Ebola history and symptoms: Difference between revisions
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Ebola hemorrhagic fever should be suspected in patients with acute febrile illness, hemorrhagic symptoms, and a history of travel to an endemic area. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Travel to endemic countries particularly in West Africa including Sierra Leone, Liberia, Guinea, and Nigeria is important to note. Other exposure to Ebola virus including direct contact, or exposure to blood or body fluids of infected patients, processing 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 questions include: duration of fever, systemic manifestations, and appearance of any hemorrhagic symptoms. | Ebola hemorrhagic fever should be suspected in patients with acute febrile illness, hemorrhagic symptoms, and a history of travel to an endemic area. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Travel to endemic countries particularly in West Africa including Sierra Leone, Liberia, Guinea, and Nigeria is important to note. Other exposure to Ebola virus including direct contact, or exposure to blood or body fluids of infected patients, processing 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 questions include: duration of fever, systemic manifestations, and appearance of any hemorrhagic symptoms. | ||
== | ==History and symptoms== | ||
Once [[infection]] occurs, it commonly takes 2 - 21 days for [[symptoms]] to develop. Patients who have fatal [[outcome]]s, often develop earlier [[symptoms]], and die between the first and second week of disease from [[shock]] and [[multiorgan failure]]. Although different [[species]] of [[Ebola virus]] have different clinical manifestations, a common progression of [[symptoms]] is 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> | Once [[infection]] occurs, it commonly takes 2 - 21 days for [[symptoms]] to develop. Patients who have fatal [[outcome]]s, often develop earlier [[symptoms]], and die between the first and second week of disease from [[shock]] and [[multiorgan failure]]. Although different [[species]] of [[Ebola virus]] have different clinical manifestations, a common progression of [[symptoms]] is 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> | ||
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* '''Hemorrhagic Disease''' - characterized by severe [[symptoms]] particularly hemorrhagic manifestations | * '''Hemorrhagic Disease''' - characterized by severe [[symptoms]] particularly hemorrhagic manifestations | ||
Without treatment, patients' clinical status may deteriorate to the point of [[shock]] and [[multiorgan failure]].<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><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> | Without treatment, patients' clinical status may deteriorate to the point of [[shock]] and [[multiorgan failure]].<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><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><ref name="pmid25244186">WHO Ebola Response Team (2014) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25244186 Ebola virus disease in West Africa--the first 9 months of the epidemic and forward projections.] ''N Engl J Med'' 371 (16):1481-95. [http://dx.doi.org/10.1056/NEJMoa1411100 DOI:10.1056/NEJMoa1411100] PMID: [http://pubmed.gov/25244186 25244186]</ref> | ||
===Incubation Period=== | ===Incubation Period=== | ||
The [[incubation period]] lasts approximately 2 - 21 days and is classically characterized by fever, chills, malaise, and myalgia. Systemic manifestations include: | The [[incubation period]] lasts approximately 2 - 21 days and is classically characterized by fever, chills, malaise, and myalgia. Systemic manifestations include: | ||
===Symptoms=== | |||
====Skin==== | ====Skin==== | ||
* Characteristic maculopapular, non-pruritic [[rash]] with erythema. Skin rash typically appears within 5-7 days of disease onset and has a centripetal distribution. | * Characteristic maculopapular, non-pruritic [[rash]] with erythema. Skin rash typically appears within 5-7 days of disease onset and has a centripetal distribution. | ||
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====Neurological==== | ====Neurological==== | ||
* [[Hiccups]] | |||
* [[Headache]] | * [[Headache]] | ||
* [[Confusion]] | * [[Confusion]] | ||
* [[Tinnitus]] | * [[Tinnitus]] | ||
* [[Dysphagia]] | |||
====Ophthalmological==== | ====Ophthalmological==== | ||
* [[Eye pain]] | |||
* [[Conjunctivitis]] | * [[Conjunctivitis]] | ||
| Line 54: | Line 58: | ||
* [[Hematuria]] | * [[Hematuria]] | ||
* Uncontrolled [[bleeding]] from venipuncture sites | * Uncontrolled [[bleeding]] from venipuncture sites | ||
* [[Vaginal bleeding]] | |||
===End-Stage Disease=== | ===End-Stage Disease=== | ||
Revision as of 17:24, 27 October 2014
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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]
Overview
Ebola causes a variety of symptoms which may include fever, chills vomiting, diarrhea, generalized pain or malaise, and sometimes internal and 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.
History
Ebola hemorrhagic fever should be suspected in patients with acute febrile illness, hemorrhagic symptoms, and a history of travel to an endemic area. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Travel to endemic countries particularly in West Africa including Sierra Leone, Liberia, Guinea, and Nigeria is important to note. Other exposure to Ebola virus including direct contact, or exposure to blood or body fluids of infected patients, processing 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 questions include: duration of fever, systemic manifestations, and appearance of any hemorrhagic symptoms.
History and symptoms
Once infection occurs, it commonly takes 2 - 21 days for symptoms to develop. Patients who have fatal outcomes, often develop earlier symptoms, and die between the first and second week of disease from shock and multiorgan failure. Although different species of Ebola virus have different clinical manifestations, a common progression of symptoms is observed:[1][2][3]
- Incubation Period - characterized by general symptoms, such as: fever, chills, asthenia and headache. Other systemic symptoms are commonly seen. After the incubation period, a pseudoremission phase may be observed, in which a patient's clinical status improves for 24 - 48 hours.
- Hemorrhagic Disease - characterized by severe symptoms particularly hemorrhagic manifestations
Without treatment, patients' clinical status may deteriorate to the point of shock and multiorgan failure.[3][4][5]
Incubation Period
The incubation period lasts approximately 2 - 21 days and is classically characterized by fever, chills, malaise, and myalgia. Systemic manifestations include:
Symptoms
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
Respiratory
Gastrointestinal
- Abdominal pain (often related to pancreatitis or intestinal swelling)
- Nausea
- Dysphagia
- Vomiting
- Diarrhea, which is usually bloody
Neurological
Ophthalmological
Hemorrhagic Disease
- Jaundice
- Petechiae
- Ecchymoses
- Epistaxis
- Mucosal bleeding
- Hematemesis
- Melena
- Hematuria
- Uncontrolled bleeding from venipuncture sites
- Vaginal bleeding
End-Stage Disease
- Metabolic disturbances
- Convulsions
- Hypovolemic shock
- Coma
References
- ↑ 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.
- ↑ 3.0 3.1 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.
- ↑ WHO Ebola Response Team (2014) Ebola virus disease in West Africa--the first 9 months of the epidemic and forward projections. N Engl J Med 371 (16):1481-95. DOI:10.1056/NEJMoa1411100 PMID: 25244186