并发症
常见于严重疾病伴或不伴明显休克,由通过呕吐和腹泻导致的脱水和持续液体丢失以及经口摄入差和可能的出血引起。[13]Mehedi M, Groseth A, Feldmann H, et al. Clinical aspects of Marburg hemorrhagic fever. Future Virol. 2011 Sep;6(9):1091-1106. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201746 http://www.ncbi.nlm.nih.gov/pubmed/22046196?tool=bestpractice.com
几乎所有并发埃博拉或马尔堡病毒病的妊娠都以自然流产或死产告终。[4]Bebell LM, Riley LE. Ebola virus disease and Marburg disease in pregnancy: a review and management considerations for filovirus infection. Obstet Gynecol. 2015 Jun;125(6):1293-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4443859 http://www.ncbi.nlm.nih.gov/pubmed/26000499?tool=bestpractice.com [13]Mehedi M, Groseth A, Feldmann H, et al. Clinical aspects of Marburg hemorrhagic fever. Future Virol. 2011 Sep;6(9):1091-1106. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201746 http://www.ncbi.nlm.nih.gov/pubmed/22046196?tool=bestpractice.com
在塞拉利昂的一项研究中,接近一半的埃博拉病毒性疾病幸存者在随访时报告难以集中精力。[69]Qureshi AI, Chughtai M, Loua TO, et al. Study of Ebola virus disease survivors in Guinea. Clin Infect Dis. 2015 Oct 1;61(7):1035-42. http://cid.oxfordjournals.org/content/61/7/1035.long http://www.ncbi.nlm.nih.gov/pubmed/26060289?tool=bestpractice.com 马尔堡病毒病幸存者的情况也可能与此类似。
已在重症疾病患者中被报告。最初可能由脱水引起,但可能是疾病较晚期马尔堡病毒对肾脏的直接损伤或者弥散性血管内凝血的后果。[27]van Paassen J, Bauer MP, Arbous MS, et al. Acute liver failure, multiorgan failure, cerebral oedema, and activation of proangiogenic and antiangiogenic factors in a case of Marburg haemorrhagic fever. Lancet Infect Dis. 2012 Aug;12(8):635-42. http://www.sciencedirect.com/science/article/pii/S147330991270018X http://www.ncbi.nlm.nih.gov/pubmed/22394985?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。
近 75% 的埃博拉病毒性疾病幸存者在随访期间报告了持续性肌肉骨骼疼痛。[64]Scott JT, Sesay FR, Massaquoi TA, et al. Post-Ebola syndrome, Sierra Leone. Emerg Infect Dis. 2016 Apr;22(4):641-6. http://wwwnc.cdc.gov/eid/article/22/4/15-1302_article http://www.ncbi.nlm.nih.gov/pubmed/26983037?tool=bestpractice.com [65]Mattia JG, Vandy MJ, Chang JC, et al. Early clinical sequelae of Ebola virus disease in Sierra Leone: a cross-sectional study. Lancet Infect Dis. 2016 Mar;16(3):331-8. http://www.sciencedirect.com/science/article/pii/S1473309915004892 http://www.ncbi.nlm.nih.gov/pubmed/26725449?tool=bestpractice.com 这也见于马尔堡病毒病幸存者中。[13]Mehedi M, Groseth A, Feldmann H, et al. Clinical aspects of Marburg hemorrhagic fever. Future Virol. 2011 Sep;6(9):1091-1106. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201746 http://www.ncbi.nlm.nih.gov/pubmed/22046196?tool=bestpractice.com
近一半的埃博拉病毒性疾病幸存者在随访期间报告了持续性头痛。[64]Scott JT, Sesay FR, Massaquoi TA, et al. Post-Ebola syndrome, Sierra Leone. Emerg Infect Dis. 2016 Apr;22(4):641-6. http://wwwnc.cdc.gov/eid/article/22/4/15-1302_article http://www.ncbi.nlm.nih.gov/pubmed/26983037?tool=bestpractice.com 这也见于马尔堡病毒病幸存者中。[13]Mehedi M, Groseth A, Feldmann H, et al. Clinical aspects of Marburg hemorrhagic fever. Future Virol. 2011 Sep;6(9):1091-1106. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201746 http://www.ncbi.nlm.nih.gov/pubmed/22046196?tool=bestpractice.com
