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{{CMG}}{{AE}} | {{CMG}}{{AE}} | ||
==Overview== | ==Overview== | ||
Ebola hemorrhagic fever is commonly associated with fever on physical examination at admission. At advanced stages of the disease, physical examination findings are more pertinent and often include unstable vital signs, such as tachycardia or relative bradycardia, orthostatic hypotension, and tachypnea. Physical examination may also be remarkable for abdominal tenderness and distension, evidence of mucosal or visceral bleeding, and neurological impairment.<ref name="FeldmannGeisbert2011">{{cite journal|last1=Feldmann|first1=Heinz|last2=Geisbert|first2=Thomas W|title=Ebola haemorrhagic fever|journal=The Lancet|volume=377|issue=9768|year=2011|pages=849–862|issn=01406736|doi=10.1016/S0140-6736(10)60667-8}}</ref><ref name="FormentyHatz1999">{{cite journal|last1=Formenty|first1=Pierre|last2=Hatz|first2=Christophe|last3=Le Guenno|first3=Bernard|last4=Stoll|first4=Agnés|last5=Rogenmoser|first5=Philipp|last6=Widmer|first6=Andreas|title=Human Infection Due to Ebola Virus, Subtype Côte d'Ivoire: Clinical and Biologic Presentation|journal=The Journal of Infectious Diseases|volume=179|issue=s1|year=1999|pages=S48–S53|issn=0022-1899|doi=10.1086/514285}}</ref><ref name="pmid10667555">{{cite journal| author=Gradon J| title=An outbreak of Ebola virus: lessons for everyday activities in the intensive care unit. | journal=Crit Care Med | year= 2000 | volume= 28 | issue= 1 | pages= 284-5 | pmid=10667555 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10667555 }} </ref> | |||
==Physical Examination== | ==Physical Examination== | ||
===Appearance of the Patient=== | |||
The general appearance of the patient depends on the stage of the disease. Typically, patients demonstrate [[prostration]], may be [[nauseated]] and [[vomiting]], and less commonly present with signs of hemorrhage, such as epistaxis or gingival bleeding. In later stages of the disease, patients are often brought with convulsions or are in a state of shock, stupor, or coma.<ref name="BorchertMutyaba2011">{{cite journal|last1=Borchert|first1=Matthias|last2=Mutyaba|first2=Imaam|last3=Van Kerkhove|first3=Maria D|last4=Lutwama|first4=Julius|last5=Luwaga|first5=Henry|last6=Bisoborwa|first6=Geoffrey|last7=Turyagaruka|first7=John|last8=Pirard|first8=Patricia|last9=Ndayimirije|first9=Nestor|last10=Roddy|first10=Paul|last11=Van der Stuyft|first11=Patrick|title=Ebola haemorrhagic fever outbreak in Masindi District, Uganda: outbreak description and lessons learned|journal=BMC Infectious Diseases|volume=11|issue=1|year=2011|pages=357|issn=1471-2334|doi=10.1186/1471-2334-11-357}}</ref> | |||
===Vitals=== | |||
====Temperature==== | |||
* High-grade [[fever]] is often present in more than 80% of patients. Fever is the most common presenting sign of Ebola virus infection. | |||
====Pulse==== | |||
*[[Tachycardia]] | |||
* Relative [[bradycardia]] | |||
====Blood Pressure==== | |||
* [[Hypotension]] (SBP<90 mmHg and/or DBP<60 mmHg) | |||
* [[Postural hypotension]] is common in dehydrated patients with inadequate volume repletion | |||
====Respiratory Rate==== | |||
*[[Signs]] of [[shortness of breath|respiratory difficulty]] may be present, such as: | |||
:* [[Intercostal]] retractions | |||
:* Paradoxical [[breathing]] | |||
:* [[Nasal]] flare | |||
*[[Tachypnea]] often precedes death during final hours of infection. | |||
===Skin=== | |||
[[Bleeding|Hemorrhagic]] manifestations tend to occur during the more severe stages of the disease and may include:<ref name="FeldmannGeisbert2011">{{cite journal|last1=Feldmann|first1=Heinz|last2=Geisbert|first2=Thomas W|title=Ebola haemorrhagic fever|journal=The Lancet|volume=377|issue=9768|year=2011|pages=849–862|issn=01406736|doi=10.1016/S0140-6736(10)60667-8}}</ref> | |||
:* [[Maculopapular rash]] on the [[trunk]], usually between the 5th and 7th day of the condition, associated with different stages of [[erythema]] and [[desquamation]], which is a valuable finding in differentiating Ebola from other diseases. | |||
:* [[Petechiae]] is a common finding | |||
:* [[Ecchymoses]] is a common finding | |||
:* [[Mucosal]] [[hemorrhages]] is a common finding | |||
:* Uncontrolled [[bleeding]] from [[venipuncture]] locals is a common finding | |||
===Eyes=== | |||
* [[Conjunctival hemorrhage]] is a the most common sign of abnormal clotting | |||
* [[Conjunctivitis]] | |||
===Nose=== | |||
* [[Epistaxis]] may be present. | |||
