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Ebola hemorrhagic fever
Last reviewed: 04.07.2025
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Ebola hemorrhagic fever is an acute viral, especially dangerous infectious disease characterized by a severe course, pronounced hemorrhagic syndrome and a high mortality rate. Synonym - Ebola fever.
ICD-10 code
A98.4. Ebola virus disease.
Epidemiology of Ebola hemorrhagic fever
The reservoir of the Ebola hemorrhagic fever virus is rodents living near human habitation. Cases of infection have been described during autopsy of wild chimpanzees and when eating monkey brains. A sick person poses a great danger to others. Mechanisms of transmission of the pathogen: aspiration, contact, artificial. Routes of transmission: airborne, contact, injection. The virus is found in blood, saliva, nasopharyngeal mucus, urine, and sperm. People become infected when caring for patients; in everyday life through hands and household items contaminated with the patient's blood and urine; through medical instruments and, possibly, sexually. The risk of intrafamilial infection is 3-17%, with a nosocomial form - more than 50%. Transmission of the virus from person to person in 5 generations has been described, with the mortality rate reaching 100% in the first generations.
Human susceptibility to the Ebola virus is high: it does not depend on age or gender. Post-infection immunity is relatively stable. Repeated cases of the disease are rare (no more than 5% of convalescents have been identified). In endemic areas, 7-10% of the population have antibodies to the Ebola virus, which indicates the possibility of developing subclinical or latent forms of the disease.
The area of distribution of the virus is Central and West Africa (Sudan, Zaire, Nigeria, Liberia, Gabon, Senegal, Cameroon, Ethiopia, Central African Republic). Outbreaks of Ebola hemorrhagic fever occur mainly in spring and summer.
What causes Ebola hemorrhagic fever?
Ebola hemorrhagic fever is caused by Ebolavirus of the genus Marburgvirus of the family Filoviridae - one of the largest viruses. The virion has a different shape - threadlike, branching. arachnid, its length reaches 12,000 nm. The genome is represented by single-stranded negative RNA surrounded by a lipoprotein membrane. The virus contains 7 proteins. Ebola and Marburg viruses are similar in their morphology, but differ in antigenic structure. According to the antigenic properties of glycoproteins (Gp), four serotypes of the Ebola virus are distinguished, three of which cause diseases of varying severity in humans in Africa (Ebola-Zaire - EBO-Z, Ebola-Sudan - EBO-S and Ebola-Ivory Coast - EBO-CI). Manifest cases of Ebola-Reston virus (EBO-R), highly pathogenic for monkeys, have not been identified in humans.
The virus is highly variable. It is passaged in guinea pig and Vero cell cultures with a weakly expressed cytopathic effect.
Ebolavirus has an average level of resistance to damaging environmental factors (pH, humidity, insolation, etc.).
Pathogenesis of Ebola hemorrhagic fever
The entry points for the pathogen are the mucous membranes and skin. The Ebola hemorrhagic fever virus penetrates the lymph nodes and spleen, where it replicates with the development of intense viremia in the acute period of the disease with multiorgan dissemination. As a result of the direct impact of the virus and autoimmune reactions, there is a decrease in platelet production, damage to the endothelium of blood vessels and internal organs with foci of necrosis and hemorrhage. The greatest changes occur in the liver, spleen, lymphoid formations, kidneys, endocrine glands, and brain.
Symptoms of Ebola hemorrhagic fever
The incubation period of Ebola hemorrhagic fever lasts 2-16 days (on average 7 days).
The onset of Ebola hemorrhagic fever is sudden with a rapid rise in body temperature to 39-40 °C, intense headache, weakness. The symptoms of Ebola hemorrhagic fever are as follows: severe dryness and irritation in the throat (a feeling of a "rope" in the throat), chest pain, dry cough. On the 2nd-3rd day, abdominal pain, vomiting, diarrhea with blood (melena) appear, leading to dehydration. From the first days of the disease, facial amymia and sunken eyes are characteristic. On the 3rd-4th day, severe symptoms of Ebola hemorrhagic fever appear: intestinal, gastric, uterine bleeding, bleeding of the mucous membranes, hemorrhages at injection sites and skin lesions, hemorrhages in the conjunctiva. Hemorrhagic syndrome progresses rapidly. On the 5th-7th day, some patients (50%) develop a measles-like rash, followed by peeling of the skin. Lethargy, drowsiness, confusion, and in some cases psychomotor agitation are observed. Death occurs on the 8th-9th day from massive blood loss and shock. With a favorable outcome, the febrile period lasts 10-12 days; recovery is slow over 2-3 months. During the convalescence period, pronounced asthenia, anorexia, cachexia, hair loss, trophic disorders, and mental disorders are observed.
Complications of Ebola hemorrhagic fever
Ebola hemorrhagic fever is complicated by infectious toxic shock, hemorrhagic and hypovolemic shock.
Diagnosis of Ebola hemorrhagic fever
Diagnosis of Ebola hemorrhagic fever is difficult, since there are no specific symptoms of the disease. Ebola fever should be suspected in cases of acute development of a febrile disease with multiple organ damage, diarrhea, neurological and severe hemorrhagic manifestations in a patient who has been in an endemic area or has had contact with such patients.
