HUMAN BIOLOGY

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AN OVERVIEW OF EBOLA VIRUS DISEASE 2

An Overview of Ebola Virus Disease

Ebola is an infectious and highly fatal disease in humans caused by contact with body

fluids infected with the Ebola virus, and depicts severe internal bleeding and fever.

Etiology of the Disease

Ebola Virus Diease (EVD) is a rare disease caused by an infection with five known Ebola

virus species. Four of these viruses can cause the disease in humans, viz. Bundibugyo virus

(Bundibugyo ebolavirus), Sudan virus (Sudan ebolavirus), Taï Forest virus (Taï Forest

ebolavirus), and Ebola virus (Zaire ebolavirus). The fifth type called Reston virus (Reston

ebolavirus) mainly causes the disease in pigs and other non-human primates (What is Ebola

Virus Disease?, 2019). Key primate examples include gorillas, monkeys, and chimpanzees.

Ebola primarily occurs in the form of occasional outbreaks on the African continent. Of the

above mentioned five virus types, it is yet not known whether the Bombali virus causes the

disease in humans. This virus was recently identified in bats.

Ebola was first discovered near the Ebola River in 1976, in what exists now as the

Democratic Republic of Congo. The origin of the Ebola virus is still unknown. However,

following detailed studies on the nature of similar virus, Ebola is assumed to originate from

animals and the non-human primates mentioned above (What is Ebola Virus Disease?, 2019).

These animals are likely carriers for the virus and they can transmit it to other animals as well as

to humans.

The outbreak that occurred in the Democratic Republic of Congo recently, as well as the

one that occurred in West African in 2014-2016, belongs to the Zaire species of Ebola virus.

When the cause of the virus involves several animal species at the same time, it is known as a

‘spillover event’. In this case, various species of animals come in contact with the host, for
AN OVERVIEW OF EBOLA VIRUS DISEASE 3

example fruit bats, consequently leading to a faster spread of the disease. The spread in this case

can occur mainly through hunting or cooking animal meat (Virus Ecology Graphic, 2019). Fruit

bats are considered to be the primary hosts or reservoirs for the Ebola virus, thus being a crucial

causative agent in the life-cycle of the disease.

Mode of Transmission

Ebola virus mainly spreads from one person to another by direct contact with bodily

fluids, blood, and animal tissues. This way of spreading is also applicable in case of animal-to-

animal transmission. A healthy person gets infected on contact with the body fluids of a person

who has got infected with Ebola or has died from it. Infection can also occur if a healthy person

touches objects that are contaminated with the virus by contact with feces, blood, and vomit.

Ebola virus can get inside the human body through skin injuries like cuts and bruises or even

through the mucous membrane present in the mouth, nose, and eyes ("Ebola virus disease",

2019).

One of the most primary ways of infections in case of Ebola is through sexual contact

with another person who is already infected with the disease. This type of transmission can also

occur if the sexual contact happens with a person who is recovering from Ebola. A key reason

for such transmission to occur rests on the fact that even through recovery times, the virus can

remain in the semen, sweat, and other body fluids ("Ebola virus disease", 2019). A person going

through recovery has to take strict precautions to ensure that the virus is not transmitted to others

even though a person might appear healthy after recovery.

In case of contact with animals, fruit bats, antelopes, porcupines, and other non-human

primates listed in the previous section are prime reasons for the transmission. The virus may

spread even when a healthy human or an animal comes in contact with another infected dead
AN OVERVIEW OF EBOLA VIRUS DISEASE 4

animal. Several cases of health-care workers getting infected have been documented, wherein the

workers operate in environments that demand close contact with patients infected with EVD.

Such infections are also caused when control precautions are not followed strictly ("Ebola virus

disease", 2019). As long as the blood contains the virus, people remain infectious.

Pathogenesis of Disease

Once infected, Ebola progresses rapidly, thus subsequently complicating the control

mechanisms that need to be implemented as fast as possible. The clinical course of this disease

has been properly mapped out through earlier research. However, specific processes regarding

the nature of its pathogenicity have not yet been completely identified (WHO Media Centre

2019). This is mainly due to difficulty in obtaining samples, and complexity in studying the

diseases in remote regions.

