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Christine Ahn MD
Carl Allen DDS, MSD
Brandon Ayres MD
Howard P. Baden MD
Robert Baran MD
Keira Barr MD
Gregory J. Basura MD, Ph.D
Donald Belsito MD
Jeffrey D. Bernhard MD
Jesse Berry MD
Victor Blanco MD
Benjamin R. Bohaty MD
William Bonnez MD
Sarah Brenner MD
Robert A. Briggaman MD
Robert Brodell MD
Roman Bronfenbrener MD
Walter Brooks MD
William Buckley MD
Philip Bulterys MD, PhD (candidate)
Susan Burgin MD
Sonya Burton MD
Sean P. Bush MD, FACEP
Jeffrey Callen MD
Scott Camazine MD
Michael Cardwell
Shelley D. Cathcart MD
Robert Chalmers MD, MRCP, FRCP
Chia-Yu Chu MD, PhD
Flavio Ciferri MD
Maria Rosa Cordisco MD
Noah Craft MD, PhD
John T. Crissey MD
Harold E. Cross MD, PhD
Charles E. Crutchfield III MD
Adriana Cruz MD
Donna Culton MD, PhD
Bart J. Currie MBBS, FRACP, DTM&H
Chicky Dadlani MD
Alexander Dane DO
C. Ralph Daniel III MD
Thomas Darling MD, PhD
William Delaney MD
Damian P. DiCostanzo MD
Ncoza Dlova MD
James Earls MD
Libby Edwards MD
Melissa K. Egge MD
Charles N. Ellis MD
Rachel Ellis MD
David Elpern MD
Nancy Esterly MD
Stephen Estes MD
E. Dale Everett MD
Janet Fairley MD
David Feingold MD
Jennifer J. Findeis-Hosey MD
Benjamin Fisher MD
Henry Foong MBBS, FRCP
David Foster MD, MPH
Brian D. Foy PhD
Michael Franzblau MD
Vincent Fulginiti MD
Sunir J. Garg MD, FACS
Kevin J. Geary MD
Lowell Goldsmith MD, MPH
Sethuraman Gomathy MD
Bernardo Gontijo MD, PhD
Kenneth Greer MD
Kenneth G. Gross MD
Alan Gruber MD
Nathan D. Gundacker MD
Akshya Gupta MD
Vidal Haddad MSC, PhD, MD
Edward Halperin MD, MA
Ronald Hansen MD
John Harvey
Rizwan Hassan MD
Michael Hawke MD
Jason E. Hawkes MD
Peter W. Heald MD
David G. Hicks MD
Sarah Hocker DO
Ryan J. Hoefen MD, PhD
Li-Yang Hsu MD
William Huang MD
Sanjana Iyengar MD
Alvin H. Jacobs MD
Saagar Jadeja MD
Shahbaz A. Janjua MD
Joshua J. Jarvis MD
Kit Johnson
Zachary John Jones MD
Robert Kalb MD
A. Paul Kelly MD
Henry Kempe MD
Loren Ketai MD
Sidney Klaus MD
Ashwin Kosambia MD
Jessica A. Kozel MD
Carl Krucke
Mario E. Lacouture MD
Joseph Lam MD
Alfred T. Lane MD
Edith Lederman MD
Nahyoung Grace Lee MD
Pedro Legua MD, PhD
Robert Levin MD
Bethany Lewis MD
Sue Lewis-Jones FRCP, FRCPCH
Taisheng Li MD
Christine Liang MD
Shari Lipner MD, PhD
Adam Lipworth MD
Jason Maguire MD
Mark Malek MD, MPH
Jere Mammino DO
Ricardo Mandojana MD
Lynne Margesson MD
Thomas J. Marrie MD
Maydel Martinez MD
Ralph Massey MD
Patrick McCleskey MD
Karen McKoy MD
Thomas McMeekin MD
Josette McMichael MD
Somchai Meesiri MD
Joseph F. Merola MD
Mary Gail Mercurio MD
Anis Miladi MD
Larry E. Millikan MD
Dan Milner Jr. MD
Zaw Min MD
Stephanie Montero
Alastair Moore MD
Keith Morley MD
Dean Morrell MD
Samuel Moschella MD
Rehan Naseemuddin MD
Taimor Nawaz MD
Vic Newcomer MD
John Nguyen MD
Matilda Nicholas MD
Thomas P. Nigra MD
Steven Oberlender MD, PhD
Maria Teresa Ochoa MD
Art Papier MD
Lawrence Parish MD
Tanner Parrent MD
Mukesh Patel MD
Lauren Patty-Daskivich MD
David Peng MD, MPH
Robert Penne MD
Nitipong Permpalung MD
Miriam Pomeranz MD
Doug Powell MD
Harold S. Rabinovitz MD
Christopher J. Rapuano MD
Sireesha Reddy MD
Angela Restrepo MD, PhD
Bertrand Richert MD, PhD
J. Martin Rodriguez, MD, FACP
Theodore Rosen MD
Misha Rosenbach MD
Scott Schiffman MD
Robert H. Schosser MD
Glynis A. Scott MD
Carlos Seas MD, MSc
Deniz Seçkin MD
Daniel Sexton MD
Paul K. Shitabata MD
Tor Shwayder MD, FAAP, FAAD
Elaine Siegfried MD
Gene Sienkiewicz MD
Christye Sisson
Philip I. Song MD
Mary J. Spencer MD, FAAP
Lawrence B. Stack MD
Sarah Stein MD
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Frances J. Storrs MD
Erik J. Stratman MD
Lindsay C. Strowd MD
Erika Summers MD
Belinda Tan MD, PhD
Robert Tomsick MD
Hensin Tsao MD, PhD
Richard P. Usatine MD
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Lisa Wallin ANP, FCCWS
Douglas Walsh MD
Ryan R. Walsh MD
George Watt MD
Clayton E. Wheeler MD
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Jan Willems MD, PhD
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Vivian Wong MD, PhD
Sook-Bin Woo MS, DMD, MMSc
Jamie Woodcock MD
Stephen J. Xenias MD
Nathaniel Yohannes
Lisa Zaba MD
Vijay Zawar MD
Bonnnie Zhang MD
Carolyn Ziemer MD
Jeffrey P. Zwerner MD, PhD
Organizations
Am. Journal of Trop. Med & Hygiene
Armed Forces Pest Management Board
Blackwell Publishing
Bugwood Network
Centers For Disease Control and Prevention
Centro Internacional de Entrenamiento e Investigaciones Mèdicas (CIDEIM)
Dermatology Online Journal
East Carolina University (ECU), Division of Dermatology
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 healthcare 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 healthcare 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:
An epidemiologic risk factor* of "high risk" or "some risk" within the 21 days before the onset of symptoms; AND
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
An epidemiologic risk factor* of "low (but not zero) risk" within 21 days before the onset of symptoms; AND
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.
