The Ebola Virus (Hemorrhagic Fever)

What Sample is needed for the Ebola Virus?

1. This can be diagnosed with the patient:
   1. Blood
   2. Sputum
   3. Tissue.

How will you define the Ebola virus?

1. Ebola virus is a rare and deadly disease in humans and nonhuman primates.
2. It is fatal in humans.
3. It is mainly seen in sub-Saharan Africa.

How will you describe the Epidemiology and History of the Ebola virus?

1. Ebola virus, formerly called Hemorrhagic fever.
2. This disease spreads from wild animals (rodents).
3. Also, this disease spreads from person to person.
4. The fatality rate ranges from 25% to 90%, with and average of around 50%.
5. This disease outbreak is seen in remote villages in Central Africa near tropical rainforests.
6. The first outbreak was seen in 1976 in Sudan and Congo.
   1. The first case was identified along the Ebola River in Congo near the Sudan border.
7. This was observed near the Ebola River in Congo, and it was named after it.
8. These cases have been reported from Senegal, Nigeria, Mali, Italy, Spain, the United States of America, and the United Kingdom.
9. Details of the Ebola virus were given on April 4, 1995.

What are the clinical presentations of the Ebola virus?

1. A patient was reported in Kikwit city, Zaire. He was a laboratory technician who developed a fever and a severe headache.
2. He has abdominal cramping pain, which settles later on.
3. He has difficulty swallowing.
4. Then he has blood in the stool.
5. Later on, blood from the nose and mouth starts to flow.
6. Within 2 weeks, his other workers developed similar signs and symptoms.
   1. Fever = 94%, diarrhea = 80%, weakness = 74%, dysphagia = 41%, hiccups = 15%, and bleeding from the mucous membranes of the GIT, vagina, and skin = 38%.
7. By June, there were 296 cases.
   1. Samples were sent to the CDC and subjected to PCR and immunoassay; the report was positive for Ebola virus.
8. Filo, in filoviridae, means filament in Latin and describes the filamentous shape of the RNA viruses Ebola and Marburg, which are part of the filovirus family.

How is the Transmission of the Ebola virus?

1. The host is a bat (Pteropodidae family).
2. This virus spreads through close contact with the blood, secretions, and body fluids of infected animals, including chimpanzees, gorillas, monkeys, and fruit bats.
3. The Ebola virus then spreads through human-to-human transmission via:
   1. Direct contact (through broken skin or mucous membranes).
   2. Through the blood, secretions, organs, or other body fluids of infected people and with surfaces and materials (e.g., bedding, clothing) contaminated with these fluids.

4. Humans and monkeys are infected during outbreaks of this disease, but the reservoir source is unknown.

6. Healthcare workers:
   1. They have frequently been infected while treating patients with suspected or confirmed Ebola virus infection. 
   2. This has occurred through close contact with patients, despite not strictly following infection control precautions.
7. People remain infectious:
   1. As long as their blood and body fluids contain the virus, including semen and breast milk.
   2. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.
   3. The primary source of spread is direct contact with body fluids.
   4. Direct contact with blood, urine, stool, vomitus, or semen from active disease patients, alive or dead, is the most important transmission source.
   5. This occurs through contact with the skin or mucous membranes from virus-infected body fluids.
   6. The reuse of unsterile needles was the primary source of transmission among patients in Kikwit, Zaire.

What are the Types of Ebola Viruses?

1. Filo means filaments in Latin, describing the filamentous shape of the RNA Ebola and Marburg virus belonging to the filovirus group.
2. Ebola is a single-stranded RNA.
3. The virus family Filoviridae includes three genera:
   1. Cuevavirus.
   2. Marburg virus,
   3. Ebola virus.

What are the Species of the Ebola virus?

These are identified as follows:

1. Zaire Ebola virus.
2. Bundibugyo Ebola virus.
3. Sudan Ebola virus.
4. Reston Ebola virus.
5. Taï Forest ebolavirus.
   1. The first 3, Bundibugyo ebolavirus, Zaire ebolavirus, and Sudan ebolavirus, have large African outbreaks.
      1. In another reference, three clinically active viruses are Zaire, Sudan, and Tai Forest.
   2. The virus causing the 2014 West African outbreak belongs to the Zaire species.

What is the incubation period of the Ebola virus?

1. It is 2 to 21 days before symptoms appear.

What are the signs and symptoms of the Ebola virus?

1. The average time for S/S to appear is 8 to 10 days.
2. 95% will have signs and symptoms during the first 14 days.
3. Humans are not infectious until they develop symptoms.
4. There is a sudden onset of:
   1. Fever.
   2. There is malaise, fatigue, myalgia, and arthralgia.
   3. Muscle pain, headache, and sore throat.
5. After 3 to 5 days:
   1. This is followed by vomiting and diarrhea.
   2. Rash.
   3. There are symptoms of impaired kidney and liver function.
   4. In some cases, internal and external bleeding (e.g., oozing from the gums, blood in the stools).
6. Nausea and vomiting worsen, and the patient cannot tolerate oral intake.
   1. Diarrhea becomes a large volume, and patients may lose 5 or more liters of fluid per day.
7. The disease progresses, and the patient may develop neurological symptoms.
   1. Encephalitis is accompanied by confusion, agitation, and occasional seizures.
8. The patient may go into shock.
9. Hemorrhagic manifestations are seen in only 1% to 5% of cases.
10. A complication of the Ebola virus:
    1. There is a hypovolemic shock.
    2. There may be a multiorgan failure.

How will you diagnose Ebola?

Laboratory findings of the Ebola virus include:

1. Blood sample:
   1. Low white blood cell and platelet counts.
   2. Abnormal Liver function tests.
   3. Increased serum creatinine level.
2. Serological tests:
   1. ELISA (antibody-capture enzyme-linked immunosorbent assay):
   2. IgM antibodies appear after 10 days of the infection.
   3. After 2 weeks, IgG antibodies appear.
   4. Serum neutralization test.
3. Antigen-capture detection tests.
4. PCR-RT (Reverse transcriptase-polymerase chain reaction) can diagnose in the first 3 days of illness.
   1. Repeat this test if negative and the patient still has signs and symptoms.
5. Electron microscopy will detect the virus.
6.  Culture can isolate the virus.

How will you prevent the Ebola virus?

1. There is no available vaccine.
   1. There are vaccines under trial.
2. If you travel to or are in an area affected by an Ebola outbreak, do the following.
   1. Practice careful hygiene. Avoid contact with blood and body fluids.
   2. After you return, monitor your health for 21 days and seek medical care immediately if you develop signs and symptoms of an Ebola virus infection.
   3. Avoid hospitals where Ebola patients are being treated.
   4. Avoid contact with bats and nonhuman primates, and with blood, fluids, and raw meat prepared from these animals.
   5. Avoid funeral or burial rituals that require handling the body of someone who has died from Ebola.
   6. Do not handle items that may come into contact with an infected person’s blood or body fluids.

How will you treat Ebola?

1. This is mainly supportive.
2. Rehydrate the patient, and that may reduce mortality.
3. Antiviral drugs may be tried.
4. People sometimes give antimalarial and broad-spectrum antibiotics.

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