其他表现
最终死于埃博拉病毒感染的患者往往会在感染早期出现临床体征,并且通常会在感染后的 6-16 天内死亡(由于休克和多器官衰竭)。[4]Leroy EM, Gonzalez JP, Baize S. Ebola and Marburg haemorrhagic fever viruses: major scientific advances, but a relatively minor public health threat for Africa. Clin Microbiol Infect. 2011 Jul;17(7):964-76.
https://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03535.x/full
http://www.ncbi.nlm.nih.gov/pubmed/21722250?tool=bestpractice.com
[13]McElroy AK, Erickson BR, Flietstra TD, et al. Ebola hemorrhagic fever: novel biomarker correlates of clinical outcome. J Infect Dis. 2014 Aug 15;210(4):558-66.
https://jid.oxfordjournals.org/content/210/4/558.long
http://www.ncbi.nlm.nih.gov/pubmed/24526742?tool=bestpractice.com
[14]Mahanty S, Bray M. Pathogenesis of filoviral haemorrhagic fevers. Lancet Infect Dis. 2004 Aug;4(8):487-98.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01103-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/15288821?tool=bestpractice.com
[15]Yan T, Mu J, Qin E, et al. Clinical characteristics of 154 patients suspected of having Ebola disease in the Ebola holding centre of Jui government hospital in Sierra Leone during the 2014 Ebola outbreak. Eur J Microbiol Infect Dis. 2015 Oct;34(10):2089-95.
http://www.ncbi.nlm.nih.gov/pubmed/26223324?tool=bestpractice.com
在以往的埃博拉病毒感染疫情暴发期间,30%-36% 的感染患者有出血表现(例如鼻衄、牙龈出血、咯血、易有瘀斑、结膜出血、血尿以及注射或静脉穿刺部位渗血);[8]Barrette RW, Metwally SA, Rowland JM, et al. Discovery of swine as a host for the Reston ebolavirus. Science. 2009 Jul 10;325(5937):204-6.
https://science.sciencemag.org/content/325/5937/204.full
http://www.ncbi.nlm.nih.gov/pubmed/19590002?tool=bestpractice.com
[16]Kortepeter MG, Bausch DG, Bray M. Basic clinical and laboratory features of filoviral hemorrhagic fever. J Infect Dis. 2011 Nov;204 Suppl 3:S810-6.
https://jid.oxfordjournals.org/content/204/suppl_3/S810.long
http://www.ncbi.nlm.nih.gov/pubmed/21987756?tool=bestpractice.com
[17]Bwaka MA, Bonnet MJ, Calain P, et al. Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo: clinical observations in 103 patients. J Infect Dis. 1999 Feb;179 Suppl 1:S1-7.
https://jid.oxfordjournals.org/content/179/Supplement_1/S1.long
http://www.ncbi.nlm.nih.gov/pubmed/9988155?tool=bestpractice.com
然而据报告,在 2014 年埃博拉疫情暴发期间,仅有 5%-18% 的患者有出血表现。[18]WHO Ebola Response Team. Ebola virus disease in West Africa: the first 9 months of the epidemic and forward projections. N Engl J Med. 2014 Oct 16;371(16):1481-95.
https://www.nejm.org/doi/full/10.1056/NEJMoa1411100#t=article
http://www.ncbi.nlm.nih.gov/pubmed/25244186?tool=bestpractice.com
[19]Dallatomasinas S, Crestani R, Squire JS, et al. Ebola outbreak in rural West Africa: epidemiology, clinical features and outcomes. Trop Med Int Health. 2015 Apr;20(4):448-54.
http://www.ncbi.nlm.nih.gov/pubmed/25565430?tool=bestpractice.com
大量出血通常仅在致命病例中可见,且通常发生在胃肠道(例如血性腹泻和黑便)。[16]Kortepeter MG, Bausch DG, Bray M. Basic clinical and laboratory features of filoviral hemorrhagic fever. J Infect Dis. 2011 Nov;204 Suppl 3:S810-6.
https://jid.oxfordjournals.org/content/204/suppl_3/S810.long
http://www.ncbi.nlm.nih.gov/pubmed/21987756?tool=bestpractice.com
[20]Bah EI, Lamah MC, Fletcher T, et al. Clinical presentation of patients with Ebola virus disease in Conakry, Guinea. N Engl J Med. 2015 Jan 1;372(1):40-7.
https://www.nejm.org/doi/full/10.1056/NEJMoa1411249#t=article
http://www.ncbi.nlm.nih.gov/pubmed/25372658?tool=bestpractice.com
[21]Chertow DS, Kleine C, Edwards JK, et al. Ebola virus disease in West Africa - clinical manifestations and management. N Engl J Med. 2014 Nov 27;371(22):2054-7.
https://www.nejm.org/doi/full/10.1056/NEJMp1413084
http://www.ncbi.nlm.nih.gov/pubmed/25372854?tool=bestpractice.com
[22]Schieffelin JS, Shaffer JG, Goba A, et al; KGH Lassa Fever Program; Viral Hemorrhagic Fever Consortium; WHO Clinical Response Team. Clinical illness and outcomes in patients with Ebola in Sierra Leone. N Engl J Med. 2014 Nov 27;371(22):2092-100.
https://www.nejm.org/doi/full/10.1056/NEJMoa1411680#t=article
http://www.ncbi.nlm.nih.gov/pubmed/25353969?tool=bestpractice.com
如果无外部体征,内出血可能会被漏诊。
提示重度感染或晚期感染的其他体征包括呃逆、低血压、心动过速、肝肿大、脾肿大、意识模糊和癫痫发作。
多达一半的患者会出现斑丘疹,在有凝血障碍的患者中,它有可能进展为紫癜样斑丘疹或瘀斑样斑丘疹。[16]Kortepeter MG, Bausch DG, Bray M. Basic clinical and laboratory features of filoviral hemorrhagic fever. J Infect Dis. 2011 Nov;204 Suppl 3:S810-6.
https://jid.oxfordjournals.org/content/204/suppl_3/S810.long
http://www.ncbi.nlm.nih.gov/pubmed/21987756?tool=bestpractice.com
[23]Nkoghe D, Leroy EM, Toung-Mve M, et al. Cutaneous manifestations of filovirus infections. Int J Dermatol. 2012 Sep;51(9):1037-43.
http://www.ncbi.nlm.nih.gov/pubmed/22909355?tool=bestpractice.com