with erythema. Skin rash typically appears within 5-7 days of disease onset and has a centripetal distribution. | * Characteristic maculopapular, non-pruritic [[rash]] with erythema. Skin rash typically appears within 5-7 days of disease onset and has a centripetal distribution. | ||
* [[Desquamation]] | * [[Desquamation]] | ||
====Musculoskeletal==== | |||
*Arthralgia | |||
*Myalgia | |||
====Respiratory==== | ====Respiratory==== | ||
*[[Sore throat | * [[Sore throat]] | ||
* [[Cough]] | * [[Cough]] | ||
* [[Nasal discharge]] | * [[Nasal discharge]] | ||
====Gastrointestinal==== | ====Gastrointestinal==== | ||
* [[Abdominal pain]] | * [[Abdominal pain]] | ||
* [[Nausea]] | * [[Nausea]] | ||
* [[Vomiting]] | * [[Vomiting]] | ||
* [[Diarrhea]], which | * [[Diarrhea]], which may be bloody even in the early phase of the disease | ||
====Ophthalmological==== | |||
* [[Eye pain]] | |||
* [[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==== | ||
* [[Hiccups]] | * [[Hiccups]], which classically herald worse outcomes and death | ||
* [[Confusion]] | * [[Confusion]] | ||
* [[Tinnitus]] | * [[Tinnitus]] | ||
* [[Hearing loss]] | |||
* [[Dysphagia]] | * [[Dysphagia]] | ||
*Convulsions | |||
*Coma | |||
* | |||
* | |||
===Hemorrhagic Disease=== | ===Hemorrhagic Disease=== | ||
| Line 57: | Line 72: | ||
* [[Melena]] | * [[Melena]] | ||
* [[Hematuria]] | * [[Hematuria]] | ||
* [[Vaginal bleeding]] | |||
* Uncontrolled [[bleeding]] from venipuncture sites | * Uncontrolled [[bleeding]] from venipuncture sites | ||
* | *Hemorrhagic shock | ||
==References== | ==References== | ||
Revision as of 17:41, 27 October 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 hemorrhagic fever should be suspected in patients with acute febrile illness, hemorrhagic symptoms, and a history of travel to an endemic area. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Travel to endemic countries particularly in West Africa including Sierra Leone, Liberia, Guinea, and Nigeria is important to note. Other exposure to Ebola virus including direct contact, or exposure to blood or body fluids of infected patients, processing 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 questions include: duration of fever, systemic manifestations, and appearance of any hemorrhagic symptoms.
Symptoms
Incubation period ranges from 2 to 21 days. The majority of symptomatic patients have fatal outcomes, often initially develop initially flu-like or malaria-like symptoms before multisystem organ failure and bleeding diasthesis take place. Symptoms onset often correlates with outcomes, where patients with fatal outcomes usually have early symptoms, while patients with non-fatal outcomes have delayed onset of symptoms.[1][2][3]. Classically, patients' symptoms may be distinguished by non-specific mild to moderate symptoms early in the course of the disease, followed by a phase of pseudoremission in the minority of patients, and eventually advanced disease characterized by hemorrhagic and neurological complications that eventually lead to multiorgan failure, coma, and death. Notably, not all patients follow the classical sequence of the clinical disease.
Early Symptoms
Constitutional symptoms
- Fever and chills are the most common presenting features of Ebola virus infection
- Headache
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
Musculoskeletal
- Arthralgia
- Myalgia
Respiratory
Gastrointestinal
- Abdominal pain
- Nausea
- Vomiting
- Diarrhea, which may be bloody even in the early phase of the disease
Ophthalmological
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
- Hiccups, which classically herald worse outcomes and death
- Confusion
- Tinnitus
- Hearing loss
- Dysphagia
- Convulsions
- Coma
Hemorrhagic Disease
- Jaundice
- Petechiae
- Ecchymoses
- Epistaxis
- Mucosal bleeding
- Hematemesis
- Melena
- Hematuria
- Vaginal bleeding
- Uncontrolled bleeding from venipuncture sites
- Hemorrhagic shock
References
- ↑ 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.
- ↑ 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.
- ↑ 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.