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Potentially life-threatening emergency
Ebola
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Potentially life-threatening emergency

Ebola

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Contributors: Justin S. Gatewood MD, Alex Garza MD, MPH
Other Resources UpToDate PubMed

Synopsis

Note: If you are considering Ebola, contact a public health authority. CDC guidelines (www.cdc.gov/vhf/ebola) are summarized below. Detailed public health protocols for screening and management can be accessed here.

If the patient has one of the following combinations of exposure and clinical criteria, implement rapid isolation with immediate contact of public health authorities to arrange for safe transport to an appropriate health care facility for Ebola evaluation. Medical evaluation is required.

Precautions: A patient with known or suspected Ebola virus disease (EVD) should be isolated in a single room (with a private bathroom), and health care personnel should follow standard, contact, and droplet precautions including the use of appropriate personal protective equipment (PPE) for all persons entering the patient room.

Implement Rapid Isolation for Patients with:
  1. An epidemiologic risk factor* of "high risk" or "some risk" within the 21 days before the onset of symptoms; AND
  2. Fever (subjective fever or measured temperature ≥100.4°F/38°C) OR any of the following: severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage (bruising or bleeding).
OR
  1. An epidemiologic risk factor* of "low (but not zero) risk" within 21 days before the onset of symptoms; AND
  2. Fever (subjective fever or measured temperature ≥100.4°F/38°C) OR any of the following: vomiting, diarrhea, unexplained hemorrhage (bruising or bleeding).
*See Diagnostic Pearls for risk factors.

Other Patients:
  • No Risk + Symptomatic – Patients with "no identifiable risk" who are symptomatic should undergo routine medical evaluation and management of ill persons, as needed.
  • Risk + Asymptomatic (no fever or other symptoms consistent with Ebola) – Patients with any level of risk (low, some, high) who are asymptomatic require active monitoring or direct active monitoring (depending on risk), coordinated by the state or local public health authority. Depending on risk factors, additional movement or travel restrictions may be warranted. Refer to CDC guidelines.
Testing: The decision to test for Ebola should be made in consultation with relevant health department. Hospitals should follow their state and/or local health department procedures for notification and consultation. Due to biosafety precautions for suspected Ebola, blood should only be drawn and processed at appropriately equipped facilities.

2014 West Africa Outbreak: The 2014 Ebola epidemic in West Africa, including Liberia, Guinea and Sierra Leone, was the largest in history. Travel-associated cases were reported in Nigeria, Spain, Italy, the United States, the United Kingdom, Mali, and Senegal. (A short, separate, unrelated EVD outbreak was reported in the Democratic Republic of the Congo.)

Transmission: Ebola is a life-threatening infection that causes a virulent viral hemorrhagic fever. Person-to-person transmission of EVD occurs through direct contact with blood or body secretions (such as urine, saliva, feces, vomit, breast milk, and semen), including the bodily fluids of the deceased. The virus gains entry via mucous membranes, breaks in the skin, or parenterally. The incubation period for Ebola is 2-21 days (usually about 7 days). Humans are not infectious until they develop symptoms.

Signs and Symptoms: Initial symptoms of EVD include the sudden onset of 4-7 days of fever, chills, headache, weakness, myalgias, rash, nausea, vomiting, chest pain, cough, sore throat, prostration, conjunctivitis, abdominal pain, and diarrhea. The disease may progress to jaundice, pancreatitis, anorexia, photophobia, delirium, shock, liver failure, hemorrhaging, and multi-system dysfunction.

About Ebola: Ebola virus is an RNA virus of the Filoviridae family endemic to Asia and Africa. It is closely related to Marburg virus and is a zoonotic (animal-borne) infection. Ebola virus is believed to be transmitted to humans by contact with blood, secretions, organs, or other bodily fluids of infected animals such as non-human primates (monkeys, gorillas, chimpanzees).

The mortality rate of naturally occurring Ebola is approximately 25%-90%, depending on the infecting viral strain. Individuals who recover from EVD develop antibodies lasting for 10 or more years. There is no Ebola vaccine yet approved; however, an experimental vaccine (rVSV-ZEBOV) was shown to be somewhat protective, and candidate vaccines ChAd3-EBO-Z and rVSVΔG-ZEBOV-GP have also been shown to elicit maintained immune responses (12 months) in a trial of adult patients.

Codes

ICD10CM:
A98.4 – Ebola virus disease

SNOMEDCT:
37109004 – Ebola hemorrhagic fever

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Early signs and symptoms of EVD are nonspecific and may resemble more commonly occurring travel-related diseases such as malaria.

In the absence of hemorrhagic findings, all other tropical fevers and worldwide causes of fever with or without rash must be ruled out.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 09/27/2019
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Potentially life-threatening emergency
Ebola
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Ebola : Abdominal pain, Diarrhea, Fever, Headache, Nausea/vomiting, ALT elevated, AST elevated, West Africa, Myalgia, Gingival bleeding, PLT decreased
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