Ebola Virus

Introduction
● Single-stranded RNA
● Filoviridae family
● Deadly disease that occur primarily on the African continent
● Discovered in 1976 when two consecutive outbreak occurred in Central Africa
○ First outbreak: village in DRC near Ebola River (Zaire ebolavirus)
○ Second outbreak: South Sudan (Sudan ebolavirus)
● Animal-borne; bats or nonhuman primates
● Affects humans and nonhuman primates (monkeys, gorillas, and chimpanzees)
● Average case fatality rate is 50%; 25% to 90% in past outbreaks.
Introduction
● It is caused by an infection with a group of viruses within the genus Ebolavirus:
○ Ebola virus (species Zaire ebolavirus)
○ Sudan virus (species Sudan ebolavirus)
○ Taï Forest virus (species Taï Forest ebolavirus, formerly Côte d’Ivoire
ebolavirus)
○ Bundibugyo virus (species Bundibugyo ebolavirus)
○ Reston virus (species Reston ebolavirus)
○ Bombali virus (species Bombali ebolavirus)
Epidemiology
Epidemiology
Epidemiology

2018 2020

Species: Zaire ebolavirus Species: Zaire ebolavirus

Reported number of cases: 3,470 *Ongoing in DRC

Reported number of deaths and
percentage of fatal cases: 2,287
(66%)
Hosts or reservoir
● Geographical and meteorological conditions are associated with hosts reservoir
● Virus that affects humans are endemic to humid rainforests
● EVD outbreaks have been associated with hunting or contact with bushmeat
● Frequently fatal epizootics among wild apes
Mode of Transmission
Mode of Transmission
● Virus spreads through direct contact such as broken skin or mucous membranes
in the eyes, nose or mouth) with:
○ Body fluids
○ Objects contaminated with body fluids
○ Infected fruit bats
○ Semen from a man who recovered from EVD
Pathogenesis
Clinical manifestations
● Incubation period: 3-25 days after which infected people develop a biphasic
syndrome
○ First phase (disease onset until around 5- days):
■ Resembles influenza; sudden onset of fever and chills, severe headaches,
cough, myalgia, pharygitis, arthralgia, rash.
○ Second phase ( ~5-7 days after disease onset and thereafter):
■ Gastrointestinal tract involvement ( abdominal pain with vomiting or
diarrhea), chest pain, cough, postural hypotension, edema, CNS
involvement ( Confusion, headache, coma)
○ Hemorrhagic manifestations are typical
Laboratory Findings
● Leukopenia
● Thrombocytopenia
● Increased concentrations of liver enzymes and pancreatic enzymes
● Hypokalemia
● Hyponatremia
● Increased creatinine and urea concentrations with proteinuria
Diagnosis
● Cannot be diagnosed in clinical presentation alone
● Epidemiologic history, exposure history, and or clinical manifestations
● Method of choice: PCR
○ Typical detection limit: 1000-5000 pfu per milliliter of serum
● Enzyme-linked immunosorbent assay (ELISA)
● Electron microscopic examination of inactivated samples or cultures
● Formalin fixed skin biopsies and swab for a safer post-mortem diagnosis
Treatment
● Appropriate personal protective equipment must be used
● Supportive treatment
○ Provide fluids and electrolytes intravenously
○ Oxygen therapy
○ Drugs to maintain blood pressure, antiemetics, anti-diarrhea, fever and pain
management
○ Treatment of other infections if they occur
Complications
● Secondary infections
● Pregnancy and labor cause severe and fatal complications
Prognosis
● Generally poor
● Convalescence may take months
● Rarely, filoviruses persists in healthy survivors and are either reactivated by
unknown means or transmitted sexually
○ Abstinence of at least 12 months
○ Use of condoms is generally recommended for sexual activities
Control and Prevention
● Ervebo- approved by FDA on December 19, 2019
● Reducing the risk of wildlife-to-human transmission
● Reducing the risk of human-to-human transmission
● Outbreak containment measures
● Reducing the risk of possible sexual transmission
● Reducing the risk of transmission from pregnancy related fluids and tissue
References
Kasper, D. L., Fauci, A. S., Hauser, S. L., Longo, D. L. 1., Jameson, J. L., & Loscalzo, J. (2018). Harrison's
principles of internal medicine (20th edition.). New York: McGraw Hill Education.
L.Mackenzie. Ebola Virus Disease.
https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease
Centers for Disease Control and Prevention.Ebola Virus.
https://www.cdc.gov/vhf/ebola/index.html