* [[Nasal discharge]] may be present.<ref name="FeldmannGeisbert2011">{{cite journal|last1=Feldmann|first1=Heinz|last2=Geisbert|first2=Thomas W|title=Ebola haemorrhagic fever|journal=The Lancet|volume=377|issue=9768|year=2011|pages=849–862|issn=01406736|doi=10.1016/S0140-6736(10)60667-8}}</ref> | |||
===Throat=== | |||
* [[Mucosal]] [[hyperemia]] of the [[oral cavity]] is a common finding. | |||
* [[Bleeding gums]] is a common finding. | |||
===Abdomen=== | |||
* [[Abdominal tenderness]] may suggest [[pancreatitis]], [[intestinal swelling]], or [[mesenteric lymphadenopathy]] | |||
* [[Abdominal distention]] may suggest [[paralytic ileus]] | |||
*Tender hepatomegaly | |||
*Splenomegaly | |||
===Extremities=== | |||
* [[Edema]] may be present. | |||
===Neurologic=== | |||
* [[Obtundation]] may be present.<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> | |||
*[[Stupor]] | |||
*[[Coma]] | |||
==References== | ==References== | ||
Revision as of 19:54, 20 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief:
Overview
Ebola hemorrhagic fever is commonly associated with fever on physical examination at admission. At advanced stages of the disease, physical examination findings are more pertinent and often include unstable vital signs, such as tachycardia or relative bradycardia, orthostatic hypotension, and tachypnea. Physical examination may also be remarkable for abdominal tenderness and distension, evidence of mucosal or visceral bleeding, and neurological impairment.[1][2][3]
Physical Examination
Appearance of the Patient
The general appearance of the patient depends on the stage of the disease. Typically, patients demonstrate prostration, may be nauseated and vomiting, and less commonly present with signs of hemorrhage, such as epistaxis or gingival bleeding. In later stages of the disease, patients are often brought with convulsions or are in a state of shock, stupor, or coma.[4]
Vitals
Temperature
- High-grade fever is often present in more than 80% of patients. Fever is the most common presenting sign of Ebola virus infection.
Pulse
- Tachycardia
- Relative bradycardia
Blood Pressure
- Hypotension (SBP<90 mmHg and/or DBP<60 mmHg)
- Postural hypotension is common in dehydrated patients with inadequate volume repletion
Respiratory Rate
- Signs of respiratory difficulty may be present, such as:
- Intercostal retractions
- Paradoxical breathing
- Nasal flare
- Tachypnea often precedes death during final hours of infection.
Skin
Hemorrhagic manifestations tend to occur during the more severe stages of the disease and may include:[1]
- Maculopapular rash on the trunk, usually between the 5th and 7th day of the condition, associated with different stages of erythema and desquamation, which is a valuable finding in differentiating Ebola from other diseases.
- Petechiae is a common finding
- Ecchymoses is a common finding
- Mucosal hemorrhages is a common finding
- Uncontrolled bleeding from venipuncture locals is a common finding
Eyes
- Conjunctival hemorrhage is a the most common sign of abnormal clotting
- Conjunctivitis
Nose
- Epistaxis may be present.
- Nasal discharge may be present.[1]
Throat
- Mucosal hyperemia of the oral cavity is a common finding.
- Bleeding gums is a common finding.
Abdomen
- Abdominal tenderness may suggest pancreatitis, intestinal swelling, or mesenteric lymphadenopathy
- Abdominal distention may suggest paralytic ileus
- Tender hepatomegaly
- Splenomegaly
Extremities
- Edema may be present.
Neurologic
References
- ↑ 1.0 1.1 1.2 Feldmann, Heinz; Geisbert, Thomas W (2011). "Ebola haemorrhagic fever". The Lancet. 377 (9768): 849–862. doi:10.1016/S0140-6736(10)60667-8. ISSN 0140-6736.
- ↑ Formenty, Pierre; Hatz, Christophe; Le Guenno, Bernard; Stoll, Agnés; Rogenmoser, Philipp; Widmer, Andreas (1999). "Human Infection Due to Ebola Virus, Subtype Côte d'Ivoire: Clinical and Biologic Presentation". The Journal of Infectious Diseases. 179 (s1): S48–S53. doi:10.1086/514285. ISSN 0022-1899.
- ↑ Gradon J (2000). "An outbreak of Ebola virus: lessons for everyday activities in the intensive care unit". Crit Care Med. 28 (1): 284–5. PMID 10667555.
- ↑ Borchert, Matthias; Mutyaba, Imaam; Van Kerkhove, Maria D; Lutwama, Julius; Luwaga, Henry; Bisoborwa, Geoffrey; Turyagaruka, John; Pirard, Patricia; Ndayimirije, Nestor; Roddy, Paul; Van der Stuyft, Patrick (2011). "Ebola haemorrhagic fever outbreak in Masindi District, Uganda: outbreak description and lessons learned". BMC Infectious Diseases. 11 (1): 357. doi:10.1186/1471-2334-11-357. ISSN 1471-2334.
- ↑ 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.
- ↑ 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.