14%-60% 的埃博拉病毒性疾病幸存者在随访期间报告了眼部症状(包括眼痛、清亮分泌物、红眼和视物模糊)或被发现患有葡萄膜炎。[64]Scott JT, Sesay FR, Massaquoi TA, et al. Post-Ebola syndrome, Sierra Leone. Emerg Infect Dis. 2016 Apr;22(4):641-6. http://wwwnc.cdc.gov/eid/article/22/4/15-1302_article http://www.ncbi.nlm.nih.gov/pubmed/26983037?tool=bestpractice.com [65]Mattia JG, Vandy MJ, Chang JC, et al. Early clinical sequelae of Ebola virus disease in Sierra Leone: a cross-sectional study. Lancet Infect Dis. 2016 Mar;16(3):331-8. http://www.sciencedirect.com/science/article/pii/S1473309915004892 http://www.ncbi.nlm.nih.gov/pubmed/26725449?tool=bestpractice.com 这也见于马尔堡病毒病幸存者中。[13]Mehedi M, Groseth A, Feldmann H, et al. Clinical aspects of Marburg hemorrhagic fever. Future Virol. 2011 Sep;6(9):1091-1106. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201746 http://www.ncbi.nlm.nih.gov/pubmed/22046196?tool=bestpractice.com 中枢神经系统和眼球被认为是纤丝病毒的庇护所,疾病可在这些部位持续存在。[18]Heeney JL. Ebola: hidden reservoirs. Nature. 2015 Nov 26;527(7579):453-5. http://www.ncbi.nlm.nih.gov/pubmed/26607539?tool=bestpractice.com
急性疾病和埃博拉病毒幸存者可能发生头痛、意识模糊、癫痫发作、记忆丧失、头痛、颅神经异常和震颤,且已证实存在神经系统症状。[66]Billioux BJ, Smith B, Nath A. Neurological complications of Ebola virus infection. Neurotherapeutics. 2016 Jul;13(3):461-70. http://rd.springer.com/article/10.1007%2F13311-016-0457-z http://www.ncbi.nlm.nih.gov/pubmed/27412684?tool=bestpractice.com 中枢神经系统和眼球被认为是纤丝病毒的庇护所,疾病可在这些部位持续存在。[18]Heeney JL. Ebola: hidden reservoirs. Nature. 2015 Nov 26;527(7579):453-5. http://www.ncbi.nlm.nih.gov/pubmed/26607539?tool=bestpractice.com
75% 的埃博拉病毒性疾病幸存者在随访期间报告了昏睡或疲乏。[67]Epstein L, Wong KK, Kallen AJ, et al. Post-Ebola signs and symptoms in U.S. survivors. N Engl J Med. 2015 Dec 17;373(25):2484-6. http://www.nejm.org/doi/full/10.1056/NEJMc1506576 http://www.ncbi.nlm.nih.gov/pubmed/26672870?tool=bestpractice.com 马尔堡病毒病幸存者的情况也可能与此类似。
在 2014 年至 2016 年西非埃博拉病毒性疾病暴发中,心理困扰在幸存者中较为常见。[68]Rabelo I, Lee V, Fallah MP, et al. Psychological distress among Ebola survivors discharged from an Ebola treatment unit in Monrovia, Liberia - a qualitative study. Front Public Health. 2016;4:142. http://journal.frontiersin.org/article/10.3389/fpubh.2016.00142/full http://www.ncbi.nlm.nih.gov/pubmed/27458576?tool=bestpractice.com 在治疗机构暴露于死亡以及在社区内的病耻感诱发了创伤后应激反应和抑郁症状。[68]Rabelo I, Lee V, Fallah MP, et al. Psychological distress among Ebola survivors discharged from an Ebola treatment unit in Monrovia, Liberia - a qualitative study. Front Public Health. 2016;4:142. http://journal.frontiersin.org/article/10.3389/fpubh.2016.00142/full http://www.ncbi.nlm.nih.gov/pubmed/27458576?tool=bestpractice.com 这些症状在马尔堡病毒病幸存者中也常见,预计在暴发情况下尤其普遍。[13]Mehedi M, Groseth A, Feldmann H, et al. Clinical aspects of Marburg hemorrhagic fever. Future Virol. 2011 Sep;6(9):1091-1106. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201746 http://www.ncbi.nlm.nih.gov/pubmed/22046196?tool=bestpractice.com
