Ebola differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Michael Maddaleni, B.S.

Differentiating Ebola from other Diseases

Before an outbreak is suspected, these early symptoms are easily mistaken for;

• Dysentery
• Influenza
• Malaria
• Marburg virus
• Typhoid fever
• Various bacterial infections

These are all far more common and reliably less fatal.

Shown below is a table summarizing the typical findings of the differential diagnoses of ebola.

Disease	Findings
Shigellosis & other bacterial enteric infections	Presents with diarrhea, possibly bloody, accompanied by fever, nausea, and sometimes toxaemia, vomiting, cramps, and tenesmus. Stools contain blood and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and blood smears, should be made. Presence of leucocytosis distinguishes bacterial infections.
Typhoid fever	Presents with fever, headache, rash, gastrointestinal symptoms, with lymphadenopathy, relative bradycardia, cough and leucopenia and sometimes sore throat. Therapeutic trial with chloramphenicol or tetracyclines. Blood and stool culture can demonstrate causative bacteria.
Malaria	Presents with acute fever, headache and sometime diarrhoea (children). Blood smears must be examined for malaria parasites. Presence of parasites does NOT exclude concurrent viral infection. Antimalarial must be prescribed in an attempt at therapy.
Lassa fever	Disease onset is usually gradual, with fever, sore throat, cough, pharyngitis, and facial edema in the later stages. Inflammation and exudation of the pharynx and conjunctiva are common.
Yellow fever and other Flaviviridae	Present with haemorrhagic complications. Epidemiological investigation may reveal a pattern of disease transmission by an insect vector. Virus isolation and serological investigation serves to distinguish these viruses. Confirmed history of previous yellow fever vaccination will rule out yellow fever.
Others	Viral hepatitis, leptospirosis, rheumatic fever, typhus, and mononucleosis produce signs and symptoms that may be confused with Ebola in the early stages of infection.
Table adapted from WHO Guidelines For Epidemic Preparedness And Response: Ebola Haemorrhagic Fever