病史和体格检查
关键诊断因素
常见
存在的危险因素
主要危险因素包括:先前 21 天生活或工作在流行区,或者前往流行区旅行;接触感染患者体液;职业暴露;或者屠宰感染(或潜在感染)动物或摄入此类动物的肉。
在过去 21 日内暴露于正埃博拉病毒
人际传播通过接触感染患者体液(例如汗液、血液、粪便、呕吐物、唾液、生殖器分泌物 [包括精液]、羊水和母乳)发生。[42]Dowell SF, Mukunu R, Ksiazek TG, et al. Transmission of Ebola hemorrhagic fever: a study of risk factors in family members, Kikwit, Democratic Republic of the Congo, 1995. Commission de Lutte contre les Epidémies à Kikwit. J Infect Dis. 1999 Feb;179 Suppl 1:S87-91. https://jid.oxfordjournals.org/content/179/Supplement_1/S87.long http://www.ncbi.nlm.nih.gov/pubmed/9988169?tool=bestpractice.com [43]Bausch DG, Towner JS, Dowell SF, et al. Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. J Infect Dis. 2007 Nov 15;196 Suppl 2:S142-7. https://jid.oxfordjournals.org/content/196/Supplement_2/S142.long http://www.ncbi.nlm.nih.gov/pubmed/17940942?tool=bestpractice.com 在更严重或晚期感染患者中,此类体液病毒水平特别高。感染后潜伏期为 2-21 天。[3]World Health Organization. Ebola virus disease fact sheet. Apr 2023 [internet publication]. https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease 在儿童中的潜伏期可能更短。[75]WHO Ebola Response Team. Ebola virus disease among children in West Africa. N Engl J Med. 2015 Mar 26;372(13):1274-7. https://www.nejm.org/doi/full/10.1056/NEJMc1415318 http://www.ncbi.nlm.nih.gov/pubmed/25806936?tool=bestpractice.com
如果在未佩戴适当防护设备的情况下暴露于感染患者的体液,则接触者(包括医疗保健工作人员和家庭接触者)存在感染风险。如果感染患者出现活动性腹泻、呕吐或出血,则感染患者的家庭接触者存在更高的感染风险。[42]Dowell SF, Mukunu R, Ksiazek TG, et al. Transmission of Ebola hemorrhagic fever: a study of risk factors in family members, Kikwit, Democratic Republic of the Congo, 1995. Commission de Lutte contre les Epidémies à Kikwit. J Infect Dis. 1999 Feb;179 Suppl 1:S87-91. https://jid.oxfordjournals.org/content/179/Supplement_1/S87.long http://www.ncbi.nlm.nih.gov/pubmed/9988169?tool=bestpractice.com
体液在患者死亡后仍然具有传染性。因此,许多感染病例发生在非洲的传统丧葬仪式上(送葬者会抚摸死者的尸体)。社区中的超级传播事件也日益被视为一个促进因素:2015 年塞拉利昂一位传统治疗师的葬礼就与 300 例感染相关。[46]World Health Organization. Sierra Leone: a traditional healer and a funeral. 2015 [internet publication]. https://www.who.int/news/item/01-09-2015-sierra-leone-a-traditional-healer-and-a-funeral 一项研究显示,在 2014 年暴发中,超级传播者造成约 61% 的感染。[47]Lau MS, Dalziel BD, Funk S, et al. Spatial and temporal dynamics of superspreading events in the 2014-2015 West Africa Ebola epidemic. Proc Natl Acad Sci U S A. 2017 Feb 28;114(9):2337-42. https://www.pnas.org/content/114/9/2337.long http://www.ncbi.nlm.nih.gov/pubmed/28193880?tool=bestpractice.com
曾前往流行区旅行的人被认为是高危易感人群。了解最新的活动性流行区地理分布知识有助于明确患者的流行病学风险。
发热
高达 90% 患者的首发症状,常 >39℃,可呈弛张热型。[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 [104]Dananché C, Bénet T, Vanhems P. Ebola: fever definitions might delay detection in non-epidemic areas. Lancet. 2014 Dec;168(12):1087-8. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61787-6/fulltext http://www.ncbi.nlm.nih.gov/pubmed/25455239?tool=bestpractice.com 一些患者初期可能会出现低热,但无其他症状,或者体温在初次评估时接近正常。[106]Lópaz MA, Amela C, Ordobas M, et al; Working group of Ebola outbreak investigation team of Madrid. First secondary case of Ebola outside Africa: epidemiological characteristics and contact monitoring, Spain, September to November 2014. Euro Surveill. 2015 Jan 8;20(1):21003. https://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21003
