Ebola history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Michael Maddaleni, B.S.; Guillermo Rodriguez Nava, M.D. [2]; Yazan Daaboul, M.D.

Patients who present with fever and have a recent travel to endemic countries, particularly to West Africa including Sierra Leone,Liberia, Guinea, and Nigeria, should be suspected to have Ebola virus infection. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Incubation period ranges from 2 to 21 days prior to development of symptoms. The majority of symptomatic patients have fatal outcomes. Patients often initially develop flu-like or malaria-like symptoms before multisystem organ failure and bleeding diasthesis take place.

Ebola hemorrhagic fever should be suspected in patients with acute febrile illness, hemorrhagic symptoms, and a history of travel to an endemic area. As such, patients who present with fever and have a recent travel to endemic countries, particularly to West Africa including Sierra Leone, Liberia, Guinea, and Nigeria, should be suspected to have Ebola virus infection. The history of a patient with suspected Ebola virus infection requires a clear assessment of exposure. Exposure to Ebola virus include direct contact, exposure to blood or body fluids of infected patients, processing of blood or body fluids of a patient with suspected or confirmed Ebola virus infection, and contact with a dead body without appropriate personal protective equipment in an endemic country. Other important clues during history-taking include: duration and character of fever and other constitutional symptoms, presence of systemic manifestations, appearance of any hemorrhagic symptoms, and presence of sick contacts and their symptoms.

Incubation period ranges from 2 to 21 days. The majority of symptomatic patients have fatal outcomes. Patients often initially develop flu-like or malaria-like symptoms before multisystem organ failure and bleeding diasthesis take place.

• Fever and chills are the most common presenting features of Ebola virus infection
• Headache
• Weight loss
• Anorexia
• Asthenia

• Characteristic maculopapular, non-pruritic rash with erythema. Skin rash typically appears within 5-7 days of disease onset and has a centripetal distribution.
• Desquamation

• Arthralgia
• Myalgia

• Sore throat
• Cough
• Nasal discharge

• Abdominal pain
• Nausea
• Vomiting
• Diarrhea, which may be bloody even in the early phase of the disease

• Eye pain
• Conjunctivitis

• Epistaxis
• Mucosal bleeding

• Dyspnea

• Chest pain

• Abdominal pain that may be related to pancreatitis, intestinal wall swelling, or mesenteric lymphadenopathy
• Abdominal distention

• Hiccups, which classically herald worse outcomes and death
• Confusion
• Tinnitus
• Hearing loss
• Dysphagia
• Convulsions

• Jaundice
• Petechiae
• Ecchymoses
• Epistaxis
• Mucosal bleeding
• Hematemesis
• Melena
• Hematuria
• Vaginal bleeding
• Uncontrolled bleeding from venipuncture sites
• Hemorrhagic shock

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