Epidemiology

• Western Africa Outbreak Occurred in 2014

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Microbiology

• xxx

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Physiology

• Incubation Period: variable, but can be up to 24 days
• Transmission: via body fluids

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Diagnosis

• xxx

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Clinical Manifestations

General Comments

• Incubation Period: 6-12 days

Initial Phase

• General Comments
  • Onset: typically abrupt
• Anorexia (see Anorexia, [[Anorexia]])
• Chills
• Diarrhea (see Diarrhea, [[Diarrhea]])
• Fever (see Fever, [[Fever]])
• Headache (see Headache, [[Headache]])
• Malaise
• Myalgias (see Myalgias, [[Myalgias]])
• Nausea/Vomiting (see Nausea and Vomiting, [[Nausea and Vomiting]])
• Sinus Bradycardia (see Sinus Bradycardia, [[Sinus Bradycardia]])
• Weakness (see xxxx, [[xxxx]])

Disease Phase

Cardiovascular Manifestations

• Chest Pain (see Chest Pain, [[Chest Pain]]): may occur in some cases
• Hypotension/Shock (see Hypotension, [[Hypotension]]): may be exacerbated by dehydration

Dermatologic Manifestations

• Diffuse, Erythematous, Non-Pruritic Maculopapular Rash (see xxxx, [[xxxx]])
  • Onset: develops by day 5-7 of the illness
  • Distribution: face, neck, trunk, arms (generally easier to see in light-skinned persons)
  • Course of Rash: may desquamate

Gastrointestinal Manifestations

• General Comments: common
  • Onset: develop within the first few days of illness
• Abdominal Pain (see Abdominal Pain, [[Abdominal Pain]])
• Diarrhea (see Diarrhea, [[Diarrhea]]): may be up to 10L per day and result in dehydration
• Elevated Liver Function Tests (LFT’s)/Transaminitis: due to multifocal hepatic necrosis
• Nausea/Vomiting (see Nausea and Vomiting, [[Nausea and Vomiting]])

Hematologic manifestations

• Anemia or Polycythemia (see Anemia, [[Anemia]] or Polycythemia, [[Polycythemia]])
• Disseminated Intravascular Coagulation (DIC) (see Disseminated Intravascular Coagulation, [[Disseminated Intravascular Coagulation]])
• Leukopenia (see Leukopenia, [[Leukopenia]])
• Thrombocytopenia (see Thrombocytopenia, [[Thrombocytopenia]])

Hemorrhagic Manifestations

• General Comments: although disease has been traditionally called “ebola hemorrhagic fever”, major hemorrhage is not seen in the majority of cases
  • However, clinically-significant hemorrhage may occur in the later stages of disease
• Ecchymoses
• Gastrointestinal Hemorrhage (see Gastrointestinal Hemorrhage, [[Gastrointestinal Hemorrhage]])
  • Only 6% of Cases Manifest Hematochezia During the Course of Their Illness
• Mucosal Bleeding
• Oozing from Venipuncture Sites
• Petechiae (see Petechiae, [[Petechiae]])

Neurologic Manifestations

• General Comments
  • Onset: usually develop after day 10 of the illness
• Meningioencephalitis (see Meningitis, [[Meningitis]] and Encephalitis, [[Encephalitis]])
  • Altered Mental Status (see Delirium, [[Delirium]])
  • Stiff Neck
  • Seizures (see Seizures, [[Seizures]])

Ophthalmologic Manifestations

• General Comments
  • Onset: develop during the acute phase of the illness or during convalescence
• Uveitis (see Uveitis, [[Uveitis]])
  • Blindness (see Blindness, [[Blindness]])
  • Blurred Vision (see Blurred Vision, [[Blurred Vision]])
  • Photophobia (see Photophobia, [[Photophobia]])

Renal Manifestations

• Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]]): may occur during both early and late stages of the disease
• Electrolyte Abnormalities: due to vomiting and/or diarrhea
  • Hypocalcemia (see Hypocalcemia, [[Hypocalcemia]])
  • Hypokalemia (see Hypokalemia, [[Hypokalemia]])
  • Hypomagnesemia (see Hypomagnesemia, [[Hypomagnesemia]])
• Proteinuria (see Proteinuria, [[Proteinuria]])

Other Manifestations

• Conjunctival Injection (see Conjunctival Injection, [[Conjunctival Injection]]): common
• Dark Red Soft Palate: common
• Dyspnea (see Dyspnea, [[Dyspnea]]): may occur in some cases
• Hiccups (see Hiccups, [[Hiccups]]): may occur in some cases
• Spontaneous Miscarriage: may occur in pregnant females

Convalescent Phase

General Comments

• Clinical Improvement is Expected to Occur During the Second Week of the Illness
• Convalescent Phase May Be Prolonged (Lasting >2 Years in Some Cases)

Manifestations During Convalescent Phase

• Acute Arthralgias (see Arthralgias, [[Arthralgias]]): due to formation of antigen-antibody complexes during recovery
• Extensive Skin Sloughing/Hair Loss: due to virus-induced necrosis of infected sweat glands and other dermal structures
• Hearing Loss (see Hearing Loss, [[Hearing Loss]])
• Retro-Orbital Pain (see Eye Pain, [[Eye Pain]])
• Uveitis (see Uveitis, [[Uveitis]])
• Persistent Viral Shedding (in Urine/Semen/Aqueous Fluids): although the clinical importance of this finding is unclear, there have been cases of late onset uveitis and meningitis weeks-months after the initial presentation

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Treatment

Supportive Care

• xxx

XXX

• xxxx

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Prognosis

• Mortality Rate: 60%

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References

• The 2014 Ebola virus disease outbreak in West Africa. J Gen Virol 2014:95:1619-1624 [MEDLINE]