Ebola Virus infection Dr ErnetElienguo,MD Dr ChritinNyndi,MD EMERGENCY DEPERTMENT
outline • Background • Epidemiology • Etiology • Pathophysiology • Clinical presentation • Work up • Prognosis • Management • prevention
background • Ebola virus disease (EVD), is a severe, often fatal illness in humans. • EVD outbreaks have a case fatality rate of up to 90%. • EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests. • The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission. • Fruit bats of the Pteropodidae family natural host of the Ebola virus. • Severely ill patients require intensive supportive care. No licensed specific treatment or vaccine is available for use in people or animals.
background • Ebola first appeared in 1976 in 2 simultaneously outbreak in NZr Sudan and Yambuku DRC the latter in village situated near Ebola river in which the disease take it name
background • Ebola virus is one of at least 30 known viruses capable of causing viral hemorrhagic fever syndrome • The genus Ebolavirus is currently classified into 5 separate species: Sudan ebolavirus, Zaire ebolavirus, Tai Forest (Ivory Coast) ebolavirus, Reston ebolavirus, and Bundibugyo ebolavirus.
background • Primary exposure • Secondary exposure
epidemiology • Ebola and Marburg viruses are responsible for well-documented outbreaks of severe human hemorrhagic fever, with resultant case mortalities ranging from 23% for Marburg virus to 89% for Ebola virus in which more than one case occurred
epidemiology • As of July 23, 2014, 1201 total suspected or confirmed cases (814 laboratory-confirmed) had been reported in these countries, resulting in 672 deaths
Disease update • New cases and deaths attributable to EVD continue to be reported by the Ministries of Health in Guinea, Liberia, Nigeria, and Sierra Leone. • Between 7 and 9 August 2014, 69 new cases (laboratory-confirmed, probable, and suspect cases) of EVD and 52 deaths were reported from the four countries as follows: • Guinea, 11 new cases and 6 deaths; Liberia, 45 new cases and 29 deaths; Nigeria, 0 new cases and 0 deaths; and Sierra Leone, 13 new cases and 17 deaths.
The current (2014) Ebola virus outbreak is significant and primarily involves 3 African countries—Guinea, Liberia, and Sierra Leone
Ep…. • Age-related demographics • In the 1995 outbreak in Kikwit, DRC, infection rates were significantly lower in children than in adults • Children re less likely to get into contacts . Sex-related demographics • Ebola virus infection has no sexual predilection • Men more likely to get primary exposure while oman more likely to secondary exposure
Race-related demographics • Black • No racil predilection
prognosis' • The overall prognosis for patients with Ebola poor.
prognosis • High mortality rte except for reton ebolaviru • The most highly lethal Ebolavirus species is Zaire ebolavirus, which has been reported to have a mortality rate as high as 89%. • Sudan ebolavirus also has high reported mortality, ranging from 41% to 65%.
clinical presentation • To type of expore • Primary exposure • Secondary exposure
Clinical presentation • Mode of tranmiion • Not entirely clear but thought to firt trnmitted to initial peron by animal body fluid or blood or by contaminated medical equipment • airbone tranmiion ha not being documented but they re however infectious breathable • Bt being identified natural reservoir
Clinical… • Secondary exposure refers to human-to-human or primate-to-human exposures. • In each major outbreak, medical personnel or family members who cared for patients or those who prepared deceased patients for burial were at very high risk
Clinical coure • Incubation period range from 2 to 21 day
Cliniclcoure • Severe headache (50%-74%) • arthralgias or myalgias (50%-79%), • fever with or without chills (95%), • anorexia (45%), • asthenia (85%-95%) occur early in the disease
Gastrointestinal (GI) symptoms, • abdominal pain (65%), • nausea and vomiting (68%-73%) • diarrhea (85%), • conjunctivitis (45%), • odynophagia or dysphasia (57%), • bleeding from multiple sites in the GI tract. Bleeding from mucous membranes and puncture sites is reported in 40%-50% of patients
Clinicl coure • A mucopupular rah 15 • Tackpnea i ingle mot discrimination betn survivors n non survivors
etilogy • The known members of the family Filoviridae are the genera Ebolavirus (Ebola virus) and Marburgvirus (Marburg virus). • Ebolavirus is classified into the following 5 separate species: • Sudan ebolavirus • Zaire ebolavirus • Tai Forest ebolavirus (formerly and perhaps still more commonly Ivory Coast ebolavirus or Côte d’Ivoire ebolavirus) • Reston ebolavirus • Bundibugyo ebolavirus
Work up • Other diseases that should be ruled out before a diagnosis of EVD can be made include: • malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral hemorrhagic fever
workups • Basic blood tests • CBC(thrombocytopenia, leucopenia, and a pronounced lymphopenia) • BIOCHEMITRY(elevations in AT ALAT) • Coagulopthy • Serum creatine and urea • Serum electrolyte
Workup • Definitive diagnosis rests on isolation of the virus by means of tissue culture or reverse-transcription polymerase chain reaction (RT-PCR) assay. • However, isolation of Ebola virus in tissue culture is a high-risk procedure that can be performed safely only in a few high-containment laboratories throughout the world.
Work up • Serologic testing for antibody and antigen • the immunoglobulin M (IgM) and immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) tests may be useful in the diagnosis of Ebola virus infection • The indirect fluorescence antibody test (IFAT) • IgG-capture ELISA uses detergent-extracted viral antigens to detect IgG anti-Ebola antibodies
Work up • Histology • endothelial cells, • hepatocytes, and • mononuclear phagocytes • Viral replication is associated with extensive focal necrosis and is most severe in the liver, spleen, lymph nodes, kidney, lung, and gonads.
Treatments and managements • Currently, no specific therapy is available that has demonstrated efficacy in the treatment of Ebola hemorrhagic fever. • There are no commercially available Ebola vaccines. • However, a recombinant human monoclonal antibody directed against the envelope GP of Ebola has been demonstrated to possess neutralizing activity
Support care • Supportive therapy with attention to • intravascular volume • Electrolytes • Nutrition • Intravascular volume repletion is one of the most important supportive measures.
Pharmacology agent • To drug re currently being approved to be used • MAPP • TKM-Ebola
prevention • Work continues on a vaccine for Ebola virus infection in primates • This work indicates that primates can be vaccinated against Ebola virus and can develop both a cell-mediated response (thought to be a result of the DNA vaccine) and a humoral antibody response (thought to be a result of the recombinant adenoviral vaccine)
prevention • Infection control inside and outside of medical facilities relies on barrier protection using • double gloves, • fluid-impermeable gowns, • face shields with eye protection, • coverings for legs and shoes.