Ebola virus infection
Ebola virus infection: Excerpt from Professional Guide to Diseases (Eighth Edition)
One of the most frightening viruses to come out of the African subcontinent, the Ebola virus first appeared in 1976. More than 400 people in Zaire (now known as Democratic Republic of Congo) and the neighboring Sudan were killed by the hemorrhagic fever that it caused. Ebola virus has been responsible for several outbreaks in the years since then, including one in Zaire in the summer of 1995.
An unclassified ribonucleic acid (RNA) virus, Ebola is morphologically similar to the Marburg virus. Both can cause headache, malaise, myalgia, and high fever, progressing to severe diarrhea, vomiting, and internal and external hemorrhage.
Four strains of the Ebola virus are known to exist: Ebola Zaire, Ebola Sudan, Ebola Tai, and Ebola Reston. All four types are structurally similar, although they have different antigenic properties. However, Ebola Reston causes illness only in monkeys, not in humans, as do the other three.
The prognosis for Ebola virus infection is extremely poor, with mortality as high as 90%. The incubation period ranges from 2 to 21 days.
Causes
Ebola virus infection is caused by an unclassified RNA virus that’s passed from person to person by direct contact with infected blood, body secretions, or organs. Nosocomial and community-acquired transmission can occur. Contaminated needles can also cause the infection. Transmission through semen may occur up to 7 weeks after clinical recovery. The virus remains contagious even after the patient has died.
Signs and symptoms
The patient's health history usually reveals contact with an infected person. However, no clear line of infection may be apparent at the beginning of an Ebola virus outbreak. The patient usually complains of flulike signs and symptoms (such as headache, malaise, myalgia, fever, cough, and sore throat), which first appear within 3 days of infection.
As the virus spreads through the body, inspection reveals bruising as capillaries rupture and dead blood cells infiltrate the skin. A maculopapular eruption appears after the fifth day of infection. The patient may also display melena, hematemesis, epistaxis, and bleeding gums. As the infection progresses, severe complications, including liver and kidney dysfunction, dehydration, and hemorrhage, may develop. In pregnant women, the Ebola virus leads to abortion and massive hemorrhage.
In the final stages of the disease, the skin blisters and sloughs off, blood seeps from all body orifices, and the patient begins vomiting his liquefied internal organs. Death usually results during the second week of illness from organ failure or hemorrhage.
Diagnosis
Specialized laboratory tests reveal specific antigens or antibodies and may show the isolated virus. As with other types of hemorrhagic fever, tests also demonstrate neutrophil leukocytosis, hypofibrinogenemia, thrombocytopenia, and microangiopathic hemolytic anemia.
Treatment
No cure exists for Ebola virus infection; treatment consists mainly of intensive supportive care. Administration of I.V. fluids helps offset the effects of severe dehydration. The patient may receive replacement of plasma heparin before the onset of clinical shock.
Experimental treatments include the administration of plasma that contains Ebola virus-specific antibodies. Although this treatment has resulted in diminished levels of Ebola virus in the body, further evaluation is needed.
Throughout treatment, the patient should remain on contact precautions. If diagnostic tests indicate that the patient is free from the virus — which typically occurs 21 days after onset in those few who survive — the patient can be released.
Special considerations
❑Follow the guidelines for standard precautions formulated by the Centers for Disease Control and Prevention (CDC) when assessing a patient who may have Ebola virus.
❑Check the results of complete blood count and coagulation studies for signs of blood loss and coagulopathy.
❑Assess the patient daily for petechiae, ecchymoses, and oozing blood. Note and document the size of ecchymoses at least every 24 hours.
❑Protect all areas of petechiae and ecchymoses from further injury.
❑Test stools, urine, and vomitus for occult blood.
❑Watch for frank bleeding, including GI bleeding and, in women, menorrhagia. Note and document the amount of bleeding every 24 hours or more often.
❑Monitor the patient's family and other close contacts for fever and other signs of infection.
❑Provide emotional support for the patient and his family during the course of this devastating disease. Encourage them to ask questions and discuss any concerns they have about the disease and its treatment.
❑In addition, the CDC recommends the following guidelines to help prevent the spread of this deadly disease:
– If possible, place the patient in a negative-pressure room at the beginning of hospitalization to avoid the need for transfer as the disease progresses.
– Restrict nonessential staff members from entering the patient's room.
– Make sure that anyone who enters the patient's room wears gloves and a gown to prevent contact with any surface in the room that may have been contaminated.
– Use barrier precautions to prevent skin or mucous membrane exposure to blood or other body fluids, secretions, or excretions when caring for the patient.
– If you must come within 3' (0.9 m) of the patient, also wear a face shield or surgical mask and goggles or eyeglasses with side shields.
– Don’t reuse gloves or gowns unless they have been completely disinfected.
❑Make sure any patient who dies of the disease is promptly buried or cremated. Precautions to prevent contact with the patient's body fluids and secretions should continue even after the patient's death.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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