Ebola natural history: Difference between revisions
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==Complications== | ==Complications== | ||
Patients who survive Ebola infection may have the following [[complications]]: | Patients who survive Ebola infection may have the following [[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> | ||
* [[Fatigue]] | * [[Fatigue]] | ||
* [[Myalgias]] | * [[Myalgias]] | ||
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== Prognosis == | == Prognosis == | ||
* Ebola infection is associated with poor survival with [[mortality rate]]s depending on the [[species]] of [[virus]]: | * Ebola infection is associated with poor survival with [[mortality rate]]s depending on the [[species]] of [[virus]]:<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> | ||
:* Zaire Ebola virus species - mortality rate of 60 - 90% | :* Zaire Ebola virus species - mortality rate of 60 - 90% | ||
:* Sudan Ebola virus species - mortality rate 40 - 60% | :* Sudan Ebola virus species - mortality rate 40 - 60% | ||
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* Patients who survived Ebola infection for two weeks are usually able to recover slowly, despite 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> | * Patients who survived Ebola infection for two weeks are usually able to recover slowly, despite 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. | * 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. | * [[Desquamation]] of the [[maculopapular rash]] by the 5th or 7th day is often associated with survival.<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> | ||
* [[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 [[hemorrhage|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 [[hemorrhage|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 | * In pregnant women there is an increased risk of miscarriage.<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> | ||
== References == | == References == | ||
Revision as of 12:29, 16 July 2014
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Ebola natural history On the Web |
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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:[4]
- 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:[4]
- 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 survived Ebola infection for two weeks are usually able to recover slowly, despite 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.[4]
- 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.[4]
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 4.2 4.3 4.4 4.5 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.