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Snapshot
  • A 42-year-old man presents to the emergency room from the airport. He was flying home after having spent 3 weeks on a safari in Africa. He reports feeling nauseous on the flight, attributing this to motion sickness. Additionally, he developed a nosebleed on the flight, prompting him to seek medical care as soon as he landed. He reports that for the past 3 days, he has had a cough, general muscle aches, and a headache. He has also had subjective fevers and chills. On physical exam, there is dried blood in his nares and conjunctival injection. After having his blood drawn, there is also bleeding from the puncture sites. He is isolated and admitted.
Introduction
  • Classification
    • ebola virus
      • an enveloped, non-segmented, linear, negative-sense, single-stranded, RNA virus
      • filovirus with a helical capsid 
      • transmission via direct contact with infected human body fluids (including post-mortem)
      • reservoirs are humans or infected animals (bats, pigs, or primates)
      • causes hemorrhagic fever
  • Epidemiology
    • incidence
      • most common in Africa
    • risk factors
      • travel to endemic countries
      • occupational exposure
      • sick contacts
  • Pathogenesis
    • the virus targets endothelial cells, hepatocytes, phagocytes, and dendritic cells
    • afteran incubation of up to 21 days, the virus will disseminate via the lymphatics and cause multiorgan failure
  • Prevention
    • vaccines are under development
  • Prognosis
    • high mortality rate
Presentation
  • Symptoms
    • flu-like symptoms
      • high fever
      • myalgia
      • headache
    • nausea and vomiting
      • may have hematemesis
    • diarrhea
      • may have melena
  • Physical exam
    • petechial rash
    • can be hemorrhagic if the disease progresses to disseminated intravascular coagulopathy (DIC) and shock
      • bleeding from puncture sites
      • conjunctival injection
Studies
  • Labs
    • thrombocytopenia
    • hepatic transaminitis
    • detection of viral RNA on reverse-transcriptase polymerase chain reaction (RT-PCR)
  • Making the diagnosis
    • diagnosis based on clinical presentation and detection of viral RNA on RT-PCR
Differential
  • Yellow fever
    • distinguishing factors
      • presents with jaundice and scleral icterus with minor hemorrhage
      • transmission via mosquitoes
  • Dengue fever
    • distinguishing factors
      • also presents with hemorrhage
      • blanching confluent erythematous maculopapular rash with lymphadenopathy
      • transmission via mosquitoes
Treatment
  • Management approach
    • immediate isolation of the patient
    • mainstay of treatment is supportive
  • Conservative
    • supportive care
      • indication
        • all patients
      • modalities
        • correct electrolyte abnormalities
        • hydration of blood transfusion
        • reversal of coagulopathy
Complications
  • Death
  • Bacteremia

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