不同国家和指南设定的发热阈值不同,使用较低的发热阈值(例如≥37.5°C)可以提高发现病例的敏感性。[104]Dananché C, Bénet T, Vanhems P. Ebola: fever definitions might delay detection in non-epidemic areas. Lancet. 2014 Dec;168(12):1087-8. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61787-6/fulltext http://www.ncbi.nlm.nih.gov/pubmed/25455239?tool=bestpractice.com [107]Lyon GM, Mehta AK, Varkey JB, et al; Emory Serious Communicable Diseases Unit. Clinical care of two patients with Ebola virus disease in the United States. N Engl J Med. 2014 Dec 18;371(25):2402-9. https://www.nejm.org/doi/full/10.1056/NEJMoa1409838#t=article http://www.ncbi.nlm.nih.gov/pubmed/25390460?tool=bestpractice.com 世界卫生组织使用>38°C 的阈值。[108]World Health Organization. Exit screening at airports, ports and land crossings: interim guidance for Ebola virus disease. November 2014 [internet publication]. https://apps.who.int/iris/bitstream/handle/10665/139691/WHO_EVD_Guidance_PoE_14.2_eng.pdf 然而,在塞拉利昂的一项大型队列研究中,尽管约 89% 的患者报告有发热史,但<30% 的患者在就诊时体温≥38℃。[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 另一项塞拉利昂的研究发现,25% 的患儿在就诊时没有发热或体温≥38°C 的病史。[103]Shah T, Greig J, van der Plas LM, et al. Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study. Lancet Glob Health. 2016 Jul;4(7):e495-501. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30097-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27340004?tool=bestpractice.com
在 2014 年的埃博拉疫情暴发期间,据报告 76% 的患者有此症状。[98]Rojek AM, Salam A, Ragotte RJ, et al. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect. 2019 Nov;25(11):1307-14. https://www.doi.org/10.1016/j.cmi.2019.06.032 http://www.ncbi.nlm.nih.gov/pubmed/31284032?tool=bestpractice.com
在适当的流行病学背景下,它的存在足以引起对感染的担忧。
体温变化幅度在病程期间可以很大,尤其在儿童中。[103]Shah T, Greig J, van der Plas LM, et al. Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study. Lancet Glob Health. 2016 Jul;4(7):e495-501. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30097-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27340004?tool=bestpractice.com [105]Lado M, Howlett P. Ebola virus disease in children: towards a better clinical picture and improved management. Lancet Glob Health. 2016 Jul;4(7):e436-7. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30111-5/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27339995?tool=bestpractice.com 患者往往会在致死性感染晚期出现正常体温或体温过低。[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 [100]Mupere E, Kaducu OF, Yoti Z. Ebola haemorrhagic fever among hospitalised children and adolescents in northern Uganda: epidemiologic and clinical observations. Afr Health Sci. 2001 Dec;1(2):60-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2141551 http://www.ncbi.nlm.nih.gov/pubmed/12789118?tool=bestpractice.com
肌痛
感染的常见症状,在以往的埃博拉病毒感染疫情暴发期间,高达 80% 的患者有此症状。[6]Roddy P, Howard N, Van Kerkhove MD, et al. Clinical manifestations and case management of Ebola haemorrhagic fever caused by a newly identified virus strain, Bundibugyo, Uganda, 2007-2008. PLoS One. 2012 Dec 28;7(12):e52986. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052986 http://www.ncbi.nlm.nih.gov/pubmed/23285243?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
在 2014 年埃博拉疫情暴发期间,据报道 48% 患者有此症状。[98]Rojek AM, Salam A, Ragotte RJ, et al. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect. 2019 Nov;25(11):1307-14. https://www.doi.org/10.1016/j.cmi.2019.06.032 http://www.ncbi.nlm.nih.gov/pubmed/31284032?tool=bestpractice.com
