Ebola Facts | What Do You Know?

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Ebola Facts | What Do You Know?

Ebola Review | Learning About Ebola, Randall Wong, M.D.I knew nothing about Ebola.  After researching for this article, I am now less ignorant.

Ebola is foreign to both the American public and American docs, because until recently, it was never diagnosed in the United States.  While it has no direct eye involvement, I still wanted to learn more about this often fatal disease and to lessen my ignorance when asked basic questions about Ebola from friends, family and patients.

I hope this will make your own Ebola discussions more meaningful.

Ebola Hemorrhagic Fever

The sickness is caused by a virus originally discovered along the Ebola River.  There are 5 types of Ebola virus, only four of which cause infection in humans.  A 5th type has been found in the Philippines (Reston), but does not infect humans.

The four different strains can cause a severe and often fatal type of hemorrhagic fever in humans though the natural hosts are likely to be fruit bats.  The disease enters the human population by contact with the blood, secretions, organs and other bodily fluids of dead or sickened animals found in the wild; chimpanzees, gorillas, fruit bats, monkeys, etc.

Once the virus has entered the human population, the virus can spread from human to human.

Recent outbreaks have occurred in Sierra Leone, Guinea and Liberia.

Problem:  Viruses, like the common cold, cant’ be cured with antibiotics.  There is no known antiviral drug which works against Ebola.

How is the Virus Spread?

The virus can only be spread by direct contact with infected blood, secretions or bodily fluids from infected patients.  In burial ceremonies in Africa, the virus is spread as mourners come into direct contact with the body/clothing of the infected deceased.

Viral infections are more easily spread via broken skin or mucous membranes (microscopic or larger cuts inside of your mouth, vagina).  Even coming into contact with surfaces/saturated clothing can increase spread.

The virus is NOT spread through the air.  Touching is the big problem.

Problem:  Limiting the spread depends upon hygiene, containment and education.

Ebola Incubation

The time between actual infection and the onset of symptoms is called the incubation period.  The incubation period for Ebola is from 2 to 21 days, that is,  you can contract the disease, but not have any symptoms for 2 to 21 days after the virus has entered your body.

Patients are not contagious (can’t spread the disease) if they are not showing symptoms.

Problem:  Because of the varied incubation period, screening (by testing for fever) becomes even more difficult.  You can be infected, be within the incubation period, and show no symptoms…such as fever.

Symptoms of Ebola Hemorrhagic Fever

Early Symptoms of Ebola

  • Fever
  • Headache
  • Muscle/Joint Aches
  • Chills
  • Fever

Advanced Symptoms

  • Nausea/vomiting
  • Diarrhea
  • Red Eyes
  • Rash
  • Chest Pain/cough
  • Stomach Pain
  • Bleeding:  External/Internal

Problem:  The symptoms of Ebola are not specific, that is, the initial symptoms are very similar to a having a cold or flu (okay, also malaria and typhoid).  It makes screening so difficult because so many of the symptoms are nonspecific for Ebola and can be signs of so many other diseases.

How Does Ebola Kill?

  • Coma
  • Disseminated Intravascular Coagulation (DIC – eats up clotting proteins)
  • Multiple Organ Failure (no blood supply)
  • Severe Bleeding (can’t clot)
  • Jaundice (liver)
  • Delirium/Seizures (poor circulation)
  • Shock (low blood pressure)

Most patients die from complications of shock, or low blood pressure.  “Shock” causes low blood flow/low blood pressure where insufficient blood reaches vital organs.  This is a common way for many vital organs to shut down, e.g. kidneys.

Complications with clotting can occur secondary to the infection itself and/or liver malfunction.  More specifically, the Ebola virus can cause clots to form inside the body (DIC).  The clots can shut off blood supply to vital organs (causing multiple organ failure).  By causing widespread clotting, the clotting proteins in the blood get depleted allowing internal and external hemorrhaging.

The liver can be directly affected by the virus.  The liver is responsible for making the clotting proteins.

Blood pressure can drop from bleeding, but more commonly by direct infection of the adrenal glands.  The adrenal glands are responsible for helping regulate blood pressure.

Problem: The disease is a systemic disease affecting multiple vital organs, the immune system and circulatory system.  There are many ways patients can succumb.

Treatment of Ebola

There is no treatment for Ebola.  Unlike other diseases caused by viruses (flu, Chicken Pox, Herpes), there is also no vaccine to prevent infection.

Several medications are in the developmental stage, but none is FDA approved.

“Supportive care” is the best treatment that can be offered in the absence of a specific treatment.  Supportive care technically means that care is given to maintain quality of life in the face of terminal or serious illness.

