EBOLA

by Jonathan Lee, MD

 

Total five species (Zaire to have the highest mortality – named after the country in which it was first discovered)

Category A Bioterrorism Agent – Agents with High transmission/dissemination and high mortality – along with Small Pox and the Bubonic Plague.

Discovered in Zaire (or current day Democratic Republic of Congo) in 1976. Named after a tributary that branches off of the Congo River that was near the site of initial outbreak.

Since 1976, there have been 14 outbreaks of Ebola Virus (including current). All have been in either in Zaire/DRC, Gabon, or Sudan.

Pathogenesis

Unclear however likely secondary to animal vector. Original host thought to be bats as they have frequently been isolated to carry the virus without actually being affected. Likely bat drops a piece of partially eaten fruit, drops it on the ground, which then other animals consume humans hunt for bushmeat…

Transmission

Body fluid contact with either open skin or contact with any mucosa. Can be carried in serum, tears, urine, saliva, semen, vaginal fluids. Thought to last in sperm even post infection. Infections go up once patients get admitted to hospitals secondary to close contact. Proper personal protective equipment and hygiene is paramount to preventing spread.

Pathophysiology

Virus can invade any cell in the body however preferentially attacks three:

  • Neutrophil CD16B – Suppresses your immune system initially.
  • Endothelium – Leading to hemorrhage. Inflammation can also trigger DIC.
  • Hepatocytes – Suppresses release of cytokines. Hepatic failure furthering coagulopathy.

Keep in mind there is an incubation period ranging from 2-21 days.

 

Symptoms/Patient Presentation

High fever >101.5, malaise, asthenia (weakness), myalgias, nausea/vomiting, diarrhea, loss of appetite, joint pains, melena, rectal bleeding, vaginal bleeding, bleeding from gums, conjunctival hemorrhage.

Further down the road Internal/external hemorrhage, rashes including hemorrhagic vesicles/bullae, petechiae, maculopapular rash

Labs

  • CBC – WBC may not be elevated at all
  • Pt/Ptt normal
  • LFTs – with worsening hepatic failure
  • Diagnostic testing: ELISA & PCR

Testing

Serum/Plasma/ or Whole blood minimum of 4ml shipped refrigerated or frozen on ice pack/dry ice (no glass tubes) as a Category B diagnostic specimen to the CDC.

 

HIGH RISK:

(1) Percutaneous OR mucous membrane exposure or direct skin contact with body fluids or a person with a confirmed or suspected case of EVD without appropriate personal protective equipment.

(2) Laboratory processing of body fluids of suspected or confirmed EVD cases without appropriate PPE or standard biosafety precautions. Thromobcytopenia can develop over time.

(3) Participation in funeral or other direct exposure to human remains in the geographic area where the outbreak is occurring without appropriate PPE.

LOW RISK:

(1) Spent time in facility where EVD patients are being treated (people not directly involved in patient care, or if involved in patient care used PPE).

(2) Household members of an EVD patient without high risk exposure.

(3) Persons who had direct unprotected contact with bats or primates from EVD affected countries.

Consultation with local and state health departments is recommended. Stay safe, and have a high index of suspicion.

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