Ebola natural history: Difference between revisions
Jump to navigation
Jump to search
Joao Silva (talk | contribs) No edit summary |
Joao Silva (talk | contribs) No edit summary |
||
| Line 6: | Line 6: | ||
==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. | 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. Often patients who have a fatal [[outcome]], have earlier [[symptoms]], dying between the 6th and 16th day of disease from [[multiorgan failure]] and [[shock]]. | ||
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> | 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> | ||
| Line 19: | Line 18: | ||
* [[Malaise]] | * [[Malaise]] | ||
* [[Prostration]] | * [[Prostration]] | ||
====Skin==== | |||
* [[Maculopapular rash]], between the 5th and 7th day | |||
* [[Erythema]] | |||
* [[Desquamation]] (good prognosis) | |||
====Respiratory==== | ====Respiratory==== | ||
* [[Chest pain]] | * [[Chest pain]] | ||
| Line 26: | Line 29: | ||
* [[Sore throat]] | * [[Sore throat]] | ||
* [[Nasal discharge]] | * [[Nasal discharge]] | ||
====Gastrointestinal==== | ====Gastrointestinal==== | ||
* [[Anorexia]] | * [[Anorexia]] | ||
| Line 34: | Line 36: | ||
* [[Abdominal pain]] - often related with true [[pancreatitis]] | * [[Abdominal pain]] - often related with true [[pancreatitis]] | ||
* [[Diarrhea]] | * [[Diarrhea]] | ||
====Vascular==== | ====Vascular==== | ||
* [[Conjunctival injection]] | * [[Conjunctival injection]] | ||
* [[Postural hypotension]] | * [[Postural hypotension]] | ||
* [[Edema]] | * [[Edema]] | ||
====Neurological==== | ====Neurological==== | ||
* [[Headache]] | * [[Headache]] | ||
* [[Confusion]] | * [[Confusion]] | ||
* [[Tinnitus]] | * [[Tinnitus]] | ||
====Osteoarticular==== | ====Osteoarticular==== | ||
* [[Myalgia]] | * [[Myalgia]] | ||
| Line 52: | Line 51: | ||
===Phase 2=== | ===Phase 2=== | ||
Generally preceded by a short pseudoremission period, which lasts about 24 - 48 hours | Generally preceded by a short pseudoremission period, which lasts about 24 - 48 hours | ||
====Haemorrhagic manifestations==== | ====Haemorrhagic manifestations==== | ||
* [[Petechiae]] | * [[Petechiae]] | ||
| Line 63: | Line 61: | ||
* Uncontroled [[bleeding]] from venepuncture sites | * Uncontroled [[bleeding]] from venepuncture sites | ||
* Diffuse [[coagulopathy]] | * Diffuse [[coagulopathy]] | ||
====Nonpsychiatric abnormalities==== | ====Nonpsychiatric abnormalities==== | ||
* [[Convulsions]] | * [[Convulsions]] | ||
| Line 69: | Line 66: | ||
* [[Shock]] | * [[Shock]] | ||
* [[Coma]] | * [[Coma]] | ||
==Complications== | ==Complications== | ||
Patients who survive Ebola infection may have the following complications: | |||
* [[Fatigue]] | * [[Fatigue]] | ||
* [[Myalgias]] | * [[Myalgias]] | ||
* [[Headache]] | |||
* [[Tinnitis]] | * [[Tinnitis]] | ||
* [[Hearing]] loss | |||
* Psychosis | |||
* Myelitis | |||
* Recurrent hepatitis | |||
* [[Amenorrhea]] | * [[Amenorrhea]] | ||
* [[ | * Unilateral [[orchitis]] | ||
* Suppurative [[parotitis]] | * Suppurative [[parotitis]] | ||
== Prognosis == | == Prognosis == | ||
* Ebola infection is associated with poor survival with mortality | * Ebola infection is associated with poor survival with [[mortality rate]]s depending on the [[species]] of [[virus]]: | ||
:* Zaire Ebola virus species - mortality rate of 60 - 90% | |||
:* Sudan Ebola virus species - mortality rate 40 - 60% | |||
:* Bundibugyo Ebola virus species - mortality rate 25% | |||
:* Côte d’Ivoire Ebola virus - mortality rate 0%, with only 1 case reported, who survived | |||
* Patients who are able to survive with [[ebola]] for two weeks are usually able to recover slowly, despite the potential [[complications]].<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> | |||
* Survival for 11 days is generally associated with recovery. | |||
* Desquamation of the [[maculopapular rash]] by the 5th or 7th day is often associated with [[survival]]. | |||
* [[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]]. | * [[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.<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> | * 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.<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> | ||
* | * In pregnant women there is an increased risk of miscarriage | ||
== References == | == References == | ||
Revision as of 12:21, 16 July 2014
|
Ebola Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Postmortem Care |
|
Case Studies |
|
Ebola natural history On the Web |
|
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. Often patients who have a fatal outcome, have earlier symptoms, dying between the 6th and 16th day of disease from multiorgan failure and shock.
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
Skin
- Maculopapular rash, between the 5th and 7th day
- Erythema
- Desquamation (good prognosis)
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
Patients who survive Ebola infection may have the following complications:
- Fatigue
- Myalgias
- Headache
- Tinnitis
- Hearing loss
- Psychosis
- Myelitis
- Recurrent hepatitis
- Amenorrhea
- Unilateral orchitis
- Suppurative parotitis
Prognosis
- Ebola infection is associated with poor survival with mortality rates depending on the species of virus:
- Zaire Ebola virus species - mortality rate of 60 - 90%
- Sudan Ebola virus species - mortality rate 40 - 60%
- Bundibugyo Ebola virus species - mortality rate 25%
- Côte d’Ivoire Ebola virus - mortality rate 0%, with only 1 case reported, who survived
- Patients who are able to survive with ebola for two weeks are usually able to recover slowly, despite the potential complications.[4]
- Survival for 11 days is generally associated with recovery.
- Desquamation of the maculopapular rash by the 5th or 7th day is often associated with survival.
- 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]
- In pregnant women there is an increased risk of miscarriage
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.