可能与关节痛具有相关性,且在整个恢复期持续存在。
结膜充血
在某些埃博拉病毒感染疫情暴发期间,大约 40% 的实验室确诊病例会在感染早期出现此症状。[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 [100]Mupere E, Kaducu OF, Yoti Z. Ebola haemorrhagic fever among hospitalised children and adolescents in northern Uganda: epidemiologic and clinical observations. Afr Health Sci. 2001 Dec;1(2):60-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2141551 http://www.ncbi.nlm.nih.gov/pubmed/12789118?tool=bestpractice.com [126]Moshirfar M, Fenzl CR, Li Z. What we know about ocular manifestations of Ebola. Clin Ophthalmol. 2014 Nov 21;8:2355-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247133 http://www.ncbi.nlm.nih.gov/pubmed/25473261?tool=bestpractice.com
在 2014 年埃博拉疫情暴发期间,据报道 27% 患者有此症状。[98]Rojek AM, Salam A, Ragotte RJ, et al. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect. 2019 Nov;25(11):1307-14. https://www.doi.org/10.1016/j.cmi.2019.06.032 http://www.ncbi.nlm.nih.gov/pubmed/31284032?tool=bestpractice.com
其他诊断因素
常见
疲劳
在以往的埃博拉病毒感染疫情暴发期间,高达 90% 的病例可见重度疲乏和昏睡。[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 [100]Mupere E, Kaducu OF, Yoti Z. Ebola haemorrhagic fever among hospitalised children and adolescents in northern Uganda: epidemiologic and clinical observations. Afr Health Sci. 2001 Dec;1(2):60-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2141551 http://www.ncbi.nlm.nih.gov/pubmed/12789118?tool=bestpractice.com
在 2014 年埃博拉疫情暴发期间,据报道 71% 患者有此症状。[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
厌食
在 2014 年埃博拉疫情暴发期间,据报道 64% 患者有此症状。[98]Rojek AM, Salam A, Ragotte RJ, et al. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect. 2019 Nov;25(11):1307-14. https://www.doi.org/10.1016/j.cmi.2019.06.032 http://www.ncbi.nlm.nih.gov/pubmed/31284032?tool=bestpractice.com
腹泻
感染的常见症状,在以往的一次埃博拉疫情暴发期间,88% 的患者有此症状。[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
在 2014 年埃博拉疫情暴发期间,据报道 51% 患者有此症状。[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 [98]Rojek AM, Salam A, Ragotte RJ, et al. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect. 2019 Nov;25(11):1307-14. https://www.doi.org/10.1016/j.cmi.2019.06.032 http://www.ncbi.nlm.nih.gov/pubmed/31284032?tool=bestpractice.com
可能会出血。
霍乱治疗用病床可用于不发达国家/地区的大量腹泻病例。
呕吐
感染的常见症状,在以往的埃博拉病毒感染疫情暴发期间,65%-70% 的患者有此症状。[6]Roddy P, Howard N, Van Kerkhove MD, et al. Clinical manifestations and case management of Ebola haemorrhagic fever caused by a newly identified virus strain, Bundibugyo, Uganda, 2007-2008. PLoS One. 2012 Dec 28;7(12):e52986. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052986 http://www.ncbi.nlm.nih.gov/pubmed/23285243?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
在 2014 年埃博拉疫情暴发期间,据报道 50% 患者有呕吐症状。[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 [98]Rojek AM, Salam A, Ragotte RJ, et al. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect. 2019 Nov;25(11):1307-14. https://www.doi.org/10.1016/j.cmi.2019.06.032 http://www.ncbi.nlm.nih.gov/pubmed/31284032?tool=bestpractice.com
呕吐物中可能含血。
剧烈头痛