Ebola virus starts infecting the affected person within fourteen to twenty one days. The

infection mainly showcases symptoms such as myalgia, fever, and malaise. Rashes,

gastrointestinal bleeding, and hematological irregularities in the form of lymphopenia and

neutrophilia start as the next process in the initial infection period. As the infection progresses,

patients depict cases of severe bleeding and coagulation-based abnormalities. During the

pathogenesis, cytokines are released after the reticuloendothelial cells come in contact with the

virus. This causes highly increased inflammation in order to provide protection to the infected

area. The process that follows after inflammation starts with the liver getting damaged from

viremia and disseminated intravascular coagulopathy (WHO Media Centre 2019). The last stages

of Ebola infection are characterized mainly by diffuse bleeding and extreme shock, thus

accounting for several fatalities.

AN OVERVIEW OF EBOLA VIRUS DISEASE 5

The Ebola virus infection starts in a transmembrane form and each product showcase

biochemical and biological characteristics. The glycoprotein of Ebola virus depicts preferential

binding to the endothelium. This process is enacted through direct and indirect binding. As the

transmembrane gains the form of Ebola glycoprotein, it targets the virus towards the cells that

are show compatibility with the pathogenesis. The virus particularly is targeted towards the

reticuloendothelial cells network and the blood vessel lining. From an overall perspective, the

hosts show immune responses in the form of cell damage as the virus infected monocytes and

macrophages (WHO Media Centre 2019). The resultant release of cytokines gives rise to

inflammation and fever.

Clinical Picture of Disease

The incubation period of the disease mainly starts from the second day after the infection.

The onset of symptoms can start by showcasing maximum intensity in twenty one days. It is

highly unlikely that an infected person could lead to spreading the disease until they exhibit

symptoms. Most symptoms of the disease are mostly sudden and include fatigue, headache,

fever, muscle pain, and sore throat (Moole et al., 2015). These symptoms are followed by the

second set of effects that include rashes, vomiting, kidney failure, rash, liver deterioration,

internal bleeding, external bleeding, gum damage, low white blood cells, etc. In some cases,

platelet count, blood in stools, high liver enzymes also are key symptoms of the disease. The

illness starts in a progressive pattern and goes from dry symptoms that include fever, pains, and

fatigue to wet symptoms like vomiting and diarrhea (Ebola virus disease ad hoc case definition

for reporting in the EU, 2019). Several common illnesses in the form of malaria and typhoid also

manifest in few cases of Ebola infections.

AN OVERVIEW OF EBOLA VIRUS DISEASE 6

Regarding signs, many Ebola survivors may experience various side effects such as

tiredness, vision issues, muscle aches, and stomach pain. Moreover, recovery from Ebola virus

disease also depends on the quality of clinical care and a patient’s immune responses. Previous

research shows that survivors of Ebola virus may depict antibody formation up to even ten years

after recovery. Many survivors might develop some protective immunity based on the type of

Ebola that could infect them. In several cases, the symptoms are mapped out as those associated

with some other major disease. And until the time Ebola is detected, several symptoms progress

and intensify.

In order to properly study the symptoms, it is highly necessary to prepare an entire map

of the virus remaining in the body at sites that are highly immunological privileged. These sites

are mostly characterized by the presence of strong viruses like the Ebola virus being shielded

from immune systems. This is showcased despite the virus not being detected anywhere in the

body. Key areas that need detailed research to study the signs and symptoms are the nervous

system, eye interiors, testes, and placenta. Special attention needs to be given to cerebrospinal

fluids in case of neurological system analysis. The time duration of the virus in such specific

internal body parts varies from person to person. To map out the symptoms, the diagnostic test

selection also needs to be properly managed, preferably under expert and international evaluation

under an independent role.

There are several signs and symptoms exhibited post Ebola infections that have been

studied in U.S. survivors. In this study, several people infected in the Ebola virus epidemic in

West Africa received care in the United States. After recovering, latest reports have suggested

the presence of post Ebola signs and symptoms. Some of these key symptoms are ocular disease,

hearing loss, extreme fatigue, and arthraglia. The duration and severity of the survivors is now
AN OVERVIEW OF EBOLA VIRUS DISEASE 7

known mainly due to the data being restricted for sharing purposes. Every survivor reported

showing at least one symptom of the disease post recovery (Epstein, Wong, Kallen & Uyeki,

2015). Some of the commonly reported symptoms reported were lethargy, fatigue, and alopecia.