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Specific and non-specific laboratory diagnostics of Ebola hemorrhagic fever
Specific laboratory diagnostics of Ebola hemorrhagic fever is carried out by virological and serological methods. The virus is isolated from the blood of patients, nasopharyngeal mucus and urine by infecting cell cultures; with electron microscopic examination of skin biopsies or internal organs. PCR, ELISA, RNIF, RN, RSK, etc. are used. All studies are carried out in special laboratories with IV level of biological safety.
Non-specific laboratory diagnostics of Ebola hemorrhagic fever includes a complete blood count (characteristic: anemia; leukopenia, alternating with leukocytosis with a neutrophilic shift; the presence of atypical lymphocytes; thrombocytopenia; decreased ESR): a biochemical blood test (revealing increased activity of transferases, amylase, azotemia); determination of a coagulogram (hypocoagulation is characteristic) and acid-base balance of the blood (revealing signs of metabolic acidosis); a complete urine test (pronounced proteinuria).
Instrumental diagnostics of Ebola hemorrhagic fever
Chest X-ray, ECG, ultrasound.
Differential diagnosis of Ebola hemorrhagic fever
Differential diagnostics of Ebola fever is extremely difficult, since in epidemic foci similar clinical manifestations are detected in patients with Marburg, Lassa, yellow fever, as well as in patients with septicemia, malaria, typhus and other diseases. In this regard, the diagnostic value is given to data from virological, electron microscopic and serological studies; negative results of conventional bacteriological and parasitological studies, as well as the lack of effect from the use of antibiotics, antimalarial and other chemotherapeutic drugs.
The clinical picture of yellow fever is also characterized by an acute onset, severe intoxication with the development of thrombohemorrhagic syndrome. In the differential diagnosis of Ebola fever, the following data are taken into account: stay in an endemic area no more than 6 days before the development of the disease; the presence of two-wave fever, insomnia; swelling of the eyelids, puffiness of the face ("amarilla mask"); in the blood - neutropenia, lymphopenia.
Ebola fever is differentiated from a number of infectious diseases with hemorrhagic syndrome. In the first 1-3 days of the disease, before the development of hemorrhagic manifestations, the clinical picture of the fever is similar to a severe form of influenza with an acute onset, headache, high fever, injection of scleral vessels and leukopenia in the blood. However, with Ebola fever, symptoms of CNS damage are more pronounced, diarrhea and vomiting often occur, catarrhal phenomena rarely develop or are absent altogether.
Acute onset of the disease, severe intoxication, hemorrhagic syndrome are characteristic of both Ebola fever and leptospirosis. However, cough, chest and abdominal pain, vomiting, diarrhea, leukopenia are not characteristic of it.
There are no difficulties in differential diagnosis of Ebola fever with the “non-infectious” hemorrhagic disease hemophilia, characterized by severe bleeding, manifested by external and internal bleeding with minor injuries, hemorrhages into the joints, and the absence of thrombocytopenia.
Indications for consultation with other specialists
Consultations with a hematologist, neurologist, gastroenterologist and other doctors are indicated when conducting differential diagnostics with diseases that have a similar clinical picture or aggravate the course of hemorrhagic fever.
Indications for hospitalization
Ebola fever is a reason for emergency hospitalization and strict isolation in a separate box.
How to examine?
What tests are needed?
Treatment of Ebola hemorrhagic fever
Etiotropic treatment for Ebola hemorrhagic fever has not been developed.
Pathogenetic treatment of Ebola hemorrhagic fever
In the epidemic focus, the use of convalescent plasma is recommended. The main treatment for Ebola hemorrhagic fever is the use of pathogenetic and symptomatic drugs. The fight against intoxication, dehydration, bleeding, and shock is carried out using generally accepted methods.
Regime and diet
The patient requires strict bed rest and round-the-clock medical supervision.
The diet corresponds to table No. 4 according to Pevzner.
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Approximate periods of incapacity for work
Taking into account the severity of the disease, convalescents are considered incapacitated for 3 months after discharge from the hospital.
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Clinical examination
Ebola hemorrhagic fever does not require follow-up observation of those who have recovered.
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Patient information sheet
A complete diet with easily digestible products, without any special restrictions, is recommended; adherence to a physical regimen.
How is Ebola hemorrhagic fever prevented?
Specific prophylaxis of Ebola hemorrhagic fever
Specific prophylaxis for Ebola hemorrhagic fever has not been developed.
Non-specific prophylaxis of Ebola hemorrhagic fever
Non-specific prevention of Ebola hemorrhagic fever consists of isolating patients in special departments or isolation wards, preferably in special plastic or glass-metal isolation cabins with autonomous life support. Special transport isolators are used for transporting patients. Medical personnel must work in personal protective equipment (respirators or gauze masks, gloves, glasses, protective suit). Strict sterilization of syringes, needles, and instruments in medical institutions is necessary.
Ebola hemorrhagic fever is prevented using specific immunoglobulin obtained from the serum of immunized horses (the method was developed at the Virology Center of the Research Institute of Microbiology).
In the outbreak areas, all patients are isolated, medical observation and monitoring of those who have been in contact are established.
The most important preventive measure to prevent the introduction of hemorrhagic fever from endemic areas is the implementation of the International Epidemiological Surveillance System.
What is the prognosis for Ebola hemorrhagic fever?
Ebola hemorrhagic fever has a serious prognosis. In diseases caused by EBO-S and EBO-CI, the mortality rate reaches 50%, EBO-Z - 90%. With a favorable outcome, recovery is long.
Mortality and causes of death
Mortality rate is 50-90%. Causes of death: infectious toxic shock, hypovolemic shock, DIC syndrome.