After an incubation period ranging from 3 to 12 days, patients present with sudden onset of the non specific symptoms of fever, malaise, arthralgia, myalgia, and chest pain followed by gastrointestinal symptoms like abdominal pain, vomiting and diarrhea. The viremia also affects other systems.

In the respiratory system it causes pharyngitis, sore throat, dyspnoea and occasionally hiccups. Late in the disease, one may see myocarditis and pulmonary oedema due to cardiovascular complications. It causes central nervous system symptoms like headaches, confusion, depression, fatigue and may even lead to coma.

In the skin, one may notice a maculopapular rash, petechial haemorrhages, ecchymosis and haematomas which make the prognosis very poor. Due to the disseminated intravascular coagulation, there is bleeding from various sites producing hematemesis, hemoptysis, gastro intestinal bleeds and malena. Bleeding from punctures sites is seen in 50% of patients.

The complications of Ebola virus disease include hearing loss and tinnitus. It may also cause photophobia, increased lachrymation, uveitis and decreased visual acuity.

Terminally ill patients may develop tachypnea, hypotension, anuria, metabolic acidosis and shock, ultimately leading to death.

• Easy Bruising

  Patients with filoviral HF often develop multiple foci of mucosal hemorrhage, most evident in the conjunctiva, together with easy bruising and persistent bleeding from injection or venipuncture sites [ 3 – 5, 9, 10, 13, 19, 20, 22, 24, 25, 28, 34 ]. [web.archive.org]

  Patients with filoviral HF often develop multiple foci of mucosal hemorrhage, most evident in the conjunctiva, together with easy bruising and persistent bleeding from injection or venipuncture sites [3–5, 9, 10, 13, 19, 20, 22, 24, 25, 28, 34 ]. [jid.oxfordjournals.org]

• Fever

  Ebola Hemorrhagic Fever Ebola ee-BO-luh ? hemorrhagic fever is a deadly disease that has occurred in outbreaks in Central Africa. Ebola hemorrhagic fever is caused by several Ebola viruses. The source of these viruses in nature is not known. [web.archive.org]

  The term viral hemorrhagic fever refers to a clinical syndrome characterized by acute onset of fever accompanied by nonspecific findings of malaise, prostration, diarrhea,and headache. [ncbi.nlm.nih.gov]

  Wikipedia: Ebola Encyclopedia article on the virus and the deadly hemorrhagic fever it causes. [curlie.org]

• Fatigue

  Depression, insomnia, fatigue, anxiety and post-traumatic stress were common sequelae in EVD survivors. However, data from high-quality studies were scarce. [ncbi.nlm.nih.gov]

  Fever, fatigue, vomiting, diarrhea, and anorexia are the most common symptoms of the 2014 West African outbreak. [doi.org]

• Malaise

  The term viral hemorrhagic fever refers to a clinical syndrome characterized by acute onset of fever accompanied by nonspecific findings of malaise, prostration, diarrhea,and headache. [ncbi.nlm.nih.gov]

  The disease is initially recognized by fever and malaise followed by gastrointestinal symptoms, bleeding, shock and finally multi-organ failure. [symptoma.com]

  Initial symptoms include high fever, headache, chills, myalgia, sore throat, red itchy eyes, and malaise. Later symptoms include severe abdominal pain, chest pain, bleeding, shock, vomiting, and diarrhea. [medical-dictionary.thefreedictionary.com]

  EBOV is characterized by the sudden onset of fever and malaise, accompanied by other nonspecific signs and symptoms such as myalgia, headache, vomiting, and diarrhea among EBOV patients, 30%-50% experience haemorrhagic symptoms (2) in severe and fatal [gpnotebook.co.uk]

  Health care professionals treating patients with this illness have learned that transmission arises from contact with bodily fluids of a person who is symptomatic — that is, has a fever, vomiting, diarrhea, and malaise. [doi.org]

• Veterinarian

  We will strive to ensure that veterinarians have a prominent voice as these issues are discussed and decided in the United States. [avma.org]

  The Organization will work with governments to also set up wildlife surveillance systems to support early detection of the virus, collaborating with wildlife rangers, veterinarians and local universities. [fao.org]

