Ebola Hemorrhagic Fever (EHF) is a serious viral hemorrhagic fever seen in Central West Africa. Identification of affected patients is important to prevent spread and to begin treatment as soon as possible. An algorithm (Figure 2, Guimard et al, page S271) can be used to classify possible cases based on exposure, signs and symptoms.
Clinical course (Bwaka, page S2):
(1) incubation period: 5-8 days (mean 6.2)
(2) duration of illness if died: 3-21 days (mean 10.1 days)
Common findings in affected patients:
(1) history of fever (>= 37.5°C axillary, >= 38.5 rectal), with tendency towards normothermia during the last 2 days before death
(2) bilateral conjunctival injection causing redness of the eyes
(3) contact with a person having a hemorrhagic fever or their body fluids
Nonhemorrhagic signs and symptoms associated with EHF (primarily from Guimard but supplemented from Table 1, Bwaka, page S3 and Figure 1, Lloyd et al, page S276):
(1) asthenia, with intense weakness persisting after rehydration
(2) diarrhea
(3) nausea or vomiting
(4) anorexia
(5) sore throat, odynophagia (pain on swallowing) or dysphagia
(6) abdominal pain
(7) headache
(8) arthralgia or myalgia
(9) hiccups or cough
(10) dyspnea or tachypnea
(11) chest pain or back pain
(12) maculopapular rash or skin eruptions
(13) hearing loss or tinnitus
(14) convulsions
Hemorrhagic signs and symptoms seen in EHF:
(1) bleeding gums
(2) hematemesis
(3) melena or bloody stools
(4) hematuria
(5) petechiae or hematoma
(6) epistaxis
(7) hemoptysis
(8) metrorrhagia
Diagnosis Based on Clinical Findings
Probably not EHF:
(1) afebrile
(2) fever , no red eyes, no contact with EHF patient, < 8 nonhemorrhagic signs and symptoms
(3) fever, no red eyes, contact with EHF patient, < 6 nonhemorrhagic signs and symptoms
(4) fever, red eyes, no hemorrhagic signs and symptoms, < 3 nonhemorrhagic signs and symptoms
Suspected EHF:
(1) fever, no red eyes, no contact with EHF patient, >= 8 nonhemorrhagic signs and symptoms
(2) fever, no red eyes, contact with EHF patient, >= 6 nonhemorrhagic signs and symptoms
(3) fever, red eyes, no hemorrhagic signs and symptoms, >= 3 nonhemorrhagic signs and symptoms
EHF:
(1) fever, red eyes and at least 1 hemorrhagic sign and symptom
Confirmatory Testing:
(1) serologic testing on serum
(2) antigen detection in formalin fixed skin biopsy
(3) viral culture
