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__NOTOC__
__NOTOC__
{{Ebola}}
{{Ebola}}
{{CMG}}; {{AE}} {{MJM}}; {{GRN}}
{{CMG}}; {{AE}} {{MJM}}; {{GRN}}; {{YD}}
==Overview==
==Overview==
Ebola causes a variety of [[symptoms]] which may include [[fever]], [[chills]] [[vomiting]], [[diarrhea]], generalized [[pain]] or [[malaise]], and sometimes [[internal bleeding|internal]] and [[hemorrhage|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]].
Patients who present with fever and have a recent travel to endemic countries, particularly to West Africa including Sierra Leone,Liberia, Guinea, and Nigeria, should be suspected to have Ebola virus infection. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Incubation period ranges from 2 to 21 days prior to development of symptoms. The majority of symptomatic patients have fatal outcomes. Patients often initially develop flu-like or malaria-like symptoms before multisystem organ failure and bleeding diasthesis take place.


==Case definition recommendations==
==History==
* The standard case definition recommended by the [[WHO]]-AFRO for the notification of [[Ebola]] or [[Marburg]] cases:<ref name=WHO>{{cite web | title = Case definition recommendations for Ebola or Marburg Virus Diseases  | url = http://www.who.int/csr/resources/publications/ebola/ebola-case-definition-contact-en.pdf?ua=1 }}</ref>
Ebola hemorrhagic fever should be suspected in patients with acute febrile illness, hemorrhagic symptoms, and a history of travel to an endemic area. As such, patients who present with fever and have a recent travel to endemic countries, particularly to [[West Africa]] including [[Sierra Leone]], [[Liberia]], [[Guinea]], and [[Nigeria]], should be suspected to have Ebola virus infection. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Exposure to Ebola virus include direct contact, exposure to blood or body fluids of infected patients, processing of blood or body fluids of a patient with suspected or confirmed Ebola virus infection, and contact with a dead body without appropriate [[Ebola primary prevention|personal protective equipment]] in an endemic country. Other important clues during history-taking include: duration and character of fever and other constitutional symptoms, presence of systemic manifestations, appearance of any hemorrhagic symptoms, and presence of sick contacts and their symptoms.
** ''Suspected [[Ebola]] or [[Marburg]] cases for routine surveillance'':  disease that presents with onset of [[fever]], no response to [[empiric therapy]] of [[fever]] for that region, and at least one of the following [[signs]]: bloody [[diarrhea]], [[bleeding gums]], [[subcutaneous]] [[bleeding]] ([[purpura]]), [[conjunctival hemorrhage]] and [[hematuria]].
 
** ''Confirmed [[Ebola]] or [[Marburg]] cases for routine surveillance'': a suspected case with laboratory confirmation (positive [[IgM]] [[antibody]], positive [[PCR]] or [[viral]] isolation)
==Early Symptoms==
Incubation period ranges from 2 to 21 days. The majority of symptomatic patients have fatal [[outcome]]s. Patients often initially develop flu-like or malaria-like symptoms before [[multisystem organ failure]] and [[bleeding diasthesis]] take place.  
====Constitutional symptoms====
*[[Fever]] and [[chills]] are the most common presenting features of Ebola virus infection
*[[Headache]]
*[[Weight loss]]
*[[Anorexia]]
*[[Asthenia]]
 
====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====
* [[Sore throat]]
* [[Cough]]
* [[Nasal discharge]]
 
====Gastrointestinal====
* [[Abdominal pain]]
* [[Nausea]]
* [[Vomiting]]
* [[Diarrhea]], which may be bloody even in the early phase of the disease


==History==
====Ophthalmological====
* In an [[outbreak]] situation, several cases occur around the same time. They may be grouped together, and there may be person-to-person [[transmission]]. An initial [[diagnosis]] of a [[viral hemorrhagic fever]] ([[VHF]]) can be made based on the [[signs]] and [[symptoms]] of the specific [[VHF]].
* [[Eye pain]]
* Suspecting a [[VHF]] during a non-[[outbreak]] situation, in a single case is more difficult. The early [[symptoms]] of a [[VHF]] include high [[fever]] and [[headache]]. These are also [[symptoms]] of many [[infections]] seen at the health facility.
* [[Conjunctivitis]]
* 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 illnesses usually seen in the area.
 
* 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.
====Hemorrhagic disease====
** Treat the most likely cause of the fever according to the appropriate treatment guidelines.
*Epistaxis
** If the fever continues after 3 days of recommended treatment, and if the patient has signs such as bleeding or shock, consider a VHF.
*Mucosal bleeding
** 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 fever and bleeding.
 