  In October 1989, when an unusually high number of their monkeys began to die, their veterinarian decided to send some samples to Fort Detrick (USAMRIID) for study. [en.wikipedia.org]

  The HRP veterinarian conducted a few necropsies of the dead monkeys from this shipment in Room F and, based on the clinical symptomatology and on gross anatomy, made an initial diagnosis of simian hemorrhagic fever (SHF). [stanford.edu]

• Laboratory Technician

  A team of Liberian laboratory technicians were trained to conduct EVD diagnostics and the laboratory had capacity to test 64-100 blood specimens per day. [ncbi.nlm.nih.gov]

  On April 4, a hospital laboratory technician in Kikwit had onset of fever and bloody diarrhea. On April 10 and 11, he underwent surgery for a suspected perforated bowel. [cdc.gov]

  The current serosurvey was conducted by a multidisciplinary team, including a doctor from the Gabonese Ministry of Health, a nurse, an epidemiologist, a virologist, a veterinarian and laboratory technicians. [plosone.org]

• Vomiting

  Pregnant women were less likely than nonpregnant women to report anorexia, asthenia, diarrhea, fever, myalgias/arthralgias, nausea, or vomiting (P < .05) at admission. [ncbi.nlm.nih.gov]

  Ebola can ONLY spread between humans by direct contact with infected body fluids including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen. [medlineplus.gov]

• Diarrhea

  We describe the management of a Sierra Leonean health care worker with severe Ebola virus disease complicated by diarrhea, significant electrolyte disturbances, and falciparum malaria coinfection. [ncbi.nlm.nih.gov]

  Symptoms of Ebola HF typically include: Fever Headache Joint and muscle aches Weakness Diarrhea Vomiting Stomach pain Lack of appetite Some patients may experience: A Rash Red Eyes Hiccups Cough Sore throat Chest pain Difficulty breathing Difficulty swallowing [web.archive.org]

• Abdominal Pain

  Symptoms of Ebola virus disease can include severe headache, myalgia, asthenia, fever, fatigue, diarrhea, vomiting, abdominal pain, and hemorrhage. Although experimental treatments are in development, there are no current U.S. [ncbi.nlm.nih.gov]

  For more information see the CDC Ebola Virus Tranmission info page http://www.cdc.gov/vhf/ebola/transmission/index.html Symptoms Fever (greater than 38°C or 100.4°F) Severe headache Muscle pain Weakness Diarrhea Vomiting Abdominal pain Unexplained hemorrhage [sjcphs.org]

• Nausea

  Common gastrointestinal manifestations include diarrhea-70 %, nausea and vomiting-60 %, and abdominal pain-45 %. [ncbi.nlm.nih.gov]

  Early symptoms — like fever and nausea — are common to many diseases, and on the scale of all diseases, Ebola virus disease is relatively rare. [dailyrx.com]

  Taking medicine to relieve fever, diarrhea, nausea, and pain. Getting oxygen. Treating other infections. Close supervision and care by health care professionals is very important. A patient with EVD may need intensive care unit (ICU) services. [familydoctor.org]

  Signs and Symptoms Ebola symptoms can include: Sudden fever, generally 101.5°F and higher Headache Joint and muscle aches Nausea Weakness Diarrhea Vomiting Stomach pain Lack of appetite Prevention If you think you have been exposed to someone who has [dps.texas.gov]

• Hematemesis

  She exhibited fever, jaundice, and hemorrhagic signs: epistaxis, hematemesis, hematuria, and conjunctival, gingival, and vaginal bleeding. [ncbi.nlm.nih.gov]

  "The illness is characterized with a high temperature of about 39°C, hematemesis [the vomiting of blood], diarrhea with blood, retrosternal abdominal pain, prostration with "heavy" articulations, and rapid evolution death after a mean of three days," [scripps.edu]

  Due to the disseminated intravascular coagulation, there is bleeding from various sites producing hematemesis, hemoptysis, gastro intestinal bleeds and malena. Bleeding from punctures sites is seen in 50% of patients. [symptoma.com]

  Further, patients requiring tracheal intubation may have hematemesis or may vomit, increasing the risk of viral transmission to healthcare workers. [doi.org]

• Jaundice

  In case 3, mild clinical jaundice was diagnosed on the basis of yellowed sclerae on the day before death. [web.archive.org]

