Page 101 - Journal of Special Operations Medicine - Fall 2014

An Ongoing Series

Ebola Hemorrhagic Fever

Mark W. Burnett, MD

ABSTRACT
Ebola hemorrhagic fever is an often-fatal disease caused between 2 and 21 days after exposure, although 8 to 10
by a virus of the Filoviridae family, genus Ebolavirus. days is the most common length of time between expo-
Initial signs and symptoms of the disease are nonspe- sure and illness. Case-fatality rates have surpassed 80%
cific, often progressing on to a severe hemorrhagic ill- in past outbreaks.
ness. Special Operations Forces Medical Providers should
be aware of this disease, which occurs in sporadic out- Transmission is only via contact with contaminated
breaks throughout Africa. Treatment at the present time bodily fluids of those who are ill or who have died of
is mainly supportive. Special care should be taken to pre- the disease. Exposures from contaminated needles have
vent contact with bodily fluids of those infected, which been a cause of disease both in Africa and in research
can transmit the virus to caregivers. labs in other nonendemic areas of the world. Standard,
contact, and droplet precautions should be observed in
Keywords: Ebolavirus, hemorrhagic fever caring for a patient with confirmed or suspected disease.
Ebola hemorrhagic fever is not transmitted via water,
food, or air or by asymptomatic patients.

Background
Ebola hemorrhagic fever is an often fatal disease caused Diagnosis
by a virus of the Filoviridae family, genus Ebolavirus. Diagnostic methods are based on the time frame of the
The first of the five known subspecies of Ebolavirus was illness and require special coordination with a receiv-
identified in 1976 near the Ebola River in what is now the ing laboratory and shipping procedures. Testing recom-
Democratic Republic of the Congo. Since that initially mended by the CDC as of August 2014 is as given in
documented outbreak, multiple sporadic resurgences of Table 1.
the disease have occurred in a dozen African countries in
northern, southern, and western areas of the continent, Table 1 Laboratory Tests Used in the Diagnosis
resulting in thousands of deaths. The latest outbreak in
Guinea, Liberia, Sierra Leone, and Nigeria has resulted Timeline of Diagnostic Tests Available
Infection
in over a 1,000 deaths, confirmed in the laboratory to be
caused by Ebolavirus, from March to early August 2014. Within a few • Antigen-capture enzyme-linked
immunosorbent assay (ELISA) testing
days after
The natural reservoir of the disease is unknown. symptoms begin • IgM ELISA
• Polymerase chain reaction (PCR)
• Virus isolation
Clinical
Later in disease • IgM and IgG antibodies
Ebola hemorrhagic fever initially has nonspecific symp- course or after
toms of abrupt-onset fever, headaches, weakness, musculo- recovery
skeletal aches, vomiting, and diarrhea. More characteristic Retrospectively • Immunohistochemistry testing
physical findings are injected sclerae, rash, hiccups, diffi- in deceased • PCR
culty breathing, and swallowing, as well as a bleeding dia- patients • Virus isolation
thesis. Symptoms have been reported to develop anywhere Source: http://www.cdc.gov/vhf/ebola/diagnosis/index.html.

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