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==Natural History== | ==Natural History== | ||
Ebola infection commonly occurs from direct contact with the virus through mucosal surfaces, cuts on the skin or parenterally. The risk of infection is increased when there is contact with patients or cadavers infected by the virus. When the virus is in the body, it commonly takes a period of 2 - 21 days for symptoms to develop. | |||
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=== | |||
[[Incubation period]] - duration approximately 2 - 21 days, followed by an abrupt onset of [[symptoms]], which include: | |||
====General==== | |||
* [[Fever]] | |||
* [[Chills]] | |||
* [[Malaise]] | |||
* [[Prostration]] | |||
====Respiratory==== | |||
* [[Chest pain]] | |||
* [[Shortness of breath]] | |||
* [[Cough]] | |||
* [[Sore throat]] | |||
* [[Nasal discharge]] | |||
====Gastrointestinal==== | |||
* [[Anorexia]] | |||
* [[Nausea]] | |||
* [[Dysphagia]] | |||
* [[Vomiting]] | |||
* [[Abdominal pain]] - often related with true [[pancreatitis]] | |||
* [[Diarrhea]] | |||
====Vascular==== | |||
* [[Conjunctival injection]] | |||
* [[Postural hypotension]] | |||
* [[Edema]] | |||
====Neurological==== | |||
* [[Headache]] | |||
* [[Confusion]] | |||
* [[Tinnitus]] | |||
====Osteoarticular==== | |||
* [[Myalgia]] | |||
* [[Arthralgia]] | |||
* [[Back pain]] | |||
===Phase 2=== | |||
Generally preceded by a short pseudoremission period, which lasts about 24 - 48 hours | |||
====Haemorrhagic manifestations==== | |||
* [[Petechiae]] | |||
* [[Ecchymoses]] | |||
* [[Epistaxis]] | |||
* [[Mucosal bleeding]] | |||
* [[Hematemesis]] | |||
* [[Melena]] | |||
* [[Hematuria]] | |||
* Uncontroled [[bleeding]] from venepuncture sites | |||
* Diffuse [[coagulopathy]] | |||
====Nonpsychiatric abnormalities==== | |||
* [[Convulsions]] | |||
* [[Metabolic]] disturbances | |||
* [[Shock]] | |||
* [[Coma]] | |||
==Complications== | ==Complications== | ||
Revision as of 11:44, 16 July 2014
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Ebola Microchapters |
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Ebola natural history On the Web |
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American Roentgen Ray Society Images of Ebola natural history |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Michael Maddaleni, B.S.; Guillermo Rodriguez Nava, M.D. [2]
Overview
In the absence of supportive care, the Ebola virus rapidly progresses to death in up to 90% of cases. An Ebola infection can be complicated by multiorgan failure and shock. The prognosis of Ebola virus disease is poor, and depends of the supportive care given and the Ebola virus strain. The Zaire Ebola virus has mortality rate as high as 90%.[1]
Natural History
Ebola infection commonly occurs from direct contact with the virus through mucosal surfaces, cuts on the skin or parenterally. The risk of infection is increased when there is contact with patients or cadavers infected by the virus. When the virus is in the body, it commonly takes a period of 2 - 21 days for symptoms to develop.
Although different species of Ebola virus have different clinical manifestations, a common progression of symptoms includes 2 phases:[2][3][4]
Phase 1
Incubation period - duration approximately 2 - 21 days, followed by an abrupt onset of symptoms, which include:
General
Respiratory
Gastrointestinal
- Anorexia
- Nausea
- Dysphagia
- Vomiting
- Abdominal pain - often related with true pancreatitis
- Diarrhea
Vascular
Neurological
Osteoarticular
Phase 2
Generally preceded by a short pseudoremission period, which lasts about 24 - 48 hours
Haemorrhagic manifestations
- Petechiae
- Ecchymoses
- Epistaxis
- Mucosal bleeding
- Hematemesis
- Melena
- Hematuria
- Uncontroled bleeding from venepuncture sites
- Diffuse coagulopathy
Nonpsychiatric abnormalities
- Convulsions
- Metabolic disturbances
- Shock
- Coma
Complications
Survivors may have unusual problems, such as hair loss and sensory changes. There are also some late complications that may occur due to Ebola: They are:
- Hearing loss
- Unilateral orchitis
- Headache
- Fatigue
- Myalgias
- Tinnitis
- Amenorrhea
- Bulimia
- Suppurative parotitis
Prognosis
- Ebola infection is associated with poor survival with mortality rates ranging from 50% for patients infected with the Sudan ebolavirus to as high as 90% for the patients infected with the Zaire ebola virus. It should be noted that patients who are able to survive with ebola for two weeks are usually able to recover slowly, despite the potential sequelae of the disease, which include:[4]
- Recurrent hepatitis
- Myelitis
- Psychosis
- Uveitis
- Tachypnea is the strongest correlate of fatal outcome. It often appears a few hours before death. Other correlates of fatal outcome are hypotension, tachycardia and anuria.
- Severe hemorrhagic complications such as hematemesis, melena, epistaxis, ear bleeding and hematuria are associated with a poorer prognosis and are often associated with death within a week.[5]
- Survival for 11 days is generally associated with recovery.
References
- ↑ "CDC Ebola Hemorrhagic Fever Information Packet" (PDF). April 2010.
- ↑ 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.
- ↑ 4.0 4.1 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.
- ↑ 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.