在塞拉利昂的一项研究中,几乎所有埃博拉病毒性疾病幸存者在随访时报告有厌食症。[69]Qureshi AI, Chughtai M, Loua TO, et al. Study of Ebola virus disease survivors in Guinea. Clin Infect Dis. 2015 Oct 1;61(7):1035-42. http://cid.oxfordjournals.org/content/61/7/1035.long http://www.ncbi.nlm.nih.gov/pubmed/26060289?tool=bestpractice.com 马尔堡病毒病幸存者的情况也可能与此类似。
见于伴转氨酶升高的严重疾病。在幸存者随访期间,已有关于急性肝衰竭和肝炎的报道。[13]Mehedi M, Groseth A, Feldmann H, et al. Clinical aspects of Marburg hemorrhagic fever. Future Virol. 2011 Sep;6(9):1091-1106. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201746 http://www.ncbi.nlm.nih.gov/pubmed/22046196?tool=bestpractice.com [27]van Paassen J, Bauer MP, Arbous MS, et al. Acute liver failure, multiorgan failure, cerebral oedema, and activation of proangiogenic and antiangiogenic factors in a case of Marburg haemorrhagic fever. Lancet Infect Dis. 2012 Aug;12(8):635-42. http://www.sciencedirect.com/science/article/pii/S147330991270018X http://www.ncbi.nlm.nih.gov/pubmed/22394985?tool=bestpractice.com 这可能是由病毒的肝组织嗜性或低血压性肝损伤所致。
大约每 4 名埃博拉病毒性疾病幸存者中有 1 名在随访期间报告了听觉症状,包括耳鸣、耳闷胀感或听力丧失。[64]Scott JT, Sesay FR, Massaquoi TA, et al. Post-Ebola syndrome, Sierra Leone. Emerg Infect Dis. 2016 Apr;22(4):641-6. http://wwwnc.cdc.gov/eid/article/22/4/15-1302_article http://www.ncbi.nlm.nih.gov/pubmed/26983037?tool=bestpractice.com [65]Mattia JG, Vandy MJ, Chang JC, et al. Early clinical sequelae of Ebola virus disease in Sierra Leone: a cross-sectional study. Lancet Infect Dis. 2016 Mar;16(3):331-8. http://www.sciencedirect.com/science/article/pii/S1473309915004892 http://www.ncbi.nlm.nih.gov/pubmed/26725449?tool=bestpractice.com 马尔堡病毒病幸存者的情况也可能与此类似。
在马尔堡疾病幸存者中曾报告无力。[13]Mehedi M, Groseth A, Feldmann H, et al. Clinical aspects of Marburg hemorrhagic fever. Future Virol. 2011 Sep;6(9):1091-1106. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201746 http://www.ncbi.nlm.nih.gov/pubmed/22046196?tool=bestpractice.com
在随访期间,美国有一小部分埃博拉病毒性疾病幸存者报告了失眠。[67]Epstein L, Wong KK, Kallen AJ, et al. Post-Ebola signs and symptoms in U.S. survivors. N Engl J Med. 2015 Dec 17;373(25):2484-6. http://www.nejm.org/doi/full/10.1056/NEJMc1506576 http://www.ncbi.nlm.nih.gov/pubmed/26672870?tool=bestpractice.com 马尔堡病毒病幸存者的情况也可能与此类似。
在美国,38% 的埃博拉病毒性疾病幸存者在随访时,报告存在感觉异常或感觉迟钝。[67]Epstein L, Wong KK, Kallen AJ, et al. Post-Ebola signs and symptoms in U.S. survivors. N Engl J Med. 2015 Dec 17;373(25):2484-6. http://www.nejm.org/doi/full/10.1056/NEJMc1506576 http://www.ncbi.nlm.nih.gov/pubmed/26672870?tool=bestpractice.com 马尔堡病毒病幸存者的情况也可能与此类似。
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