Causes and risk factors
The Ebola virus is transmitted to people through wild animals such as fruit bats, monkeys and spreads in human population by human to human transmission. The infection spreads by direct contact with body fluids such as blood, faeces, or vomit of the infected person. Contact with dead decayed human bodies, or dead animals can spread the infection. Healthcare workers, persons working at mortuaries are at high risk.
Clinical presentation
The incubation period is from 2 to 21 days. Humans are not infectious till they develop symptoms. Patient presents with sore throat, sudden onset fever, fatigue, headache. There is weakness and muscle pain. It is followed by abdominal pain diarrhoea, nausea, vomiting. This leads to dehydration and hypotension. Skin rash is developed. Bleeding such as petechiae, ecchymosis, bleeding from gums, blood in stools is observed. There is an impaired kidney and liver function. Additional sign and symptoms include hiccups, chest pain, and shortness of breath. There is confusion, dizziness, seizures, cerebral oedema. Pregnant women may experience spontaneous miscarriage.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Routine haemogram reveals low WBC and platelet count. LFT is recommended. ELSIA, antigen capture detection test, serum neutralisation test, RT PCR, virus isolation by cell culture confirm the diagnosis.
Treatment
No specific treatment is available for Ebola patients. Isolation of the patient is required. Oral rehydration, intravenous fluid infusion will help in managing the condition. Symptomatic relief is obtained by analgesics, anti pyretics, NSAIDs medicines. Immune therapies, drug therapies are being advocated. Care should be taken to prevent further infection. Direct contact with dead decayed bodies, wild animals should be avoided. Prompt and safe burial of the dead is necessary with good hygiene and clean environment. Healthcare workers, lab workers should follow proper hygienic measures such as hand hygiene-washing hands with soap; using hand sanitizers containing alcohol, respiratory hygiene, use of personal protective equipments [gloves, masks etc]
Other Modes of treatment
The other modes of treatment can also be effective in treating EVD. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating EVD.
Recent updates
The current Ebola outbreak in March 2014 in West Africa was largest and most complex one since first outbreak discovered in 1976. The highest numbers of EVD cases have been found in countries Guinea, Liberia, and Sierra Leone of West Africa. The case incidence continues to fall in Guinea, Liberia, and Sierra Leone as reported till 21 Jan 2015. 1 case has been reported from United Kingdom. Previously affected countries with number of cases include Nigeria [20], Senegal [1], Spain [1], US [4], and Mali [8]. The national EVD outbreak is considered to be over when 42 days [double the 21 days incubation period of Ebola virus] has elapsed since the last patient in isolation was lab negative for EVD.
Facts and figures
The average fatality rate of EVD is 50%. The recent figures as updated on 27 Jan 2015 show fall in fatality rate in west Africa[ total number of cases are 22057 and total deaths are 8795] .
