1. Dr Ernet Elienguo,MD Dr Chritin Nyndi,MD EMERGENCY DEPERTMENT
Ebola Virus infection
Dr Ernet Elienguo,MD
Dr Chritin Nyndi,MD
EMERGENCY DEPERTMENT

2. ebol

3. outline Background Epidemiology Etiology Pathophysiology
Clinical presentation
Work up
Prognosis
Management
prevention

5. background
Ebola virus disease (EVD), is a severe, often fatal illness in humans.
EVD outbreaks have a case fatality rate of up to 90%.
EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests.
The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
Fruit bats of the Pteropodidae family natural host of the Ebola virus.
Severely ill patients require intensive supportive care. No licensed specific treatment or vaccine is available for use in people or animals.

6. background
Ebola first appeared in 1976 in 2 simultaneously outbreak in NZr Sudan and Yambuku DRC the latter in village situated near Ebola river in which the disease take it name

7. background
Ebola virus is one of at least 30 known viruses capable of causing viral hemorrhagic fever syndrome
The genus Ebolavirus is currently classified into 5 separate species: Sudan ebolavirus, Zaire ebolavirus, Tai Forest (Ivory Coast) ebolavirus, Reston ebolavirus, and Bundibugyo ebolavirus.

8. background
Primary exposure
Secondary exposure

10. epidemiology
Ebola and Marburg viruses are responsible for well-documented outbreaks of severe human hemorrhagic fever, with resultant case mortalities ranging from 23% for Marburg virus to 89% for Ebola virus in which more than one case occurred

11. epidemiology
As of July 23, 2014, 1201 total suspected or confirmed cases (814 laboratory-confirmed) had been reported in these countries, resulting in 672 deaths

12. outbreak Year Location Reported Cases, No. Deaths, No. (%) 1976 Sudan
284
151 (53)
England* 1
0 (0)
1979 34
22 (65)
Uganda
425
224 (53)
2004 17
17 (41)
2011
1 (100)
Total
762
405 (53)

13. Outbreaks

14. New (1)
Confirmed
Probable
Suspect
Totals
Guinea
Cases 11
362
133
506
Deaths 6
238 2
373
Liberia 45
158
306
135
599 29
146
125 52
323
Nigeria 10 3 13
Sierra Leone
656 37
730 17
276 34 5
315 69
1176
486
186
1848
660
294 59
1013
1. New cases were reported between 7 and 9 August 2014.

15. Disease update
New cases and deaths attributable to EVD continue to be reported by the Ministries of Health in Guinea, Liberia, Nigeria, and Sierra Leone.
Between 7 and 9 August 2014, 69 new cases (laboratory-confirmed, probable, and suspect cases) of EVD and 52 deaths were reported from the four countries as follows:
Guinea, 11 new cases and 6 deaths; Liberia, 45 new cases and 29 deaths; Nigeria, 0 new cases and 0 deaths; and Sierra Leone, 13 new cases and 17 deaths.

16. The current (2014) Ebola virus outbreak is significant and primarily involves 3 African countries—Guinea, Liberia, and Sierra Leone

17. Ep…. Age-related demographics
In the 1995 outbreak in Kikwit, DRC, infection rates were significantly lower in children than in adults
Children re less likely to get into contacts
. Sex-related demographics
Ebola virus infection has no sexual predilection
Men more likely to get primary exposure while oman more likely to secondary exposure

18. Race-related demographics
Black
No racil predilection

19. prognosis'
The overall prognosis for patients with Ebola poor.

20. prognosis High mortality rte except for reton ebolaviru
The most highly lethal Ebolavirus species is Zaire ebolavirus, which has been reported to have a mortality rate as high as 89%.
Sudan ebolavirus also has high reported mortality, ranging from 41% to 65%.