早期感染的非特异性症状,在以往的埃博拉病毒感染疫情暴发期间,10%-70% 的患者有此症状。[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 [100]Mupere E, Kaducu OF, Yoti Z. Ebola haemorrhagic fever among hospitalised children and adolescents in northern Uganda: epidemiologic and clinical observations. Afr Health Sci. 2001 Dec;1(2):60-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2141551 http://www.ncbi.nlm.nih.gov/pubmed/12789118?tool=bestpractice.com
在 2014 年埃博拉疫情暴发期间,据报道 56% 患者有此症状。[98]Rojek AM, Salam A, Ragotte RJ, et al. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect. 2019 Nov;25(11):1307-14. https://www.doi.org/10.1016/j.cmi.2019.06.032 http://www.ncbi.nlm.nih.gov/pubmed/31284032?tool=bestpractice.com
假性脑膜炎较为罕见。
腹痛或烧心
在 2014 年埃博拉疫情暴发期间,据报道 40% 患者有此症状。[98]Rojek AM, Salam A, Ragotte RJ, et al. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect. 2019 Nov;25(11):1307-14. https://www.doi.org/10.1016/j.cmi.2019.06.032 http://www.ncbi.nlm.nih.gov/pubmed/31284032?tool=bestpractice.com
可能难以将烧心与下前胸痛或吞咽困难区别开来。吞咽困难和烧心可能是因为食管炎。
咳嗽、呼吸困难、胸痛
据报告,在 2014 年的埃博拉疫情暴发期间,出现胸痛和咳嗽的患者比例分别为 10% 和 7%;然而,直接累及肺部的报道却很少见。[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 [109]Petrosillo N, Nicastri E, Lanini S, et al. Ebola virus disease complicated with viral interstitial pneumonia: a case report. BMC Infect Dis. 2015 Oct 16;15:432. https://www.biomedcentral.com/1471-2334/15/432 http://www.ncbi.nlm.nih.gov/pubmed/26471197?tool=bestpractice.com
在 2014 年埃博拉疫情暴发期间,据报道 18% 患者有呼吸困难症状。[98]Rojek AM, Salam A, Ragotte RJ, et al. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect. 2019 Nov;25(11):1307-14. https://www.doi.org/10.1016/j.cmi.2019.06.032 http://www.ncbi.nlm.nih.gov/pubmed/31284032?tool=bestpractice.com
与成人相比,呼吸道症状在儿童患者中往往更常见;不过,相关数据有限。[100]Mupere E, Kaducu OF, Yoti Z. Ebola haemorrhagic fever among hospitalised children and adolescents in northern Uganda: epidemiologic and clinical observations. Afr Health Sci. 2001 Dec;1(2):60-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2141551 http://www.ncbi.nlm.nih.gov/pubmed/12789118?tool=bestpractice.com [101]Peacock G, Uyeki TM, Rasmussen SA. Ebola virus disease and children: what pediatric health care professionals need to know. JAMA Pediatr. 2014 Dec;168(12):1087-8. https://jamanetwork.com/journals/jamapediatrics/fullarticle/1918461 http://www.ncbi.nlm.nih.gov/pubmed/25325785?tool=bestpractice.com 在 2014 年的疫情暴发中,有 14% 的患儿出现呼吸困难。[103]Shah T, Greig J, van der Plas LM, et al. Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study. Lancet Glob Health. 2016 Jul;4(7):e495-501. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30097-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27340004?tool=bestpractice.com
咽痛
咽炎是一种非特异性病症,在以往的埃博拉病毒感染疫情暴发期间,10%-58% 的患者有此症状。[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 [100]Mupere E, Kaducu OF, Yoti Z. Ebola haemorrhagic fever among hospitalised children and adolescents in northern Uganda: epidemiologic and clinical observations. Afr Health Sci. 2001 Dec;1(2):60-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2141551 http://www.ncbi.nlm.nih.gov/pubmed/12789118?tool=bestpractice.com
在 2014 年埃博拉疫情暴发期间,据报道 29% 患者有此症状。[98]Rojek AM, Salam A, Ragotte RJ, et al. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect. 2019 Nov;25(11):1307-14. https://www.doi.org/10.1016/j.cmi.2019.06.032 http://www.ncbi.nlm.nih.gov/pubmed/31284032?tool=bestpractice.com
