Morning Report: Ebola

Today’s Morning Report is courtesy of Dr. Rolston-Cregler!

EBOLA!!!!

Primary exposure: work in an endemic area

Secondary Exposure: human to human, primate to human

Presentation:

– Early findings include high fevers, pharyngitis, severe constitutional signs and symptoms, bilateral conjuntival injection. Myalgias, anorexia and fevers occur first, usually followed by GI symptoms (abdominal pain, N/V/D).

– Maculopapular Rash becomes evident around day 5 of infection, more easily visualized on lighter skin

– Patients who develop tachypnea have a much poorer prognosis than those who don’t

– Myocarditis, pulmonary edema, tachypnea, hypotension, anuria and coma predominate in later phases of the disease

– Late in the disease patients develop expressionless facies and bleeding from IV puncture sites and mucous membranes

– Survivors often have late manifestations including but not limited to myalgia, amenorrhea in woman, unilateral orchitis in males, asymmetric and migratory arthralgias

Management:

– Supportive care: replacement of intravascular volume losses, correction of electrolyte abnormalities,

– Many patients develop DIC, severe GI bleeds may also occur

o consider FFP, platelets, cryoprecipitate if indicated

o consider TXA if bleeding predominates

Transmission/Precautions:

– Strict barrier precautions for all infected patients, all body fluids should be disinfected with 0.5% sodium hypochlorite solution

– Deceased patients should be buried quickly and with as little direct contact as possible

– Complete recovery requires months in survivors and transmission has be reported via semen of infected males for up to two months

Be vigilant and be sure to ask about recent travel (Guinea, Sierra Leone, Liberia, or Lagos, Nigeria) in patients presenting with this constellation of symptoms. The incubation period is usually 3-8 days but can be as long as 21 days.