** 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
==Late Symptoms==
Setting  | url = http://www.who.int/csr/resources/publications/ebola/whoemcesr982sec1-4.pdf }}</ref>
====Respiratory====
* Symptoms are varied and often appear suddenly.
*[[Dyspnea]]


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
====Cardiovascular====
|+ '''Two clinical phases can be observed'''<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>
*[[Chest pain]]
! style="width: 300px;background: #4479BA" colspan=2|{{fontcolor|#FFF| '''''First phase'''''}}
! style="width: 200px;background: #4479BA"|{{fontcolor|#FFF| '''''Second phase'''''}}
|-
|  style="background: #F5F5F5"; valign=top |
* '''General Symptoms''':<br>[[Fever]]<br>[[Asthenia]]<br>[[Malaise]]<br>Postration
<br>
* '''Gastrointestinal''':<br>[[Anorexia]]<br>[[Abdominal pain]]<br>[[Diarrhea]]<br>[[Nausea]]<br>[[Vomiting]]<br>[[Dysphagia]]
<br>
* '''Respiratory''':<br>[[Chest pain]]<br>[[Shortness of breath]]<br>[[cough]]<br>[[Nasal discharge]]<br>[[Sore throat]]
|  style="background: #F5F5F5"; valign=top |
* '''Osteoarticular''':<br>[[Myalgia]]<br>[[Arthralgia]]<br>[[Lumbar pain]]
<br>
* '''Neurological''':<br>[[Headache]]<br>[[Confusion]]<br>[[Dysesthesia]]<br>[[Tinnitus]]
|  style="background: #F5F5F5"; valign=top |
* '''Hemorrhagic manifestations''':<br>[[Hematemesis]]<br>[[Epistaxis]]<br>Gingival bleeding<br>Bleeding from venipuncture sites<br>[[Melena]]<br>[[Hematuria]]
<br>
* '''Neuropsychiatric abnormalities''':<br>[[Convulsions]]<br>[[Delirium]]<br>[[Neck stiffness]]<br>[[Coma]]
<br>
* '''General''':<br>[[Oliguria]]
|-
|}


The interior bleeding is caused by a chemical reaction between the [[virus]] and the [[platelets]] which creates a chemical that will cut cell sized holes into the [[capillary]] walls. After 5-7 days the person will die of "a million cuts."
====Gastrointestinal====
Occasionally, [[internal bleeding|internal]] and external [[hemorrhage]] from [[orifice]]s, such as the nose and mouth may also occur, as well as from incompletely healed injuries such as needle-puncture sites. [[Ebola virus]] can affect the levels of [[white blood cells]] and [[platelets]], disrupting [[thrombosis|clotting]]. Fewer than 50 percent of patients will not develop any hemorrhaging.
*[[Abdominal pain]] that may be related to pancreatitis, intestinal wall swelling, or mesenteric lymphadenopathy
*[[Abdominal distention]]


==Common Symptoms==
====Neurological====
* [[Hiccups]], which classically herald worse outcomes and death
* [[Confusion]]
* [[Tinnitus]]
* [[Hearing loss]]
* [[Dysphagia]]
*[[Convulsions]]


==Less Common Symptoms==
===Hemorrhagic Disease===
* [[Jaundice]]
* [[Petechiae]]
* [[Ecchymoses]]
* [[Epistaxis]]
* [[Mucosal bleeding]]
* [[Hematemesis]]
* [[Melena]]
* [[Hematuria]]
* [[Vaginal bleeding]]
* Uncontrolled [[bleeding]] from venipuncture sites
*[[Hemorrhagic shock]]


==References==
==References==
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[[Category:Zoonoses]]
[[Category:Zoonoses]]
[[Category:Hemorrhagic fevers]]
[[Category:Hemorrhagic fevers]]
[[Category:Infectious disease]]
 
[[Category:Disease]]
[[Category:Disease]]


{{WH}}
{{WH}}
{{WS}}
{{WS}}

Latest revision as of 17:37, 18 September 2017

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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]; Yazan Daaboul, M.D.

Overview

Patients who present with fever and have a recent travel to endemic countries, particularly to West Africa including Sierra Leone,Liberia, Guinea, and Nigeria, should be suspected to have Ebola virus infection. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Incubation period ranges from 2 to 21 days prior to development of symptoms. The majority of symptomatic patients have fatal outcomes. Patients often initially develop flu-like or malaria-like symptoms before multisystem organ failure and bleeding diasthesis take place.

History

Ebola hemorrhagic fever should be suspected in patients with acute febrile illness, hemorrhagic symptoms, and a history of travel to an endemic area. As such, patients who present with fever and have a recent travel to endemic countries, particularly to West Africa including Sierra Leone, Liberia, Guinea, and Nigeria, should be suspected to have Ebola virus infection. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Exposure to Ebola virus include direct contact, exposure to blood or body fluids of infected patients, processing of 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 clues during history-taking include: duration and character of fever and other constitutional symptoms, presence of systemic manifestations, appearance of any hemorrhagic symptoms, and presence of sick contacts and their symptoms.

Early Symptoms

Incubation period ranges from 2 to 21 days. The majority of symptomatic patients have fatal outcomes. Patients often initially develop flu-like or malaria-like symptoms before multisystem organ failure and bleeding diasthesis take place.

Constitutional symptoms

Skin

Musculoskeletal

Respiratory

Gastrointestinal

Ophthalmological

Hemorrhagic disease

  • Epistaxis
  • Mucosal bleeding

Late Symptoms

Respiratory

Cardiovascular

Gastrointestinal

Neurological

Hemorrhagic Disease

References

Template:WH Template:WS

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