可能会引起吞咽困难,在 2014 年埃博拉疫情暴发期间,据报道 22% 患者有此症状。[98]Rojek AM, Salam A, Ragotte RJ, et al. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect. 2019 Nov;25(11):1307-14. https://www.doi.org/10.1016/j.cmi.2019.06.032 http://www.ncbi.nlm.nih.gov/pubmed/31284032?tool=bestpractice.com
虚脱
据报告,在 2014 年的埃博拉疫情暴发期间,重度虚脱是 73% 的患者的典型表现。[127]Lado M, Walker N, Baker P, et al. Clinical features of patients isolated for suspected Ebola virus disease at Connaught Hospital, Freetown, Sierra Leone: a retrospective cohort study. Lancet Infect Dis. 2015 Sep;15(9):1024-33. http://www.ncbi.nlm.nih.gov/pubmed/26213248?tool=bestpractice.com
呼吸急促
在以往的埃博拉病毒感染疫情暴发期间,31% 的致死性感染患者有此症状,但是所有存活者皆未见此症状。[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
在 2014 年的埃博拉疫情暴发期间,据报告 5% 的患者有此症状。[127]Lado M, Walker N, Baker P, et al. Clinical features of patients isolated for suspected Ebola virus disease at Connaught Hospital, Freetown, Sierra Leone: a retrospective cohort study. Lancet Infect Dis. 2015 Sep;15(9):1024-33. http://www.ncbi.nlm.nih.gov/pubmed/26213248?tool=bestpractice.com
可能表明存在代谢性酸中毒(由尿毒症和低灌注引起)。
不常见
斑丘疹
在以往的埃博拉病毒感染疫情暴发期间,25%-52% 的患者会在病程早期出现此症状。[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
在 2014 年埃博拉疫情暴发期间,据报道 3% 患者有此症状。[98]Rojek AM, Salam A, Ragotte RJ, et al. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect. 2019 Nov;25(11):1307-14. https://www.doi.org/10.1016/j.cmi.2019.06.032 http://www.ncbi.nlm.nih.gov/pubmed/31284032?tool=bestpractice.com
频繁被描述为非瘙痒性的红色斑丘疹。它在初期可能是局灶性的,随后逐渐进展为弥散性、全身性和融合性。一些人将它描述为麻疹样皮疹。在凝血功能障碍患者中,感染较晚期可能变为紫癜样或瘀斑样皮疹。[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
在深色皮肤的患者中可能难以识别。
出血
此症状的存在提示晚期感染和存在弥散性血管内凝血。
在既往暴发期间,30%-36% 的感染者有出血表现(如鼻衄、牙龈出血、咯血、易发瘀斑、结膜出血、血尿、注射或静脉穿刺部位渗血); 但在 2014 年暴发中,仅 11% 的患者报告有出血表现。[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 [98]Rojek AM, Salam A, Ragotte RJ, et al. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect. 2019 Nov;25(11):1307-14. https://www.doi.org/10.1016/j.cmi.2019.06.032 http://www.ncbi.nlm.nih.gov/pubmed/31284032?tool=bestpractice.com
大量出血通常仅在致命病例中可见,通常发生在胃肠道(例如血性腹泻、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 在以往的埃博拉病毒感染疫情暴发期间,8% 的致死性感染患者和 16% 的存活者有此症状。[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
如果无外部体征,内出血可能会被漏诊。
出血表现在儿童中不常见。[102]Fitzgerald F, Naveed A, Wing K, et al. Ebola virus disease in children, Sierra Leone, 2014-2015. Emerg Infect Dis. 2016 Oct;22(10):1769-77. https://wwwnc.cdc.gov/eid/article/22/10/16-0579_article http://www.ncbi.nlm.nih.gov/pubmed/27649367?tool=bestpractice.com
肝肿大
在以往的埃博拉病毒感染疫情暴发期间,2% 的致死性感染患者和 8% 的存活者有肝肿大压痛伴胸腔下肝脏边缘可触及。[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
淋巴结肿大
关于淋巴结增大病例已有报道。[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
呃逆
晚期感染和预后不良征象,通常见于致死性感染的最后 2-3 天。[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
可能由尿毒症、低钾血症、低钠血症、低钙血症或低碳酸血症(由代谢性酸中毒的呼吸代偿引起)引起。
在以往的埃博拉病毒感染疫情暴发期间,17% 的致死性感染患者和 5% 的存活者有呃逆症状。[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
在 2014 年埃博拉疫情爆发期间,据报道 13% 患者有此症状。[98]Rojek AM, Salam A, Ragotte RJ, et al. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect. 2019 Nov;25(11):1307-14. https://www.doi.org/10.1016/j.cmi.2019.06.032 http://www.ncbi.nlm.nih.gov/pubmed/31284032?tool=bestpractice.com