  These lingering effects may include: joint problems hair loss extreme weakness and fatigue delirium inflammation of the liver and eyes sensory changes jaundice According to the Mayo Clinic, such complications can last for a few weeks to several months [healthline.com]

  • Jaundice in the Emergency Department: Meeting the Challenges of Diagnosis and Treatment Apr 2018 This issue reviews the critical steps that should be taken to manage a patient who presents with jaundice, including the history and physical examination [ebmedicine.net]

  Photophobia, conjunctival injection, jaundice, and lymphadenopathy also occur. Vomiting and diarrhea may soon follow. Delirium, stupor, and coma may occur, indicating central nervous system involvement. [merckmanuals.com]

• Back Pain

  Pain manifestation started after Ebola infection in all but one patient. Patients had mainly both mechanical and inflammatory pain (45%) and low back pain (77%). All patients reported pain in at least one peripheral joint. [ncbi.nlm.nih.gov]

  After discharge, 10 weeks after the onset of EVD symptoms, the patient’s word-finding difficulty and exercise tolerance were markedly improved, but he had new symptoms, including low back pain involving the right lumbar and sacroiliac region, bilateral [doi.org]

  […] in 54.2% headache in 52.4% anemia in 50% skin disorders in 48.8% back pain in 32.5% alopecia in 31.9% presentation with red/injected eyes during acute phase of Ebola virus disease associated with increased risk of uveitis (adjusted odds ratio 10.4, 95% [health.ebsco.com]

• Conjunctival Injection

  Associated signs and symptoms included asthenia, headache, conjunctival injection, chest pain, abdominal pain, arthralgias, myalgias, and hiccups. Respiratory symptoms, such as cough, were rare. [nejm.org]

  Haemorrhage was manifested in Case 1 by oral and conjunctival petechiae on day 4 of illness, haematemesis and melaena from day 5, gingival bleeding on day 7, and bleeding injection sites on day 8. Case 2 had melaena from day 6. [web.archive.org]

  Photophobia, conjunctival injection, jaundice, and lymphadenopathy also occur. Vomiting and diarrhea may soon follow. Delirium, stupor, and coma may occur, indicating central nervous system involvement. [merckmanuals.com]

  Bilateral conjunctival injection is also common. Late in the disease, patients often develop an expressionless facies. At this point, bleeding from intravenous (IV) puncture sites and mucous membranes is common. [emedicine.medscape.com]

• Skin Rash

  The illness progresses to vomiting, diarrhea, skin rashes, liver and kidney malfunction, as well as internal and external bleeding. Laboratory testing reveals low white blood cell and platelet counts as well as elevated liver enzymes. [iamat.org]

  Diagnosing Ebola HF in an individual who has been infected only a few days is difficult because early symptoms, such as red eyes and a skin rash, are nonspecific to the virus and are seen in other patients with diseases that occur much more frequently [web.archive.org]

  Some patients may develop a skin rash, red eyes, hiccups, cough, difficulty breathing, and chest pain. [emedicinehealth.com]

  It was originally called “black measles” because of the look of its rash in the late stages of the illness, when the skin turns black. It was a dreaded, often fatal disease, affecting hundreds of people in Idaho. [niaid.nih.gov]

• Eczema

  People with eczema also may be particularly susceptible to bacterial, viral, and fungal skin infections. [niaid.nih.gov]

• Visual Hallucination

  […] and another with visual hallucinations, and 1 with suicidal ideation and 3 with attempted suicide. [ncbi.nlm.nih.gov]

• Epistaxis

  On May 6, she experienced intense fatigue and epistaxis. The patient’s grandmother then took her to a local health clinic where she received adrenaline nasal packs for her epistaxis and injections of quinine and vitamin K. [ncbi.nlm.nih.gov]

  Haemorrhagic symptoms may begin 4 - 5 days after onset, including hemorrhagic conjunctivitis, pharyngitis, bleeding gums, oral/lip ulceration, hematemesis, melena, hematuria, epistaxis, and vaginal bleeding Footnote 15. [phac-aspc.gc.ca]

  A suspect case was defined as “any severely ill patient with history of fever 38.5°C of less than 3 weeks duration with vomiting and diarrhea, with or without any one of the following manifestations: abdominal pains, epistaxis, general body weakness, [frontiersin.org]