In other words, supportive care means that medical care is given to specifically treat symptoms, for instance, if a patient is bleeding, “supportive” care is aimed at fixing the bleeding, if a patient has fever, care is given to bring down the fever.

Problem:  Supportive care does not focus on treating the disease.  Supportive care “supports” the patient during the worst phases of a disease or illness.

Testing for Ebola

There are specific blood tests available to detect Ebola, but the testing make takes several days to complete and the testing can not be done until several days after symptoms have started.

Problem:  There is no screening test.  Basically testing can only confirm suspected cases of infection.

What Does This Mean?

I am not an authority of this disease.  I do feel some responsibility as a doctor to have some personal knowledge of Ebola.

Share these facts with others, the only thing worse than a deadly disease is widespread hysteria and ignorance.

Some References;
http://www.cdc.gov/vhf/ebola/
http://www.nlm.nih.gov/medlineplus/ency/article/001339.htm
http://www.who.int/mediacentre/factsheets/fs103/en/

 

 

Comments
  • Judith Nicotra October 10, 2014 at 12:31 pm

    Thanks for taking the time to bring us this useful information during a period of great uncertainty.

    • Randall V. Wong, M.D. October 12, 2014 at 10:00 am

      Judith,

      You are welcome – I needed to learn a few things myself and thought I’d share without being too presumptive.

      r

  • susan October 10, 2014 at 2:03 pm

    Thanks Doctor Wong–this is very informative.

    • Randall V. Wong, M.D. October 12, 2014 at 10:00 am

      susan,

      You are welcome. Thanks for taking the time to read…and share.

      Randy

  • JVR October 10, 2014 at 3:52 pm

    Thanks Dr. Wong for this helpful explenation.

    • Randall V. Wong, M.D. October 12, 2014 at 10:01 am

      JVR,

      Thanks for reading. Hope you were able to learn something, I certainly did!

      Randy

  • Kara Siegfried October 10, 2014 at 10:10 pm

    Excellent article, very informative thank you!

  • Paul Bjarnason October 11, 2014 at 9:46 am

    Hi Dr. Wong –

    Thank you for putting together the thorough treatment of Ebola.

    Although I am merely a retired government accountant, I would like to question one fact about Ebola widely stated in discussions about Ebola, which is also repeated in your piece on Ebola: “Patients are not contagious (can’t spread the disease) if they are not showing symptoms.”

    I wonder if this assertion may be incorrect: if person A has just taken in the virus through his nostrils, and the virus is sitting on his mucous membranes inside his nasal passages and, then, sneezes or blows his nose, couldn’t the very same virus person A just took in be then further passed on to person B, even though the person A has not yet developed any symptoms?

    You probably read that the Spanish authorities just destroyed “Excalibur”, a dog that had tested positive for the virus. This puzzles me as, reportedly, dogs can be carriers, but dogs can’t actually get sick from the virus. So, why were the authorities worried about transmission to humans by a dog, if transmission can only occur when symptoms appear?!

    I always worry when the government tells me with complete confidence that there is no reason to worry, i.e., they have everything under control. I would have more confidence in them, if they would admit the obvious, i.e., that they don’t know everything.

    Best.

    Paul Bj

    • Randall V. Wong, M.D. October 12, 2014 at 10:23 am

      Paul,

      All comments must queue for my approval – avoids spam, etc.

      My response to your two comments;

      1. There are many factors which define how “contagious” a virus can be; mechanisms of spread (airborne vs. contact), viral load (how many viral particles are shared), likelihood of how a single virus (virion) can infect the individual. I agree with your description of a single virus being transmitted, but compared to an infected patient where thousands of virus particles may be shared….the infection is less likely.

      2. Excalibur, the dog, may not get sick, but might be able to replicate or “carry” the virus without getting sick. Not all mammals react the same way to infections. I think in this case, think of the dog as a carrier which may/may not allow the virus to replicate and thereby spread without sickening the host.

      Good points. These are just my opinions.

      r

  • Farid December 23, 2014 at 1:19 am

    I’m writing comment here due the comments are closed under your “Scleral Buckle vs. Vitrectomy” post, sorry. Now after 5 weeks I feel very very little improve in my left eye vision. But I’m not sure it is due mental or real improve.

    • Randall V. Wong, M.D. January 3, 2015 at 7:02 pm

      Farid,

      I’m getting so much spam that I’ve decided to limit the number of articles where you can leave comments. I apologize for the inconvenience. I’ve been hacked continuously for the last 5 months.

      What exactly happened to your eye?

      r

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