Ebola physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Guillermo Rodriguez Nava, M.D. [2]; João André Alves Silva, M.D. [3]

Ebola hemorrhagic fever is commonly associated with fever on physical examination at admission. At advanced stages of the disease, physical examination findings are more pertinent and often include unstable vital signs, such as tachycardia or relative bradycardia, orthostatic hypotension, and tachypnea. Physical examination may also be remarkable for abdominal tenderness and distension, evidence of mucosal or visceral bleeding, and neurological impairment.^[1][2][3]

The general appearance of the patient depends on the stage of the disease. Typically, patients demonstrate prostration, may be nauseated and vomiting, and less commonly present with signs of hemorrhage, such as epistaxis or gingival bleeding. In later stages of the disease, patients are often brought with convulsions or are in a state of shock, stupor, or coma.^[4]

• High-grade fever is often present in more than 80% of patients. Fever is the most common presenting sign of Ebola virus infection.

• Tachycardia
• Relative bradycardia

• Hypotension (SBP<90 mmHg and/or DBP<60 mmHg)
• Postural hypotension is common in dehydrated patients with inadequate volume repletion

• Signs of respiratory difficulty may be present, such as:

• Intercostal retractions
• Paradoxical breathing
• Nasal flare

• Tachypnea often precedes death during final hours of infection.

Hemorrhagic manifestations tend to occur during the more severe stages of the disease and may include:^[1]

• Maculopapular rash on the trunk, usually between the 5th and 7th day of the condition, associated with different stages of erythema and desquamation, which is a valuable finding in differentiating Ebola from other diseases.
• Petechiae is a common finding
• Ecchymoses is a common finding
• Mucosal hemorrhages is a common finding
• Uncontrolled bleeding from venipuncture locals is a common finding

• Conjunctival hemorrhage is a the most common sign of abnormal clotting
• Conjunctivitis

• Epistaxis may be present.
• Nasal discharge may be present.^[1]

• Mucosal hyperemia of the oral cavity is a common finding.
• Bleeding gums is a common finding.

• Abdominal tenderness may suggest pancreatitis, intestinal swelling, or mesenteric lymphadenopathy
• Abdominal distention may suggest paralytic ileus
• Tender hepatomegaly
• Splenomegaly

• Edema may be present.

• Obtundation may be present.^[5][6][7]
• Stupor
• Coma