  Some have described it as morbilliform May become purpuric or petechial later on in the infection in patients with coagulopathy May be difficult to discern in dark skinned patients Bleeding Bleeding manifestations (such as epistaxis, bleeding gums, haemoptysis [doi.org]

• Headache

  Headaches could also represent ongoing tension headaches or might result from underlying undiagnosed changes in vision. [doi.org]

  The term viral hemorrhagic fever refers to a clinical syndrome characterized by acute onset of fever accompanied by nonspecific findings of malaise, prostration, diarrhea,and headache. [ncbi.nlm.nih.gov]

  Symptoms of Ebola HF typically include: Fever Headache Joint and muscle aches Weakness Diarrhea Vomiting Stomach pain Lack of appetite Some patients may experience: A Rash Red Eyes Hiccups Cough Sore throat Chest pain Difficulty breathing Difficulty swallowing [web.archive.org]

• Confusion

  This finding does not imply inferiority of the academic literature, nor does it draw direct causation between confusion in review articles and public misunderstanding. [ncbi.nlm.nih.gov]

  It causes central nervous system symptoms like headaches, confusion, depression, fatigue and may even lead to coma. [symptoma.com]

  Dazed and confused, the man who only minutes before had been confirmed as the new Vice-President of the United States is told that he is now President. President John Patrick Ryan. And that is where Executive Orders begins. [books.google.com]

  […] and diarrhea, sometimes with blood in it—this can lead to dehydration (having too little water in your body) Bleeding under your skin (purple spots or patches), from your mouth or nose, or from organs inside your body A rash on your chest and belly Confusion [merckmanuals.com]

• Seizure

  A benzodiazepine can be used to abort the seizure and can be given intramuscularly or rectally if intravenous access is unavailable. [doi.org]

  As the illness progresses, it can cause failure of multiple organs (such as the lung, kidney, and liver ), severe bleeding inside and outside the body, jaundice, seizures, coma, and shock ( low blood pressure ). [emedicinehealth.com]

  Commonly observed neurologic symptoms included delirium, both hypoactive and hyperactive, manifested by confusion, slowed cognition, or agitation, and less frequently, seizures. [nejm.org]

  Live ABC News Live Trump meets with American manufacturers at White House Roger Stone speaks in DC days after arraignment in Russia probe Officials discuss cases of fentanyl seizures at US-Mexico border Senate resumes debate on Middle East defense bill [abcnews.go.com]

  Failure to promptly correct these violations may result in legal action without further notice, including seizure and/or injunction. [fda.gov]

• Stupor

  Delirium, stupor, and coma may occur, indicating central nervous system involvement. Hemorrhagic symptoms begin within the first few days and include petechiae, ecchymoses, and frank bleeding around puncture sites and mucous membranes. [merckmanuals.com]

Ebola virus disease is indistinguishable from other viral diseases with similar manifestations like malaria, typhoid, Marburg hemorrhagic fever, acute surgical abdomen and other hemorrhagic fevers like dengue, etc.

However, the most important indicator to distinguish it is the patient’s history of travel to an endemic area and occupational history of working with infected patients.

Basic laboratory tests include blood tests like complete blood counts with differential counts which show thrombocytopenia, leucopenia while lymphopenia, neutrophilia develop after several days of infection. Liver enzymes are elevated. Bilirubin may or may not be elevated. In extreme cases, Blood Urea Nitrogen and Creatinine may increase.

Studies for isolating the Ebola virus include tissue culture which is performed only in specialized class 4 laboratories and reverse transcription polymerase chain reaction assays (RT-PCR).

Other serological test includes ELISA for antigens or IgM and IgG antibodies. Electron microscopy was used to detect filoviruses in tissues but obvious limitations of this diagnostic modality prevent it from being used in the areas of human outbreaks [3].

• Decreased Platelet Count

  Decreasing platelet count with marked lymphopenia can be seen in the initial stages of infection but is not diagnostic. [doi.org]

The basic treatment for Ebola virus disease is supportive care with special attention being paid to barrier isolation. All body fluids contain infected virions and thus should be handled with care and disinfected with 0.5% sodium hypochlorite solution.

