Ebola Virus Disease: Causes, Picture, Symptoms and Treatment

Ebola virus disease or EVD is a severe form of viral infection causing fatal complications. Earlier known as Ebola hemorrhagic fever trigger fatal illness in humans as well as other primates. It mostly transmits from wild animals to people. When you come in direct contact with secretions, blood, organs, or other body fluids of infected animals or people, you can contract the disease. People also catch the viral infection when they touch the surface or materials like clothing or bedding contaminated with secretions or infected fluids. It is a dangerous disease as it has a fatality rate of around 50%. In the past, outbreaks have fatality rates varying from 25-90%. It is a serious disease that requires immediate medical attention. Read ahead to know more about EVD and how to handle the problem without triggering severe complications.

History Of Ebola Virus Disease

The world first learned about the disease in 1976 when two outbreaks occurred simultaneously. One occurs in a town in South Sudan, Nzara while the other in a village called Yambuku in the Democratic Republic of Congo. The disease derives its name from the Ebola River that flows near Yambuku. The outbreaks have occurred mostly in the Western African countries subjected to tropical climate. So, it has occurred mostly at intermittent intervals in sub-Saharan Africa. From its discovery in 1976 until 2013, the World Health Organization has reported twenty-four outbreak of EVD in the region. It resulted in 2,387 people becoming infected with the disease. Unfortunately, 1,590 people died. The region also experienced the largest outbreak from 2013 to 2016. It caused EVD to affect 28,646 people with 11,323 dying as a result.

Since then, the Western African region has witnessed asymptomatic or sporadic eruptions of the disease in both humans as well as animals. Around the world, the following regions have suffered the viral infection due to accidents, laboratory contamination, and outbreaks:

• South Sudan
• The Democratic Republic of the Congo (DRC)
• Senegal
• Uganda
• Liberia
• Sierra Leone
• USA (United States America)
• United Kingdom
• Italy
• Philippines
• Gabon
• Spain
• Ivory Coast
• Russia
• South Africa
• Guinea

Risk Factors Associated With Ebola Virus Disease Outbreak

In normal cases, the risk of contracting the infection is low. But, certain factors can result in infection and subsequent outbreaks. The factors influencing it are:

• When you travel to the regions in Africa with confirmed presence of EVD.
• Conduct animal research, for example, on monkeys imported from regions like the Philippines or Africa.
• Provide personal care or medical care to people who suffer from the infection or have become exposed to EVD.
• Preparing to bury dead people infected with the virus.

Symptoms Of Ebola Virus Disease

EVD is rare but can trigger severe complications, including death. You can feel severe body discomfort when you get the infection. As the virus starts spreading through your body, it starts affecting your immune system as well as your internal organs. Ultimately, the virus causes a reduction of blood-clotting cells. This can lead to severe and uncontrollable internal or external bleeding. Without proper medical intervention, the disease can kill 90% of infected people. EVD is a serious and fatal condition in both humans as well as nonhuman primates. From contracting the infection to the onset of symptoms, EVD takes two to twenty-one days. Most people can observe the symptoms within eight to ten days of contracting the virus. Based on the different stages of infection, you can diverse signs. The different stages and related symptoms of Ebola virus disease are:

Onset Of Ebola Virus Disease

The incubation period (time length between the exposure to the virus and the early signs of symptoms) is around two to twenty-one days. Most people can show signs within four to ten days. But, studies and estimates based on the mathematical models indicate that around 5% of the infected people take more than twenty-one days to develop. During the stage, people can develop the following symptoms:

• Sudden influenza-like signs
• Decreased appetite
• Extreme tiredness
• Weakness
• Fever (higher than 38.3 degree Celsius)
• Joint and muscular pain
• Sore throat
• Headache
• Vomiting
• Nausea
• Diarrhea
• Abdominal pain
• Hiccups (rare cases)
• Dehydration (Due to the combination of diarrhea and vomiting)
• Chest pain
• Shortness of breath
• Swelling in different body parts
• Confusion
• Maculopapular (a flat red rash full of small bumps) rash on the skin
• Some of the symptoms usually appear from five to seven days after the first symptom begins.

Internal/External Bleeding

Five to seven days after the initial symptoms appear, the infected person can develop internal or external bleeding. It occurs due to the drastic decrease in the cells facilitating blood clotting. So, it results in bleeding from mucous membranes or the areas with a needle puncture. The problem occurs in more than 40% to 50% of people affected by the Ebola virus disease. During the stage, people can also suffer from other signs like:

• Vomiting blood
• Coughing up blood
• Bleeding into the skin (it can lead to ecchymoses, purpura, petechiae, hematomas around needle puncture site)
• Blood in stool
• Heavy bleeding in the gastrointestinal tract
• Bleeding into the whites of infected person’s eyes

Recovery And Death

Infected people will begin recovery from seven to fourteen days after the first symptom appears. Others who succumb to the infection can see their condition worsening from six to sixteen days. During the period, their blood pressure can reduce to lower levels due to fluid loss. Blood loss due to internal or external bleeding can also result in death. In most cases, people who face the risk of death can go into a coma. People who recover from a viral infection can suffer from health issues. They can experience the following:

• Ongoing muscular pain
• Pain in joints
• Decreased hearing
• Liver inflammation
• Continued weakness
• Extreme tiredness
• Reduced appetite (making it difficult to return to pre-illness weight)
• Develop problems with vision

People who survive Ebola virus disease develop antibodies that last for ten years. But, it remains unclear if the antibodies offer immunity to other infections.

