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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.


==History==
==History==
* The early [[symptoms]] of a [[VHF]] such as Ebola include high [[fever]] and [[headache]]. These are also [[symptoms]] of many [[infections]] seen at the health facility
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.
* 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 illness 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
** Treat the most likely cause of the [[fever]] according to the appropriate treatment guidelines
** If the [[fever]] continues after 3 days of recommended treatment, and if the patient shows evidence of [[bleeding]] or [[shock]], consider a [[VHF]]
** 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 these [[symptoms]].
** 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
Setting  | url = http://www.who.int/csr/resources/publications/ebola/whoemcesr982sec1-4.pdf }}</ref>
* Fewer than 50 percent of patients will not develop any [[hemorrhage]].
* A history of contact with another infected individual should be elicited particularly in the setting of an outbreak.


==Common Symptoms==
==Early Symptoms==
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>
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]]


===Phase 1===
====Skin====
[[Incubation period]] of duration approximately 2 - 21 days, followed by an abrupt onset of [[symptoms]], which include:
* Characteristic [[maculopapular]], non-[[pruritic]] [[rash]] with [[erythema]]. Skin rash typically appears within 5-7 days of disease onset and has a [[centripetal]] distribution.
* [[Desquamation]]


====General====
====Musculoskeletal====
* [[Fever]]
*[[Arthralgia]]
* [[Chills]]
*[[Myalgia]]
* [[Malaise]]
* [[Prostration]]


====Respiratory====
====Respiratory====
* [[Chest pain]]
* [[Sore throat]]
* [[Shortness of breath]]
* [[Cough]]
* [[Cough]]
* [[Sore throat]]
* [[Nasal discharge]]
* [[Nasal discharge]]


====Gastrointestinal====  
====Gastrointestinal====  
* [[Anorexia]]
* [[Abdominal pain]]
* [[Nausea]]
* [[Nausea]]
* [[Dysphagia]]
* [[Vomiting]]
* [[Vomiting]]
* [[Abdominal pain]] - often related with true [[pancreatitis]]
* [[Diarrhea]], which may be bloody even in the early phase of the disease
* [[Diarrhea]]  
 
====Ophthalmological====
* [[Eye pain]]
* [[Conjunctivitis]]
 
====Hemorrhagic disease====
*Epistaxis
*Mucosal bleeding
 
==Late Symptoms==
====Respiratory====
*[[Dyspnea]]
 
====Cardiovascular====
*[[Chest pain]]


====Vascular====
====Gastrointestinal====
* [[Conjunctival injection]]
*[[Abdominal pain]] that may be related to pancreatitis, intestinal wall swelling, or mesenteric lymphadenopathy
* [[Postural hypotension]]
*[[Abdominal distention]]
* [[Edema]]


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


====Osteoarticular====
===Hemorrhagic Disease===
* [[Myalgia]]
* [[Jaundice]]
* [[Arthralgia]]
* [[Back pain]]
 
===Phase 2====
Generally preceded by a short pseudoremission term, which lasts about 24-48 hours
 
====Haemorrhagic manifestations====
* [[Petechiae]]
* [[Petechiae]]
* [[Ecchymoses]]
* [[Ecchymoses]]
* [[Epistaxis]]
* [[Epistaxis]]
* Mucosal hemorrhages
* [[Mucosal bleeding]]
* [[Hematemesis]]
* [[Hematemesis]]
* [[Melena]]
* [[Melena]]
* [[Hematuria]]
* [[Hematuria]]
* Uncontroled [[bleeding]] from venepuncture sites
* [[Vaginal bleeding]]
* Diffuse [[coagulopathy]]
* Uncontrolled [[bleeding]] from venipuncture sites
 
*[[Hemorrhagic shock]]
====Nonpsychiatric abnormalities====
* [[Convulsions]]
* [[Metabolic]] disturbances
* [[Shock]]
* [[Coma]]
 
==Less Common Symptoms==
* Severe [[bleeding]] ([[urine]] and/or [[gastrointestinal tract]])


==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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