21. clinical presentation
To type of expore
Primary exposure
Secondary exposure

22. Clinical presentation

23. Clinical presentation
Mode of tranmiion
Not entirely clear but thought to firt trnmitted to initial peron by animal body fluid or blood or by contaminated medical equipment
airbone tranmiion ha not being documented but they re however infectious breathable
Bt being identified natural reservoir

24. Clinical…
Secondary exposure refers to human-to-human or primate-to-human exposures.
In each major outbreak, medical personnel or family members who cared for patients or those who prepared deceased patients for burial were at very high risk

25. Clinical coure
Incubation period range from 2 to 21 day

26. Clinicl coure Severe headache (50%-74%)
arthralgias or myalgias (50%-79%),
fever with or without chills (95%),
anorexia (45%),
asthenia (85%-95%) occur early in the disease

27. Gastrointestinal (GI) symptoms,
abdominal pain (65%),
nausea and vomiting (68%-73%)
diarrhea (85%),
conjunctivitis (45%),
odynophagia or dysphasia (57%),
bleeding from multiple sites in the GI tract. Bleeding from mucous membranes and puncture sites is reported in 40%-50% of patients

28. Clinicl coure A mucopupular rah 15
Tackpnea i ingle mot discrimination betn survivors n non survivors

29. etilogy
The known members of the family Filoviridae are the genera Ebolavirus (Ebola virus) and Marburgvirus (Marburg virus).
Ebolavirus is classified into the following 5 separate species:
Sudan ebolavirus
Zaire ebolavirus
Tai Forest ebolavirus (formerly and perhaps still more commonly Ivory Coast ebolavirus or Côte d’Ivoire ebolavirus)
Reston ebolavirus
Bundibugyo ebolavirus

30. pathophyilogy

31. Work up
Other diseases that should be ruled out before a diagnosis of EVD can be made include:
malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral hemorrhagic fever

32. workups Basic blood tests
CBC(thrombocytopenia, leucopenia, and a pronounced lymphopenia)
BIOCHEMITRY(elevations in AT ALAT)
Coagulopthy
Serum creatine and urea
Serum electrolyte

33. Workup
Definitive diagnosis rests on isolation of the virus by means of tissue culture or reverse-transcription polymerase chain reaction (RT-PCR) assay.
However, isolation of Ebola virus in tissue culture is a high-risk procedure that can be performed safely only in a few high-containment laboratories throughout the world.

34. Work up Timeline of Infection Diagnostic tests available
Within a few days after symptoms begin
Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing
IgM ELISA
Polymerase chain reaction (PCR)
Virus isolation
Later in disease course or after recovery
IgM and IgG antibodies
Retrospectively in deceased patients
Immunohistochemistry testing
PCR

35. Work up Serologic testing for antibody and antigen
the immunoglobulin M (IgM) and immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) tests may be useful in the diagnosis of Ebola virus infection
The indirect fluorescence antibody test (IFAT)
IgG-capture ELISA uses detergent-extracted viral antigens to detect IgG anti-Ebola antibodies

36. Work up Histology endothelial cells, hepatocytes, and
mononuclear phagocytes
Viral replication is associated with extensive focal necrosis and is most severe in the liver, spleen, lymph nodes, kidney, lung, and gonads.

37. Treatments and managements
Currently, no specific therapy is available that has demonstrated efficacy in the treatment of Ebola hemorrhagic fever.
There are no commercially available Ebola vaccines.
However, a recombinant human monoclonal antibody directed against the envelope GP of Ebola has been demonstrated to possess neutralizing activity

38. Support care Supportive therapy with attention to intravascular volume
Electrolytes
Nutrition
Intravascular volume repletion is one of the most important supportive measures.

39. Pharmacology agent To drug re currently being approved to be used MAPP
TKM-Ebola

40. Diet

41. prevention
Work continues on a vaccine for Ebola virus infection in primates
This work indicates that primates can be vaccinated against Ebola virus and can develop both a cell-mediated response (thought to be a result of the DNA vaccine) and a humoral antibody response (thought to be a result of the recombinant adenoviral vaccine)

42. prevention
Infection control inside and outside of medical facilities relies on barrier protection using
double gloves,
fluid-impermeable gowns,
face shields with eye protection,
coverings for legs and shoes.