General medical support like replacement of coagulation factor and administration of heparin is to be done if disseminated intravascular coagulation (DIC) occurs. Checking the intravascular volume and electrolytes imbalance and correcting them are essential.

A drug containing activated C protein is under study and trials against the Ebola virus [4]. Another drug under study is a recombinant inhibitor for the tissue factor VIIa [5]. Although this study is still being undertaken only in the rhesus monkeys and human trials are yet to begin. Studies on pharmacological drugs against Ebola virus disease are under process.

S-Adenosylhomocystein Hydrolase (SAH) inhibits transmethylation reaction required for replication of Zaire virus. It was tried on mice and 90% survived [6]. Administration of interferon beta early after exposure with the virus may be a promising adjunct in the treatment of Ebola virus disease. The study on rhesus monkeys with the interferon significantly improved survival time but did not reduce mortality [7].

Work on a vaccine is under progress. A recombinant human monoclonal antibodies vaccine directed against the envelope glycoprotein (GP) of the virus has a neutralizing effect. It may be useful in vaccine development as a passive prophylactic agent.

A vaccine containing naked DNA was reported by Sullivan et al that could encode the Ebola proteins and be followed up with a booster dose having recombinant adenoviral vector expressing the glycoprotein of Ebola virus [8]. Geisbert et al analyzed multiple vaccines which protected rodents against the Ebola virus infection but failed to protect rhesus or cynologus macaques [9].

Nutrition post infection is altered due to gastro intestinal symptoms. Weight gain and strength comes slowly during recovery. Ebola virus continues to be present in the body fluids even after the clinical illness is over. Care should be take to closely watch the recovering patients as the recovery is slow and may take months to recover.

Though the prognosis is poor, it varies from species to species. Zaire and Sudan Ebola virus are the most fatal with mortality rate of 89% and 41-65% respectively.

Those who can survive up to two weeks make a slow recovery. Pregnancy causes poor prognosis of the disease.

Ebola virus disease is caused by four out of the five viruses in the genus Ebola virus of the family Filoviridae, order Mononegavirus. Those are Bundibugyo Ebola virus, Zaire Ebola virus, Sudan Ebola virus and Tai Forest Ebola virus. The fifth one, Reston Ebola virus, is non-pathogenic in humans.

The virus affects human and non-human primates through transmission from unknown hosts, mostly fruit and insectivorous bats, via direct contact through body fluids like blood, saliva and other body tissues.

Evidence shows that the Sudan and Zaire species of the Ebola virus family can be transmitted via contact with mucous membrane, breaks in skin, pharyngeal and conjunctival surface, gastrointestinally and lastly, by aerosolization [1].

Individuals who come into direct contact with the infected person without proper barrier protection are at high risk of becoming infected with the disease. A study observing 24 contacts that remained close to infected symptomatic persons found that the contacts had an active Ebola virus infection [2].

Ebola virus disease first occurred in Zaire and Sudan in 1976. It is mainly restricted to Africa. Individuals at risk are those with travel history to Sub Saharan Africa, medical workers who care for infected patients, animal workers who have worked with primates infected with the disease.

It has no sexual or racial predilection. Children are less likely to come into direct contact with infected patients.

Ebola virus mainly affects the endothelial cells, phagocytes and hepatocytes. It has two glycoproteins; a smaller one which is secreted early in the disease, a surface glycoprotein (sGP) which inhibits the early neutrophil activation, thus preventing the effective host immune response. It thereby causes lymphopenia.

Second somewhat larger protein is a transmembrane glycoprotein which invades, replicates and destroys the endothelial cells of the host resulting in the disseminated intravascular coagulation (DIC), leading to the hemorrhagic manifestations of the Ebola virus disease.

The virus replicates in all tissues leading to focal necrosis most commonly seen in liver, known as Councilman-like bodies, which are also seen in yellow fever. In most fatal cases, the host’s tissues and blood contain large virions making them highly infectious.

Currently, no specific therapy or vaccine is available, as a consequence, raising awareness of the risk factors and the protective measures individuals can take is the only way to reduce human infection and death.

Ebola virus disease (EVD) or Ebola hemorrhagic disease is caused by Ebola virus first found in the Ebola river in the Democratic Republic of Congo.

