Ebola Virus

 

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Leann Bruce and Kara Cannon from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Leann Bruce, Kara Cannon, Ylice Bridges, Elaine Lonnemann, Kim Jackson, 127.0.0.1, Evan Thomas, WikiSysop and Nupur Smit Shah  

Definition/Description

     “Ebola Virus Disease (EVD) is a severe, often fatal, zoonotic infection caused by a virus of the Filoviridae family (genus Ebolavirus),”¹. EVD is one type of hemorrhagic fever that is commonly found in west, central, and east Africa. The disease is caused by a single-stranded RNA Flavovirus which tends to replicate on dendritic cells, macrophages, and monocytes. The virus then uses multiple mechanisms to invade its host including migration to the spleen, liver, and lymph nodes which leads to widespread infection.¹ There are five known strains of EVD: Zaire ebolavirus, Bundibugyo virus, Sudan Virus, Taï Forest virus, and Reston virus. Of the five strains, only the Reston virus has not affected humans. The other strains have fatality rates ranging from 30-90% depending on the specific outbreak.²

     EVD originates in animals and is spread to humans through hunting and eating of bushmeat or contact with bat feces. Once a human has EVD, the virus is spread through contact with bodily fluids or reuse of needles that have not been properly decontaminated.¹ “Classification by the Centers for Disease Control as a category A agent also designates EBOV as a bioterrorism threat, making this virus a biodefense research priority”³.

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Prevalence

     The Ebola Virus has been through 25 outbreaks since the first cases were discovered in humans in 1976⁴. The epidemics have centered mainly in west African countries with some occurring in the eastern and central areas as well. There have been more than 26,000 high- fatality cases of the virus documented in western Africa⁵. “The West African outbreak of Ebola virus disease (EVD) has been described as one of the most devastating health crises of the 21st century. It has resulted in over 11,000 deaths”⁶. The three largest outbreaks have occurred in Sierra Leone, Guinea, and Liberia^5,7. The statistics available from each outbreak are variable and likely underrepresenting the disease prevalence due to a lack of healthcare reporting. Also contributing to this problem are a lack of education, recovery from civil war, a failing economy, mobile populations leading to urban overcrowding or movement to isolated, rural communities, and a lack of transportation to healthcare facilities.⁶

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Characteristics/Clinical Presentation

Ebola Virus is characterized by the following signs and symptoms:

1. Early Stage

• Fever (>37.5⁰C)
• Myalgia
• Diarrhea
• Vomiting
• Headache
• Fatigue
• Sore throat
• Asthenia (extreme)
• Anorexia
• Abdominal Pain
• Back Pain
• Arthralgia

2. Mid Stage

• Nausea and Vomiting
• Headache
• Confusion
• Capillary Leak
• Difficulty Breathing/Respiratory Distress
• Low Blood Pressure
• Rash (macropapular)

3. Late Stage

• Multi-Organ Failure
• Hemorrhage (internal/external)
• Hiccups
• Dilirium
• Shock (Septic and Hypovolemic)

Other symptoms of EVD, although rare, include hepatomegaly, lymphadenopathy, encephalopathy, and seizures.^1,2,4,8

Associated Co-morbidities

     The are very few studies on comorbidities found in patients with Ebola. The most common comorbidity seen in patients with Ebola is Malaria. One study of epidemiological, clinical, and outcome features found that 72% of the 90 patients with Ebola were also diagnosed with malaria. The only other comorbidity found in the study was diabetes (2% of the 90 patients).⁹

Medications

     There is currently no preventative vaccine or licensed treatment for the Ebola virus. However, recent research has focused on experimental drugs and treatments to fight the disease, and many other medications are used to treat the numerous symptoms that Ebola patients experience. The following are current medications and treatments that are used to combat the Ebola virus:

1. Antibiotics for the prevention and treatment of bacterial infections: ^4,5

• Cefixime
• Ceftriaxone
• Ertapenem
• Levofloxacin
• Meropenem
• Metronidazole
• Piperacillin-tazobactam
• Vancomycin

2. Antidiarrheal: ⁵

• Diphenoxylate-atropine

3. Antifungal: ⁵

• Micafungin

4. Rehydration: ⁴

• Oral rehydration solution
• Ringer lactate

5. Sedative: ⁵

• Propofol

6. Supportive care and analgesics for treatment of general symptoms: ^1,4,5

• Acetaminophen
• Diphenhydramine
• Electrolyte supplements
• Hydrocodone
• Meperidine
• Ondansetron
• Opioid analgesics (ex. morphine)
• Pantoprazole
• Paracetamol
• Phenazopyridine
• Protein-rich oral supplements
• Vitamins

The following are experimental drugs and treatments that researchers are currently testing for the therapeutic benefits towards Ebola:

Emerging treatments: 1,2

• ZMapp (best known emerging treatment to date; experimental drug that has shown therapeutic benefits against Ebola in humans)
• TKM-Ebola (proven to be protective in non-human primates and has been given to a few patients under emergency protocols)
• Brincidofovir (has shown activity against Ebola in vitro; has been given to patients under emergency protocols; future trials are planned in west Africa)
• Favipiravir (effective against Ebola in mice; future human trials are planned to start in west Africa)
• BCX-4430 (no human studies have been performed, but shown to be active against Ebola in non-human primates and rodents)
• AVI-7537 (improves survival in non-human primates infected with the Ebola virus)
• Interferons, amiodarone, clomiphene, and chloroquine (other agents that are being investigated with uncertain benefits against Ebola in humans)
• cAd3-ZEBOV and rVSV-ZEBOV (two experimental vaccines that are currently undergoing human trials in the US)
• Convalescent whole blood or plasma (limited evidence that transfusion of blood from convalescent patients might reduce mortality, but investigative trials are planned)
  
  

Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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