Case history

Case history #1

A 35-year-old man is brought to the Ebola screening centre in Liberia with a 3-day history of diarrhoea, vomiting, and fever. He reports that he attended the funeral of a nurse who died from Ebola virus infection 2 weeks ago. He developed dysphagia and hiccups 24 hours ago, but had been eating normally until then. He has no symptoms of bleeding. On examination, he is found to have mild conjunctival injection, a faint maculopapular rash over his trunk, mild epigastric tenderness, and hepatomegaly. His vital signs on admission are a temperature of 38.3°C, heart rate 100 bpm, blood pressure 115/62 mmHg, respiratory rate 25 breaths per minute, and oxygen saturation 99%.

Case history #2

A 37-year-old doctor who worked in an Ebola treatment centre in Sierra Leone returned to the UK 3 days ago. She presents with a fever of approximately 12 hours duration, headache, and myalgia. She reports sustaining a cut while opening a vial at the Ebola treatment centre 10 days ago. During her stay, she reports taking atovaquone/proguanil for malaria prophylaxis. There are no abnormal findings on examination except for several mosquito bites. Her vital signs are a temperature of 39.0°C, heart rate 110 bpm, blood pressure 120/75 mmHg, respiratory rate 25 breaths per minute, and oxygen saturation 99%.

Other presentations

People who eventually die from Ebola virus infection tend to develop clinical signs early on in the infection, with death (due to shock and multi-organ failure) typically occurring between days 6 and 16 of infection. [6] [13] [14] [15]

Bleeding manifestations (e.g., epistaxis, bleeding gums, haemoptysis, easy bruising, conjunctival bleeding, haematuria, oozing from injection or venipuncture sites) were present in 30% to 36% of infected patients in previous outbreaks; [11] [16] [17] however, they were only reported in 5% to 18% of patients in the 2014 outbreak. [18] [19] Massive bleeding is usually only observed in fatal cases, and typically occurs in the gastrointestinal tract (e.g., bloody diarrhoea, melaena). [16] [20] [21] [22] Internal bleeding may be missed if there are no external signs.

Other signs that indicate severe or advanced infection include hiccups, hypotension, tachycardia, hepatomegaly, splenomegaly, confusion, and seizures.

Up to half of patients develop a maculopapular rash, which may become purpuric or petechial in patients with coagulopathy. [16] [23]

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