埃博拉病毒感染

常见于重疾。可能最初是由脱水引起，但也可能是由弥散性血管内凝血或埃博拉病毒在感染较晚期直接损伤肾脏引起。[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 [68]Fletcher T, Fowler RA, Beeching NJ. Understanding organ dysfunction in Ebola virus disease. Intensive Care Med. 2014 Dec;40(12):1936-9. http://www.ncbi.nlm.nih.gov/pubmed/25366120?tool=bestpractice.com [92]Hunt L, Gupta-Wright A, Simms V, et al. Clinical presentation, biochemical, and haematological parameters and their association with outcome in patients with Ebola virus disease: an observational cohort study. Lancet Infect Dis. 2015 Nov;15(11):1292-9. http://www.ncbi.nlm.nih.gov/pubmed/26271406?tool=bestpractice.com 通过监测尿量和血液生化指标进行早期识别，能够促使采取行动。

急性肾损伤

目前仍不太明确埃博拉病毒感染的病因学。多个因素皆有可能诱发休克，包括细菌性脓毒症（可能通过肠道菌群移位）、埃博拉病毒的直接作用、弥散性血管内凝血和出血。[68]Fletcher T, Fowler RA, Beeching NJ. Understanding organ dysfunction in Ebola virus disease. Intensive Care Med. 2014 Dec;40(12):1936-9. http://www.ncbi.nlm.nih.gov/pubmed/25366120?tool=bestpractice.com 患者的治疗遵循与细菌性脓毒症相同的原则。[147]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11): e1063-e1143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com

成人脓毒症

导致患者易患出血并发症。大出血不常发生，但却是通常致命的晚期感染的一种临床表现。若条件允许，应根据当地政策给予新鲜全血或血小板和血浆，并由临床指标和实验室（若有条件的话）指标（如血红蛋白、红细胞比容、国际标准化比值）指导后续治疗。[146]World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. February 2016 [internet publication]. https://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1 [148]Wada H, Thachil J, Di Nisio M, et al. Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines. J Thromb Haemost. 2013 Feb 4;11(4):761-7. https://onlinelibrary.wiley.com/doi/10.1111/jth.12155/full http://www.ncbi.nlm.nih.gov/pubmed/23379279?tool=bestpractice.com

弥散性血管内凝血

孕妇的流产率高，而且埃博拉病毒感染对这些孕妇而言通常是致命的。[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 [159]Mupapa K, Mukundu W, Bwaka MA, et al. Ebola hemorrhagic fever and pregnancy. J Infect Dis. 1999 Feb;179 Suppl 1:S11-2. https://jid.oxfordjournals.org/content/179/Supplement_1/S11.long http://www.ncbi.nlm.nih.gov/pubmed/9988157?tool=bestpractice.com [161]Jamieson DJ, Uyeki TM, Callaghan WM, et al. What obstetrician-gynecologists should know about Ebola: a perspective from the Centers for Disease Control and Prevention. Obstet Gynecol. 2014 Nov;124(5):1005-10. http://www.ncbi.nlm.nih.gov/pubmed/25203368?tool=bestpractice.com [162]Association of Women's Health, Obstetric and Neonatal Nurses. Ebola: caring for pregnant and postpartum women and newborns in the United States: AWHONN practice brief number 3. J Obstet Gynecol Neonat Nurs. 2015 Jan-Feb;44(1):164-5 https://onlinelibrary.wiley.com/doi/10.1111/1552-6909.12518/full http://www.ncbi.nlm.nih.gov/pubmed/25421426?tool=bestpractice.com

流产

存活者和病故患者的遗孤在许多社区内会受到侮辱和排斥。可能与心理问题有关，包括抑郁、焦虑、创伤后应激障碍、强迫症、物质成瘾和自杀倾向。约 20% 的存活者被诊断为抑郁。[194]Locsin RC, Barnard A, Matua AG, et al. Surviving Ebola: understanding experience through artistic expression. Int Nurs Rev. 2003 Sep;50(3):156-66. http://www.ncbi.nlm.nih.gov/pubmed/12930284?tool=bestpractice.com [195]De Roo A, Ado B, Rose B, et al. Survey among survivors of the 1995 Ebola epidemic in Kikwit, Democratic Republic of Congo: their feelings and experiences. Trop Med Int Health. 1998 Nov;3(11):883-5. https://onlinelibrary.wiley.com/doi/10.1046/j.1365-3156.1998.00322.x/full http://www.ncbi.nlm.nih.gov/pubmed/9855400?tool=bestpractice.com [196]Cénat JM, Felix N, Blais-Rochette C, et al. Prevalence of mental health problems in populations affected by the Ebola virus disease: a systematic review and meta-analysis. Psychiatry Res. 2020 Apr 29;289:113033. https://www.doi.org/10.1016/j.psychres.2020.113033 http://www.ncbi.nlm.nih.gov/pubmed/32388176?tool=bestpractice.com [197]James PB, Wardle J, Steel A, et al. Post-Ebola psychosocial experiences and coping mechanisms among Ebola survivors: a systematic review. Trop Med Int Health. 2019 Jun;24(6):671-91. https://www.doi.org/10.1111/tmi.13226 http://www.ncbi.nlm.nih.gov/pubmed/30843627?tool=bestpractice.com

