WESLEYAN UNIVERSITY-PHILIPPINES

College of Nursing & Allied Medical Sciences

Seminar I

Ebola virus
-one of at least 30 known viruses capable of causing viral hemorrhagic fever syndrome
-under the family Filoviridae, the same as Marburg virus
-currently classified into 5 separate species:
1. Sudan ebolavirus
2. Zaire ebolavirus
3. Tai Forest (Ivory Coast) ebolavirus
4. Reston ebolavirus
5. Bundibugyo ebolavirus
-The 2014 outbreak of Ebola virus disease in West Africa, involving Zaire ebolavirus, is the largest outbreak of
Ebola virus disease in history.
Signs and symptoms
Studies have demonstrated that patients who die of Ebola viral infection do not develop a humoral immune
response. However, in survivors neutralizing antibody can be detected. It is likely that a broad humoral
immune response can increase the likelihood of an infected patient surviving Ebola.
The following 2 types of exposure history are recognized:
Primary exposure This typically involves travel to or work in an Ebola-endemic area
Secondary exposure This refers to human-to-human exposure (eg, medical caregivers, family
caregivers, or persons who prepared deceased patients for burial), primate-to-human exposure (eg,
animal care workers who provide care for primates), or persons who collect or prepare bush meat for
human consumption
Physical findings depend on the stage of disease at the time of presentation. With Africanderived Ebolavirus infection, there is an incubation period (typically 3-8 days in primary cases and slightly
longer in secondary cases).
Early findings may include the following:
Fever
Pharyngitis
Maculopapular rash (best seen in white patients)
o Macules- flat discolored area of the skin
o Papules- small raised bump
Bilateral conjunctival injection
Later findings may include the following:
Expressionless faces
Bleeding from intravenous (IV) puncture sites and mucous membranes
Myocarditis and pulmonary edema
In

terminally ill patients may include the following:

Tachypnea-excessively rapid respiration
Hypotension
Anuria
Coma

Survivors of Ebola virus disease have developed the following late manifestations:
Myalgias- muscle pain
Asymmetric and migratory arthralgias- joint pain
Headache
Fatigue
Bulimia- hyperphagia/ excessive eating with induced vomiting

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WESLEYAN UNIVERSITY-PHILIPPINES
College of Nursing & Allied Medical Sciences
Seminar I

Amenorrhea
Hearing loss
Tinnitus- ringing/ similar sensation of sounds in the ear
Unilateral orchitis- inflammation of testicles
Suppurative parotitis- mumps

International statistics for signs and symptoms

1976 outbreak- most cases have bleeding

1995 outbreak- half of the cases have bleeding
50%-74%- with severe headache
50%-79%- with arthralgias and/or myalgias
95%- with fever, with or without chills
45%- with bulimia/anorexia

85-95%- with astheria (weakness)

Some patients have GI symptoms:
65%- with abdominal pain
68%-73%- with nausea and vomiting
85%- experienced diarrhea
In 1976 and 1995 outbreaks, some patients
experienced having hiccups

Diagnosis
Diagnostic studies that may be helpful include the following:
I: Basic blood tests
Complete blood count (CBC) with differential
o Elevated Hemoglobin, Hematocrit, Immature granulocytes, Platelet count
o Decreased Lymphocyte count
o Decreased plasma volume
Bilirubin
o Normal or Slightly elevated
liver enzymes
o Serum Glutamate-Pyruvate Transaminase(SGPT)/alanine aminotransferase(ALT)- Elevated
o Serum Glutamic-Oxaloacetic Transaminase(SGOT)/aspartate aminotransferase(AST)- Elevated
o Gamma-Glutamyl Transpeptidase(GGT)- slightly elevated
blood urea nitrogen (BUN)- elevated
creatinine- elevated
Albumin- decreased
Total Protein- normal level
II: Studies for isolating the virus
Tissue culture (only to be performed in one of a few high-containment laboratories throughout the
world)
reverse-transcription polymerase chain reaction (RT-PCR) assay
III: Serologic testing
Enzyme-linked immunosorbent assay (ELISA) for antigens or for immunoglobulin M (IgM) and
immunoglobulin G (IgG) antibodies
IV: Other studies:
Immunochemical testing of postmortem skin
electron microscopy
Management
Currently, no specific therapy is available that has demonstrated efficacy in the treatment of Ebola
hemorrhagic fever, and there are no commercially available Ebola virus vaccines. (See Treatment.) General
medical support is critical. Care must be administered with strict attention to barrier isolation. Because the
source of Ebola virus is unknown, education and prevention of primary cases is problematic. Education of
communities at risk, especially healthcare workers, can greatly reduce the number of secondary person-toperson transmissions.
General principles of care are as follows:

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WESLEYAN UNIVERSITY-PHILIPPINES
College of Nursing & Allied Medical Sciences
Seminar I

Supportive therapy with attention to intravascular volume, electrolytes, nutrition, and comfort care is
of benefit to the patient
Such therapy must be administered with strict attention to barrier isolation; all body fluids contain infectious
virions and should be handled with great care
At present, no specific anti-Ebolavirus agents are available.
Agents that have been studied for the treatment or prevention of Ebola virus disease include the following:
Ribavirin (possesses no demonstrable anti- Ebolavirus activity in vitro and has failed
protect Ebolavirus -infected primates)
Nucleoside analogue inhibitors of S-adenosylhomocysteine hydrolase (SAH)
Interferon beta
Horse- or goat-derived immune globulins
Human-derived convalescent immune globulin preparations
Recombinant human interferon alfa-2
Recombinant human monoclonal antibody against the envelope glycoprotein (GP) of Ebola virus
DNA vaccines expressing either envelope GP or nucleocapsid protein (NP) genes of Ebola virus
Activated protein C
Recombinant inhibitor of factor VIIa/tissue factor

to

In those patients who do recover, recovery often requires months, and delays may be expected before full
resumption of normal activities. Weight gain and return of strength are slow. Ebola virus continues to be
present for many weeks after resolution of the clinical illness.
Standard Treatment:
Balancing patients fluids and electrolytes
Maintaining oxygen status and Blood Pressure
Treating complications
Timeline of Infection
1. Within few days after symptoms begin
to manifest

2. Later in disease course/ After recovery

3. Retrospectively in deceased patients

Diagnostic Test

Antigen-captured- ELISA
IgM- ELISA
PCR
Virus Isolation
IgM and IgG Antibodies
Immunohistochemisytry
PCR
Virus Isolation

Ebola virus Infection in the Philippines

A fourth Ebolavirus species, Reston ebolavirus, was first isolated in 1989 in monkeys imported from a single
Philippine exporter.

1989: 1st nonhuman primates were infected (Monkeys)

1992-1993: 2nd nonhuman primates were infected (Monkeys)
1996: last recorded infection for Monkeys
2008: pigs were infected by Ebola virus
The only species of monkeys that were infected was Macaca fascicularis/ Cyanomolgus macaques

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