Health : What is Ebola?

The Mirror Health Aug - 08 - 2014 , 14:02

Dear Mirror Doctor, Please can you explain what Ebola is and how to contain the situation?

Dear Mahmoud, Ebola virus is one of at least 30 known viruses capable of causing bleeding from orifices once fully infected. Although the Ebola virus disease is not fully understood; part of the disease process has been unravelled.

After infection, there is a period of rapid multiplication of the virus. In lethal cases, the virus is able to paralyse the white blood cells of the host responsible for fighting it.

It is also able to bind to the cells that line the blood vessels, destroy and cause blood to leak from these vessels accounting for the bleeding manifestations that characterise many, but not all, Ebola infections.

In fatal infections, the host’s tissues and blood contain large numbers of Ebola viral particles, and the tissues and body fluids are highly infectious.

Insect-eating bats and fruit bats have been found to support Ebola virus replication without dying.

Ebola infections are characterised by transmission from an unknown host (possibly bats) to humans or nonhuman primates, presumably via direct contact with body fluids such as saliva or blood or other infected tissues.

Dogs have been shown to acquire asymptomatic Ebola virus infections, possibly by contact with virus-laden droplets of urine, faeces, or blood of unknown hosts.

Human infections have often occurred in caregivers (either family or medical) and in family members who have prepared dead relatives for burial.

Spread is mainly by direct contact than via the respiratory route which occurs in certain types of Ebola particularly those found in Asia.

Once exposed, the incubation period typically is three to eight days in primary cases and slightly longer in secondary cases.

Early signs of the infection may include: fever, sore throat, rash which may be present around day five of infection and is most evident on the trunk. Red eyes, seen on both sides, is also a common feature. Later findings may include:

Bleeding from puncture sites and mucous membranes, Heart infections and wet lungs, abdominal pain, nausea and vomiting, and diarrhoea.

Evidence of mucous membrane involvement includes painful swallowing and bleeding from multiple sites. Eye complications reported include eye pain, fear of light and increased tearing from the eyes.

Although the mechanism is unclear, hiccups is noted in fatal cases of Ebola virus disease.

For the terminally ill patients, there may be fast breathing, low blood pressure, reduced passage of urine and coma. At this stage death is almost a certainty.

For those fortunate enough to survive the Ebola viral infection, they may develop muscle pain, joint pains or severe headache.

Diagnosing the infection, besides the clinical pointers, rests on demonstrating viral particles or antibodies to the organism in the blood.

Tissue culture which involves demonstrating growth of the virus from a tissue sample from the patient is the surest way of diagnosing. This is normally done in a high - containment laboratory such as Nogouchi for very obvious reasons.

In managing a patient with the Ebola virus, attention must be on supportive therapy. The spotlight must be put on maintaining intravascular volume, electrolytes, nutrition, and comfort care.

No specific therapy is available that has demonstrated efficacy in the treatment of Ebola hemorrhagic fever.

Several antiviral agents have been tried but none has been so efficacious.

There are no commercially available Ebola vaccines; even worse is the fact that no specific anti-Ebola virus agents are available.

I read of serum from somebody who has survived Ebola being used in treatment of the Americans exposed to the virus but I don't know how valid it is.

A main concern in dealing with Ebola virus infections is the potential for human-to-human spread of the virus before the correct diagnosis is made.

This risk includes all medical personnel in direct contact with the patient, the patient’s blood, or other body fluids or tissues.

Protective gear and strict barrier nursing must be observed for all persons who care for infected people.

Emergency preparedness and isolation of infected patients are very important for its containment. I hope Ghana is not waiting to record its first case before putting in place containment policies.

I pray that what I read about our preparedness is really the case, else we may be sitting on a time bomb.

Recovery often requires months, and delays may be expected before full resumption of normal activities. Weight gain and return of strength are slow.

The Ebola virus continues to be present for many weeks after resolution of the clinical illness.

Semen from men recovering from Ebola infection has been shown to contain infectious virus, and Ebola has been transmitted by sexual intercourse involving recovering men and their sex partners.

People who were exposed to infected patients should be watched closely for signs of early Ebola virus disease.

astom2@yahoo.com

A member of Paediatric Society of Ghana