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Ebola Virus Disease

Ebola Virus Disease is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • An enveloped, negative-stranded RNA virus with a characteristic filamentous structure (family Filoviridae)
  • A high mortality rate, combined with the absence of specific antiviral treatment and no proven vaccine, makes Ebola virus one of the most virulent human pathogens.
  • Incubation period between 2 and 21 days; most cases present the 2nd week after exposure.
  • Patients become infected through contact with body fluids from an infected human or animal.
  • The predominant clinical syndrome involves substantial volume loss due to vomiting and diarrhea, leading to circulatory collapse. Frank hemorrhage is less common. Thus, the prior description of Ebola as a “hemorrhagic fever” has given way to Ebola virus disease (EVD).

Epidemiology

  • Four principal strains of the virus are known to cause disease in humans: Zaire, Sudan, Bundibugyo, and Taï Forest.
  • The Zaire strain caused the historically largest and most widespread outbreak of Ebola (West African, 2014 to 2015).
  • As of June 2016, a total of 28,616 Ebola cases have been reported in Guinea, Liberia, and Sierra Leone, with 11,310 deaths. This includes 881 infected health care workers.
  • In May 11, 2017, a cluster of eight suspected cases of EVD were reported by the Government of Congo, two samples tested positive for Ebola Zaire.
  • Reservoir: Indirect evidence strongly indicates the fruit bat as a host organism.
  • Outbreaks start as a zoonotic, animal–human species jump and spread through human–human contact.
  • Ebola virus enters the body through mucous membranes, breaks in the skin, or parenterally.
  • Ebola virus can also be spread through direct contact with the skin of an infected patient.
  • The most infectious body fluids are blood, feces, and vomit. Ebola virus persists longer in semen, CSF, and aqueous humor. All body fluids should be considered infectious and handled with maximum (biosafety level 4) precautions.

Etiology and Pathophysiology

  • The virus spreads through direct contact (through broken skin or mucous membranes) with
    • Blood or body fluids of an infected person (alive or recently deceased)
    • Objects (e.g., clothing, bedding, needles, and syringes) that have been contaminated with body fluids from an infected person (alive or dead)
    • Infected fruit bats or primates (apes and monkeys)
  • Male-female sexual transmission has been documented (virus persists in semen).
  • The early steps of infection lead to aberrant immune responses in monocytes, macrophages, dendritic cells, and hepatocytes. This leads to a cytokine cascade, loss of endothelial cell adhesion, and vascular leakage/collapse.
Pregnancy Considerations
  • Atypical presentation of EVD may be observed in pregnant women presenting as abdominal pain, preterm labor, vaginal bleeding, premature rupture of membranes, or spontaneous miscarriages.
  • Fetal death may occur even if the mother has recovered.
  • Ebola virus RNA has been detected at low levels in breast milk up to 16 months after onset of symptoms. There have been no documented maternal-child transmissions attributed to nursing.

Risk Factors

Health care providers, family, and friends in close contact with Ebola-infected patients are at highest risk.

General Prevention

  • A vaccine derived from a chimpanzee adenovirus and a human recombinant vesicular stomatitis virus (rVSV) vaccine have been studied (1).
  • The rVSV-ZEBOV demonstrates protection against EVD (2).

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Citation

Stephens, Mark B., et al., editors. "Ebola Virus Disease." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816933/all/Ebola_Virus_Disease.
Ebola Virus Disease. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816933/all/Ebola_Virus_Disease. Accessed April 24, 2019.
Ebola Virus Disease. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816933/all/Ebola_Virus_Disease
Ebola Virus Disease [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816933/all/Ebola_Virus_Disease.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Ebola Virus Disease ID - 816933 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816933/all/Ebola_Virus_Disease PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -