Ebola Facts October 14 2014 Symptoms of Ebola
Ebola Facts October 14, 2014
Symptoms of Ebola • • Initial symptoms are nonspecific - may include fever, chills, myalgias, and malaise. Patients can progress to develop gastrointestinal symptoms: – severe watery diarrhea, nausea, vomiting, abdominal pain • Other symptoms: – chest pain, shortness of breath, headache or confusion, conjunctival injection, hiccups, seizures, and cerebral edema • • • Bleeding not universally present but can manifest later as petechiae, ecchymosis/ bruising, or oozing. Frank hemorrhage less common. Some develop diffuse erythematous maculopapular rash that can desquamate. Most common symptoms reported during current outbreak: – – – • • • fever (87%) fatigue (76%) vomiting (68%) diarrhea (66%) loss of appetite (65%) Patients with fatal disease develop more severe clinical signs early during infection and die between days 6 - 16 of complications (mean of 7. 5 days). In non-fatal cases, patients may have fever for several days and improve, around day 6. The case fatality proportion in West Africa is about 71% Source: Centers for Disease Control and Prevention. http: //www. cdc. gov/vhf/ebola/hcp/clinician-information-ushealthcare-settings. html Accessed Oct. 14, 2014
Diagnosis of Ebola • Diagnosing Ebola can be difficult at first since early symptoms, such as fever, are nonspecific to Ebola infection. • However, if a person has the early symptoms and has had contact with Ebola they should be isolated and public health professionals notified. • Samples from the patient can then be collected and tested to confirm infection. Timeline of Infection Diagnostic tests available • Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing Within a few days after symptoms begin • Ig. M ELISA • Polymerase chain reaction (PCR) • Virus isolation Later in disease course or after recovery • Ig. M and Ig. G antibodies Retrospectively in deceased patients • Immunohistochemistry testing • PCR • Virus isolation Source: Centers for Disease Control and Prevention http: //www. cdc. gov/vhf/ebola/diagnosis/index. html Accessed Oct. 14, 2014
Source: http: //www. cdc. gov/vhf/ebola/pdf/checklistpatients-evaluated-us-evd. pdf Accessed Oct. 14, 2014
Treatment of Ebola • • There are no approved treatments available for EVD. Clinical management focus - supportive care of complications: – hypovolemia, electrolyte abnormalities, hematologic abnormalities, refractory shock, hypoxia, hemorrhage, septic shock, multi-organ failure, and DIC. • Recommended care includes: – volume repletion – maintenance of blood pressure (with vasopressors if needed) – maintenance of oxygenation – pain control – nutritional support – treating secondary bacterial infections and pre-existing comorbidities • Among patients from West Africa, large volumes of intravenous fluids have often been required to correct dehydration due to diarrhea and vomiting. • Several investigational therapeutics for Ebola virus disease are in development. There are no approved vaccines available for EVD. Several investigational Ebola vaccines are in development, and Phase I trials are underway for some vaccine candidates. Source: Centers for Disease Control and Prevention. http: //www. cdc. gov/vhf/ebola/hcp/clinician-informationus-healthcare-settings. html Accessed Oct. 14, 2014
For more detail on PPE for Health Care Workers, please visit: http: //www. cdc. gov/vhf/ ebola/hcp/infectionprevention-and-controlrecommendations. html Source: http: //www. cdc. gov/vhf/ebola/pdf/ppeposter. pdf Accessed Oct. 14, 2014
References • Baize S. et al. Emergence of Zaire Ebola Virus Disease in Guinea - Prepminary Report. N Engl J Med. 2014 Apr 16. epub • Feldmann H , Geisbert TW. Ebola Haemorrhagic Fever. Lancet. 2011 Mar 5; 377(9768): 849 -62. • Fowler RA, Fletcher T, Fischer WA, et al. Caring for Critically Ill Patients with Ebola Virus Disease: Perspectives from West Africa. Am J Respir Crit Care Med. 2014 Aug 25. Epub • Kortepeter MG, Bausch DG, Bray M. Basic Cpnical and Laboratory Features of Filoviral Hemorrhagic Fever. J Infect Dis. 2011 Nov; 204 Suppl 3: S 810 -6 • WHO Ebola Response Team. Ebola Virus Disease in West Africa – The First 9 Months of the Epidemic and Forward Projections. N Eng J Med. 2014 Sept 23. Epub Source: http: //www. cdc. gov/vhf/ebola/index. html Accessed Oct. 14, 2014
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