Ebola-Marburg viral diseases

0 (US); 100 (Global)
African hemorrhagic fever; Marburg virus disease; Ebola virus hemorrhagic fever;
Probably 5-15 days; [CCDM]
Severe flu-like illness with fever, myalgia, and headache followed by sore throat, vomiting, diarrhea, and maculopapular rash; Patients with severe cases have hemorrhagic diathesis, hepatic damage, renal failure, CNS involvement, and shock; [CCDM]
"Under natural conditions, airborne transmission among humans has not been documented. . . . The diseases are not communicable before the febrile phase, and communicability increases with stage of illness as long as blood and secretions contain virus." [CCDM, p. 176] See http://who.int/csr/resources/publications/ebola/infection-prevention/en/
Findings include fever, weakness, headache, sore throat, vomiting, diarrhea, and rash. [WHO website] Hemorrhage, shock, liver injury, and renal failure are prominent findings. Laboratory studies show thrombocytopenia, lymphopenia, and liver transaminase elevations. [CCDM, p. 173] Other symptoms include: chest and abdominal pain, cough, conjunctivitis, jaundice, pancreatitis, lymphadenopathy, delirium, and coma. Other complications after the second week of infection include transverse myelitis, hepatitis, orchitis, and uveitis. [Merck Manual, p. 1488; PPID, p. 2140] A maculopapular rash that later desquamates appears on about the 5th day of the illness. Bleeding is common from the skin, nose, mouth, GI tract, and vagina. Laboratory abnormalities include thrombocytopenia and leukopenia with left shift; leukocytosis develops after the initial phase. Serum bilirubin levels are normal or slightly elevated. Shock is frequently the cause of death. [ID, p. 2138-40] Serum amylase may be elevated. Acute renal failure occurs as a consequence of shock. [Harrison ID, 2nd Ed, p. 1054]
In Africa, Ebola has a case-fatality rate of 32-88%. At highest risk are patients injected with contaminated needles, family caregivers, healthcare workers, laboratory workers, and people working with bats or primates from central Africa. [CCDM, p. 173-6] "Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus. . . . Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest." The virus was isolated from semen of an infected laboratory worker 61 days after the onset of his illness. "Unlike influenza or tuberculosis, Ebola does not spread through the air." [WHO website]
Culture; Detect antigen with ELISA or PCR; Formalin-fixed tissue--then immunohistochemical exam; IgM antibodies suggests recent infection; Paired serology; [CCDM]
Uganda, Kenya, Zimbabwe, Angola, Gabon, Sudan, The Congo (DRC), and Ivory Coast; The 2014 outbreak occurred in Guinea, Liberia, .Sierra Leone, Nigeria, and Senegal; [CCDM]
  • >arthralgia
  • >fatigue, weakness
  • >fever
  • >fever, biphasic or relapsing
  • >myalgia
  • E epistaxis
  • E pharyngitis
  • E stomatitis
  • G abdominal pain
  • G blood in stool
  • G diarrhea
  • G hematemesis
  • G hepatomegaly
  • G jaundice
  • G liver function test, abnormal
  • G nausea, vomiting
  • H leukocytosis
  • H leukopenia
  • H lymphadenopathy
  • H thrombocytopenia
  • N confusion, delirium
  • N headache
  • N lethargy
  • O conjunctivitis, acute
  • R chest pain
  • R cough
  • S papules or plaques
  • S petechiae and ecchymoses
  • S rash (exanthem)
  • *acute renal failure
  • *bleeding tendency
  • *epididymo-orchitis
  • *hepatitis
  • *myelitis
  • *pancreatitis
  • *shock
  • *stupor, coma
  • *uveitis
  • *weight loss




Inhalation, Ingestion, Needle (Includes Drug Abuse), Scalpel or Transfusion, Skin or Mucous Membranes (Includes Conjunctiva), Sexual Contact
Human, Wild Animals
  • Care for patients (bloodborne pathogen)
  • Care for patients (droplet/airborne)
  • Handle animal carcasses or placentas
  • Handle needles or surgical instruments
  • Travel to endemic area
  • Victim--air release of infectious agents
  • Work in a medical or research lab
“It was the ninth Ebola outbreak to hit the Democratic Republic of Congo in a decade, killing 29 people and leaving at least 60 children orphaned. While one death is too many, the West Africa epidemic of 2014-16 claimed more than 11,000 lives and it is hoped that later this week the most recent outbreak will be declared officially over by the World Health Organization. The relatively small number of deaths follows the use of an experimental vaccine, which may have saved hundreds, or even thousands of lives.” [BBC News, July 23, 2018]
2. (Global) Cases reported in England & Wales: Zero cases of Ebola or Marburg ever imported; [Public Health England website] Occurs as outbreaks; [Cecil, p. 2214] An Ebola outbreak in West Africa occurred in 2014. By August 20, there were 2615 suspected cases and 1427 deaths. [CDC Health Alert Network] As of 24 December 2014, there were 19,497 reported cases and 7588 reported deaths mainly in Guinea, Liberia, and Sierra Leone. [WHO website] Guesstimate = 100 cases/year;