在儿童中较少见。[102]Fitzgerald F, Naveed A, Wing K, et al. Ebola virus disease in children, Sierra Leone, 2014-2015. Emerg Infect Dis. 2016 Oct;22(10):1769-77. https://wwwnc.cdc.gov/eid/article/22/10/16-0579_article http://www.ncbi.nlm.nih.gov/pubmed/27649367?tool=bestpractice.com [103]Shah T, Greig J, van der Plas LM, et al. Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study. Lancet Glob Health. 2016 Jul;4(7):e495-501. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30097-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27340004?tool=bestpractice.com
心动过速
在致死性感染的较晚期可能出现。[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
低血压
终末前期疾病和休克的特征。由于流行区缺乏测量设备,在现场检查时未被充分记录。[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
然而,伴血管渗漏和微循环衰竭的脓毒性休克似乎不是主要临床特点。
神经系统体征
据报道,在 2014 年埃博拉疫情暴发期间,9% 患者出现意识模糊。[98]Rojek AM, Salam A, Ragotte RJ, et al. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect. 2019 Nov;25(11):1307-14. https://www.doi.org/10.1016/j.cmi.2019.06.032 http://www.ncbi.nlm.nih.gov/pubmed/31284032?tool=bestpractice.com 与以前暴发的疫情相比,该症状似乎变得更常见,是死亡的预测指标之一。[103]Shah T, Greig J, van der Plas LM, et al. Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study. Lancet Glob Health. 2016 Jul;4(7):e495-501. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30097-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27340004?tool=bestpractice.com [105]Lado M, Howlett P. Ebola virus disease in children: towards a better clinical picture and improved management. Lancet Glob Health. 2016 Jul;4(7):e436-7. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30111-5/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27339995?tool=bestpractice.com [127]Lado M, Walker N, Baker P, et al. Clinical features of patients isolated for suspected Ebola virus disease at Connaught Hospital, Freetown, Sierra Leone: a retrospective cohort study. Lancet Infect Dis. 2015 Sep;15(9):1024-33. http://www.ncbi.nlm.nih.gov/pubmed/26213248?tool=bestpractice.com 儿童的意识模糊可以是多病因导致的,且多预后不良。[103]Shah T, Greig J, van der Plas LM, et al. Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study. Lancet Glob Health. 2016 Jul;4(7):e495-501. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30097-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27340004?tool=bestpractice.com [105]Lado M, Howlett P. Ebola virus disease in children: towards a better clinical picture and improved management. Lancet Glob Health. 2016 Jul;4(7):e436-7. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30111-5/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27339995?tool=bestpractice.com
经常与出血和低血压共存,使液体复苏变得有风险。
脑病可能与感染末期的电解质紊乱、尿毒症和脑部低灌注有关。
在以往的某次埃博拉病毒感染疫情暴发期间,2% 的致死性感染患者会出现癫痫发作。[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
危险因素
强
先前 21 天在流行区生活或工作或者从流行区归来
在流行区生活或工作(例如西非、刚果民主共和国)者是感染的高危人群。然而,近期从流行区归来也是一个显著的危险因素。发达国家的大多数疑似感染患者是归国的旅行者,以及在埃博拉病毒感染疫情暴发期间照顾患者的医护人员。
了解最新的活动性流行区地理分布知识有助于明确患者的流行病学风险。
接触感染者的体液