Most of the symptoms showed improvement with time. However, only a single survivor

was reported to show a complete resolution of every symptom. This study showcases the need

for assessments post primary care are even after the infected people are out of danger. In this

way, the frequency of symptom manifested can be mapped out properly, including suggested

tweaks needed in case of preliminary diagnostic techniques. Neurological, musculoskeletal, and

optical assessments are most necessary while evaluating post infection periods in affected people

(Epstein, Wong, Kallen & Uyeki, 2015). A key method identified to understand more about these

symptoms is a systemic longitudinal analysis followed by quality medical care.

Diagnosis, Treatment, and Prognosis of the Disease

Diagnosis of Ebola virus disease is often difficult due to clinical similarity of the illness

with other diseases such as typhoid, malaria, and meningitis. Confirmation of the disease during

diagnosis is mainly carried out through various methods. Antigen-capture detection tests,

antibody-capture enzyme-linked immunosorbent assay (ELISA), and serum neutralization tests

are key diagnostic procedures followed in most cases. In addition, electron microscopy, reverse

transcriptase polymerase chain reaction (RT-PCR) assay, and virus isolation by cell culture are

additional methods. It is recommended that selection of diagnostic tests should be considered

carefully, after taking several factors into account (What is Ebola Virus Disease?, 2019). Some

of these factors are disease incidence, technical specifications, social implications, and

prevalence.
AN OVERVIEW OF EBOLA VIRUS DISEASE 8

Extensive need of biohazard containment is required for studying the disease in

laboratories followed by supportive clinical analysis. A high level of prevention is needed to

avoid short outbreaks. Various prevention tactics such as surveillance, effective case

management, and contact tracing are currently employed (What is Ebola Virus Disease?, 2019).

Successful social engagement with affected communities and generating awareness also are key

prevention tactics.

As of current times, there is no proven treatment available for Ebola virus disease.

Supportive care including oral and intravenous fluid rehydration is implemented for treatment of

particular symptoms (Treatment, 2019). Several treatment procedures include immunity

therapies, injection of blood products and drug therapies. A multi-drug trial is conducted in the

ongoing Ebola outbreak in the Democratic Republic of Congo. An experimental vaccine was

developed against Ebola in Guinea in 2015. Several tests and trails are required before the

vaccine is properly implemented as a treatment method.

Regarding prognosis, a high mortality rate is associated with Ebola virus infections.

Currently, a fatality rate of about 50% is estimated to exist. Previous mortality rates have been

substantially less although they vary from 25% to 90%. Most of the short outbreaks have

occurred in the remote villages of Central and Western Africa.

AN OVERVIEW OF EBOLA VIRUS DISEASE 9

Bibliography and References

Ebola virus disease ad hoc case definition for reporting in the EU. (2019). Retrieved 17

November 2019, from https://www.ecdc.europa.eu/en/all-topics-zebola-and-marburg-

feversthreats-and-outbreaksebola-outbreak-west-africa-2013-2016/ebola

Ebola virus disease. (2019). Retrieved 16 November 2019, from https://www.who.int/news-

room/fact-sheets/detail/ebola-virus-disease

Jain, S., Birla, D., & Mishra, D. (2018). Ebola: Etiology, Prevention and Treatment by Herbal

Remedies. Pharmatutor, 6(9), 20. doi: 10.29161/pt.v6.i9.2018.20

Moole, H., Chitta, S., Victor, D., Kandula, M., Moole, V., & Ghadiam, H. et al. (2015).

Association of clinical signs and symptoms of Ebola viral disease with case fatality: a

systematic review and meta-analysis. Journal Of Community Hospital Internal Medicine

Perspectives, 5(4). doi: 10.3402/jchimp.v5.28374

Treatment | Ebola Virus Disease | CDC (2019). Retrieved 17 November 2019, from

https://www.cdc.gov/vhf/ebola/treatment/index.html

Virus Ecology Graphic. (2019). Retrieved 17 November 2019, from

https://www.cdc.gov/vhf/ebola/resources/virus-ecology.html

What is Ebola Virus Disease?. (2019). Retrieved 17 November 2019, from

https://www.cdc.gov/vhf/ebola/about.html

WHO. Media Centre (2019). Ebola virus disease, Fact sheet N°103, Retrieved 17 November

2019, from: http://www.who.int/news-room/fact- sheets/detail/ebola-virus-disease