The genus Ebola virus is from the Filoviridae family and five different species of Ebola virus have been identified till date of which only four are pathogenic to human. It is a RNA virus with lipid envelope mainly affecting the microvascular system.

The exposure to virus is either primary i.e. presence in Ebola virus endemic area or secondary i.e. human to human or primates to human transmission.

The disease is initially recognized by fever and malaise followed by gastrointestinal symptoms, bleeding, shock and finally multi-organ failure. Currently no specific treatment or vaccine is available for the disease and care should be administered with strict attention to barrier isolation.

Ebola virus disease is one of the least known hemorrhagic fever disease and is caused by the Ebola virus first isolated in the Ebola river in Africa. It is mainly found in sub Saharan region and remote parts of Africa.

There are 5 species of the Ebola virus of which 4 are pathogenic to humans. The mammal bat is believed to be a primary reservoir of Ebola virus affecting the primates like gorilla, chimpanzees through saliva or other body fluids. Dogs have shown to get infected asymptomatically with the virus [10].

Disease spreads to humans by coming in contact with those affected with disease, either primates or humans, residing in the endemic area of Ebola virus. Source of infection includes body fluids like saliva, blood and semen of the infected person. Thus special attention should be paid towards barrier isolation of the infected person.

Ebola virus disease is easily confused with other hemorrhagic fevers due to atypical manifestation like fever with or without chills, malaise, body pain, headache, chest pain followed by gastric symptoms like nausea, vomiting, diarrhea. It mainly affects liver causing localized cell death. There is bleeding at the site of puncture and also from various orifices of the body.

Patient at end stage may present with increased heart rate, hypovolemia and even shock. There is lastly multi organ failure.

Treatment includes differentiating the disease with simple blood tests, liver test, isolation of virus through tissue culture in specialized laboratories.

Pharmacological treatment is still under research, however the supportive treatment includes managing the basic life support of patient i.e. airway, breathing and circulation, fluid and electrolyte balance.

Vaccines for ebola virus disease are being researched. The mainstay of treatment is isolation of patients suffering from Ebola virus disease and proper disposal of materials used for their treatment.

Prognosis is poor with those surviving for two weeks having slow recovery period which can take even months. Mortality is high if infected with Zaire and Sudan Ebola virus.

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2. Leroy EM, Baize S, Volchkov VE, Fisher-Hoch SP, Georges-Courbot MC, Lansoud-Soukate J, et al. Human asymptomatic Ebola infection and strong inflammatory response. Lancet. Jun 24 2000;355(9222):2210-5.
3. Geisbert TW, Jahrling PB. Differentiation of filoviruses by electron microscopy. Virus Res. Dec 1995;39(2-3):129-50.
4. Hensley LE, Stevens EL, Yan SB, Geisbert JB, Macias WL, Larsen T, et al. Recombinant human activated protein C for the postexposure treatment of Ebola hemorrhagic fever. J Infect Dis. Nov 15 2007;196 Suppl 2:S390-9.
5. Geisbert TW, Hensley LE, Jahrling PB, Larsen T, Geisbert JB, Paragas J, et al. Treatment of Ebola virus infection with a recombinant inhibitor of factor VIIa/tissue factor: a study in rhesus monkeys. Lancet. Dec 13 2003;362(9400):1953-8.
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7. Smith LM, Hensley LE, Geisbert TW, Johnson J, Stossel A, Honko A, et al. Interferon-ß Therapy Prolongs Survival in Rhesus Macaque Models of Ebola and Marburg Hemorrhagic Fever. J Infect Dis. Jan 15 2013
8. Sullivan NJ, Sanchez A, Rollin PE, Yang ZY, Nabel GJ. Development of a preventive vaccine for Ebola virus infection in primates. Nature. Nov 30 2000;408(6812):605-9
9. Geisbert TW, Pushko P, Anderson K, Smith J, Davis KJ, Jahrling PB. Evaluation in nonhuman primates of vaccines against Ebola virus. Emerg Infect Dis. May 2002;8(5):503-7
10. Allela L, Boury O, Pouillot R, Delicat A, Yaba P, Kumulungui B, et al. Ebola virus antibody prevalence in dogs and human risk. Emerg Infect Dis. Mar 2005;11(3):385-90