存活患者通常会出现迁延性恢复，特征为乏力、体重下降和移行性关节痛。皮肤脱屑和暂时性脱发也经常发生。

恢复期的晚期表现不常见，但可能包括睾丸炎、脊髓炎、腮腺炎、胰腺炎、肝炎、精神疾病和听力损失/耳鸣。[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 幸存者也有患葡萄膜炎（前、后或全葡萄膜炎）的风险，这可能导致继发结构性并发症、视力障碍或失明。[185]Shantha JG, Yeh S, Nguyen QD. Ebola virus disease and the eye. Curr Opin Ophthalmol. 2016 Nov;27(6):538-44. http://www.ncbi.nlm.nih.gov/pubmed/27585217?tool=bestpractice.com 一项无对照的回顾性横断面研究发现，约 28% 的幸存者发生埃博拉病毒相关的葡萄膜炎，3% 的患者发生埃博拉病毒相关的视神经病。在葡萄膜炎患者中，38.5% 的患者出现失明。[186]Shantha JG, Crozier I, Hayek BR, et al. Ophthalmic manifestations and causes of vision impairment in Ebola virus disease survivors in Monrovia, Liberia. Ophthalmology. 2017 Feb;124(2):170-7. http://www.ncbi.nlm.nih.gov/pubmed/27914832?tool=bestpractice.com 一名幸存者在感染发病后 14 周、病毒从血液中清除后 9 周时发生急性葡萄膜炎，并被检测到活的埃博拉病毒。[187]Varkey JB, Shanth JG, Crozier I, et al. Persistence of Ebola virus in ocular fluid during convalescence. N Engl J Med. 2015 Jun 18;372(25):2423-7. http://www.ncbi.nlm.nih.gov/pubmed/25950269?tool=bestpractice.com 还报告了单眼白内障和解剖上沿视神经轴突分布的新型视网膜病变。[189]Steptoe PJ, Scott JT, Baxter JM, et al. Novel retinal lesion in Ebola survivors, Sierra Leone, 2016. Emerg Infect Dis. 2017 Jul;23(7):1102-9. https://wwwnc.cdc.gov/eid/article/23/7/16-1608_article http://www.ncbi.nlm.nih.gov/pubmed/28628441?tool=bestpractice.com

一名外籍医务人员在 2015 年原发性重度埃博拉病毒病恢复 9 个月后，出现埃博拉病毒性脑膜脑炎（CSF 和血浆 RT-PCR 检测呈埃博拉病毒阳性）。对其作了全基因组测序，以比较最初就诊时在其血液中发现的病毒与 10 个月时在 CSF 中发现的病毒，结果并未发现编码区有改变。这项研究的作者总结道，并不能确定病毒究竟是一直在潜伏而后恢复活性，还是在不断复制中，但通过基因测序能够确定的是，还未出现免疫逃逸的病毒变种。[191]Jacobs M, Rodger A, Bell DJ, et al. Late Ebola virus relapse causing meningoencephalitis: a case report. Lancet. 2016 Jul 30;388(10043):498-503. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967715 http://www.ncbi.nlm.nih.gov/pubmed/27209148?tool=bestpractice.com 还报道了一例晚发性脑炎和多发性关节炎。[192]Howlett P, Brown C, Helderman T, et al. Ebola virus disease complicated by late-onset encephalitis and polyarthritis, Sierra Leone. Emerg Infect Dis. 2016 Jan;22(1):150-2. https://wwwnc.cdc.gov/eid/article/22/1/15-1212_article http://www.ncbi.nlm.nih.gov/pubmed/26690042?tool=bestpractice.com

这些表现的病因尚不明确，但可能与免疫复合物现象或埃博拉病毒在免疫豁免部位的持续存在有关。