人际间传播通过接触感染者的体液(例如汗液、血液、粪便、呕吐物、唾液、生殖器分泌物 [包括精液] 羊水和母乳)或感染体液污染物品而发生。[42]Dowell SF, Mukunu R, Ksiazek TG, et al. Transmission of Ebola hemorrhagic fever: a study of risk factors in family members, Kikwit, Democratic Republic of the Congo, 1995. Commission de Lutte contre les Epidémies à Kikwit. J Infect Dis. 1999 Feb;179 Suppl 1:S87-91. https://jid.oxfordjournals.org/content/179/Supplement_1/S87.long http://www.ncbi.nlm.nih.gov/pubmed/9988169?tool=bestpractice.com [43]Bausch DG, Towner JS, Dowell SF, et al. Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. J Infect Dis. 2007 Nov 15;196 Suppl 2:S142-7. https://jid.oxfordjournals.org/content/196/Supplement_2/S142.long http://www.ncbi.nlm.nih.gov/pubmed/17940942?tool=bestpractice.com 在更严重或晚期感染患者中,这些体液中的病毒水平特别高。感染后潜伏期为 2-21 日。[3]World Health Organization. Ebola virus disease fact sheet. Apr 2023 [internet publication]. https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease 在儿童中的潜伏期可能更短。[75]WHO Ebola Response Team. Ebola virus disease among children in West Africa. N Engl J Med. 2015 Mar 26;372(13):1274-7. https://www.nejm.org/doi/full/10.1056/NEJMc1415318 http://www.ncbi.nlm.nih.gov/pubmed/25806936?tool=bestpractice.com
如果在未佩戴适当防护设备的情况下暴露于感染患者的体液,则接触者(包括医疗保健工作人员和家庭接触者)存在感染风险。如果感染患者出现活动性腹泻、呕吐或出血,则感染患者的家庭接触者存在更高的感染风险。[42]Dowell SF, Mukunu R, Ksiazek TG, et al. Transmission of Ebola hemorrhagic fever: a study of risk factors in family members, Kikwit, Democratic Republic of the Congo, 1995. Commission de Lutte contre les Epidémies à Kikwit. J Infect Dis. 1999 Feb;179 Suppl 1:S87-91. https://jid.oxfordjournals.org/content/179/Supplement_1/S87.long http://www.ncbi.nlm.nih.gov/pubmed/9988169?tool=bestpractice.com
体液在患者死亡后仍然具有传染性。因此,许多感染病例发生在非洲的传统丧葬仪式上(送葬者会抚摸死者的尸体)。[76]Nielsen CF, Kidd S, Sillah AR, et al. Improving burial practices and cemetery management during an Ebola virus disease epidemic - Sierra Leone, 2014. MMWR Morb Mortal Wkly Rep. 2015 Jan 16;64(1):20-7. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6401a6.htm http://www.ncbi.nlm.nih.gov/pubmed/25590682?tool=bestpractice.com 社区中的超级传播事件也日益被视为一种促进因素:2015 年塞拉利昂一位传统治疗师的葬礼就与 300 例感染相关。[46]World Health Organization. Sierra Leone: a traditional healer and a funeral. 2015 [internet publication]. https://www.who.int/news/item/01-09-2015-sierra-leone-a-traditional-healer-and-a-funeral 一项研究显示,在 2014 年暴发中,超级传播者造成约 61% 的感染。[47]Lau MS, Dalziel BD, Funk S, et al. Spatial and temporal dynamics of superspreading events in the 2014-2015 West Africa Ebola epidemic. Proc Natl Acad Sci U S A. 2017 Feb 28;114(9):2337-42. https://www.pnas.org/content/114/9/2337.long http://www.ncbi.nlm.nih.gov/pubmed/28193880?tool=bestpractice.com
关于活动性感染期间发生性传播已有报道。在感染痊愈 12 个月后,仍可在精液中检测到该病毒,这可能是由于睾丸组织是一个免疫保护部位。[50]World Health Organization. Clinical care for survivors of Ebola virus disease: interim guidance. Apr 2016 [internet publication]. https://apps.who.int/iris/handle/10665/204235 这意味着感染消退后仍可能长时间存在性传播风险,并且在 2014 年疫情暴发期间有此类病例确诊。[43]Bausch DG, Towner JS, Dowell SF, et al. Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. J Infect Dis. 2007 Nov 15;196 Suppl 2:S142-7. https://jid.oxfordjournals.org/content/196/Supplement_2/S142.long http://www.ncbi.nlm.nih.gov/pubmed/17940942?tool=bestpractice.com [48]Emond RT, Evans B, Bowen ET, et al. A case of Ebola virus infection. Br Med J. 11977 Aug 27;2(6086):541-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1631428/pdf/brmedj00478-0011.pdf http://www.ncbi.nlm.nih.gov/pubmed/890413?tool=bestpractice.com [49]Rowe AK, Bertolli J, Khan AS, et al. Clinical, virologic, and immunologic follow-up of convalescent Ebola hemorrhagic fever patients and their household contacts, Kikwit, Democratic Republic of the Congo. Commission de Lutte contre les Epidémies à Kikwit. J Infect Dis. 1999 Feb;179 Suppl 1:S28-35. http://www.ncbi.nlm.nih.gov/pubmed/9988162?tool=bestpractice.com [51]Rogstad KE, Tunbridge A. Ebola virus as sexually transmitted infection. Curr Opin Infect Dis. 2015 Feb;28(1):83-5. http://www.ncbi.nlm.nih.gov/pubmed/25501666?tool=bestpractice.com [52]Sonnenberg P, Field P. Sexual and mother-to-child transmission of Ebola virus in the post-convalescent period. Clin Infect Dis. 2015 Mar 15;60(6):974-5. http://www.ncbi.nlm.nih.gov/pubmed/25501984?tool=bestpractice.com [53]Mate SE, Kugelman JR, Nyenswah TG, et al. Molecular evidence of sexual transmission of Ebola virus. N Engl J Med. 2015 Dec 17;373(25):2448-54. https://www.nejm.org/doi/full/10.1056/NEJMoa1509773#t=article http://www.ncbi.nlm.nih.gov/pubmed/26465384?tool=bestpractice.com [54]Crozier I. Ebola virus RNA in the semen of male survivors of Ebola virus disease: the uncertain gravitas of a privileged persistence. J Infect Dis. 2016 Nov 15;214(10):1467-9. https://jid.oxfordjournals.org/content/early/2016/05/03/infdis.jiw079.long http://www.ncbi.nlm.nih.gov/pubmed/27142203?tool=bestpractice.com [55]Thorson A, Formenty P, Lofthouse C, et al. Systematic review of the literature on viral persistence and sexual transmission from recovered Ebola survivors: evidence and recommendations. BMJ Open. 2016 Jan 7;6(1):e008859. https://bmjopen.bmj.com/content/6/1/e008859 http://www.ncbi.nlm.nih.gov/pubmed/26743699?tool=bestpractice.com
职业暴露
接触感染患者的医疗保健工作人员存在高感染风险,大多数流行病暴发疫情会导致大量医疗保健专业人士受到感染。
来自感染供者的针刺伤是一种超高风险暴露因素,风险程度取决于接种物和损伤的性质。1976 年第一次埃博拉病毒流行期的院内感染传播可归因于非灭菌注射针的使用。[24]Report of an International Commission. Ebola haemorrhagic fever in Zaire, 1976. Bull World Health Organ. 1978;56(2):271-93. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2395567/pdf/bullwho00439-0113.pdf http://www.ncbi.nlm.nih.gov/pubmed/307456?tool=bestpractice.com 英国、俄罗斯和德国的研究实验室曾发生过意外针刺伤暴露。此类病例的潜伏期可能要比人际间传播短得多。[7]Feldmann H, Geisbert TW. Ebola haemorrhagic fever. Lancet. 2011 Mar 5;377(9768):849-62. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406178 http://www.ncbi.nlm.nih.gov/pubmed/21084112?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 [48]Emond RT, Evans B, Bowen ET, et al. A case of Ebola virus infection. Br Med J. 11977 Aug 27;2(6086):541-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1631428/pdf/brmedj00478-0011.pdf http://www.ncbi.nlm.nih.gov/pubmed/890413?tool=bestpractice.com
其他高危职业包括与来自流行区的灵长类动物或蝙蝠,或者与高风险临床样本打交道的人。
屠宰感染(或潜在感染)动物或摄入此类动物的肉
在散发流行时该传播途径可能是动物与人之间传播的一种原因。[77]Georges-Courbot MC, Sanchez A, Lu CY, et al. Isolation and phylogenetic characterization of Ebola viruses causing different outbreaks in Gabon. Emerg Infect Dis. Jan-Mar 1997;3(1):59-62. https://wwwnc.cdc.gov/eid/article/3/1/97-0107_article http://www.ncbi.nlm.nih.gov/pubmed/9126445?tool=bestpractice.com
弱
生物恐怖主义
由于正埃博拉病毒的致死率高且容易实现人传人,很久以来都被当作一种潜在的生物恐怖袭击武器。然而,尽管存在这种可能性,目前尚无证据表明这些病毒已被用作武器。[78]Strauss S. Ebola research fueled by bioterrorism threat. CMAJ. 2014 Nov 4;186(16):1206. https://www.cmaj.ca/content/186/16/1206 http://www.ncbi.nlm.nih.gov/pubmed/25288318?tool=bestpractice.com
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