Causes Of Ebola Virus Disease

What causes EVD? The disease is one of the several viral hemorrhagic fevers triggered due to a virus from the Filoviridae family. The virus of the Ebolavirus genus causes the disease. Ebolavirus comes under zoonosis. It means the virus present in animals can transmit to humans. Ebola virus disease can occur due to four of the five viruses. So, the virus types causing EVD in humans are:

• BDBV (Bundibugyo Virus)
• TAFV (Tai Forest Virus)
• SUDV (Sudan Virus)
• EBOV (Ebola Virus, formerly known as Zaire Ebola Virus)

Among the four different viruses, EBOV is the most dangerous one. It is the virus responsible for the largest number of the outbreak and causes severe complications. The fifth virus known as RESTV (Reston Virus) does not cause diseases in humans. But the virus infects other primates and causes issues. These five viruses have a close relation to marburgviruses.

Transmission Of Ebola Virus Disease

The exact method of transmission and outbreak of the virus remains unclear. But, people in Africa have developed EVD after handling infected animals. So, people who have come in contacts with ill or dead animals like fruit bats, gorillas, chimpanzees, monkeys, porcupines, and forest antelope have suffered from the viral infection. In the majority of the cases, person-to-person transmission occurred after an infected person becomes symptomatic. So, once a person showed signs of the disease, others who come in contact with infected persons have high chances of suffering from the viral infection. Since a person infected by EVD can take two to twenty-one days for symptoms to develop, it increases the chances of spreading the virus. It is because, by the time the symptoms develop, the infected person comes in contact with hundreds of people. So, the infection spreads rapidly and leads to an outbreak.

Methods Of Transmission Of Ebolavirus In Humans

The virus can spread in different methods and affects humans. The transmission of EVD in human can occur in the following ways:

• When the virus comes in direct contact with humans through mucous membranes and broken skin with secretions, blood, organs or other fluids of infected people.
• Indirect contact with the contaminated environment with the above-mentioned fluids.
• Indirect contact with environments contaminated with such fluids.
• Direct exposure to contaminated objects like needles.
• Mourners coming in contact with dead people infected by the virus during burial ceremonies.
• Exposure to the semen of infected people or who have recovered from EVD as the virus can transmit through semen for up to seven weeks after recovering from the illness.
• Healthcare workers or caretakers who come in contact with infected people or people suspected of infection during treatment.

While the transmission can occur in the above-mentioned methods, it never spreads through insect bites. Currently, no evidence suggests the spread of EVD via insect bites.

What Makes Ebola Virus Disease Dangerous?

What is the reason that results in EVD causing fatal results? It is because the Ebola virus disease can result in coagulation abnormalities. So, infected people can trigger gastrointestinal bleeding and other issues like:

• Cytokine release
• Rash development
• Liver Damage
• Massive Viremia (presence of a large number of viruses in the blood)

The above-mentioned problem results in damage to the vascular cells. These vascular cells help form blood vessels. With massive viremia, your coagulation factor gets compromised. So, an infected person’s microvascular endothelial cells get damaged or destroyed, leading to profuse internal or external bleeding. The uncontrolled bleeding, as well as fluid loss, can lead to hypotensive shock and death. It is the reason why most patients suffering m EVD face a high risk of death.

Diagnosing Ebola Virus Disease

When people see the signs of infection, they need to inform the doctor about it. But, it is important to inform the doctor beforehand regarding the suspicions. The WHO has issued strict guidelines regarding the testing methods to detect Ebola virus disease. Samples of patients showing the symptoms have extreme biohazard risk linked to it. So, all the testing related to the disease must happen under maximum biological containment conditions to prevent the spread of the virus. Before the testing, the healthcare professional need to isolate the patients. Without isolation the risk of infection spreading increases. It is also essential to notify public health officials regarding the case. The different tests used to eliminate the possibility of other disease and diagnose EVD are:

• PCR (Polymerase chain reaction)
• IgM ELISA
• Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing
• Virus isolation

When a patient has more advanced stages of the disease or is recovering, then diagnosing the problem is possible using IgM as well as IgG antibodies detection. It is also possible to diagnose if EVD caused the death of a patient with other forms of testing.

Treatments For Ebola Virus Disease

Unfortunately, no specific therapy is available for treating the condition. Supportive therapy is the standard treatment suggested by healthcare professionals. It means the treatment focuses on balancing the patient’s fluid as well as electrolyte levels. The treatment also maintains the oxygen status and blood pressure levels from causing the patient harm. The treatment also manages any infections. Before starting the treatment, the healthcare professionals must follow the guidelines like:

Isolate Patients

The healthcare professionals must isolate the patients suspected with the infection. It is to prevent the spread of the disease to caregivers. Patients need to transfer to special centers with ample facilities to treat EVD. Healthcare professionals need to maintain caution as around the world incidents indicate the spread of the virus from patients to caretakers due to not following the safety guidelines.

Follow Protocols

Health officials handling Ebola virus disease in people need to contact their local health department for accessing treatment protocols, get the necessary information on vaccines, and the guidelines for treatment. Healthcare professionals need to wear PPE (personal protective equipment) while dealing with infection cases.

Treatment Options For Ebola Virus Disease

The supportive treatment options available for patients suffering from EVD includes:

• Provide fluids intravenously (through IV) to balance the body salts (electrolytes).
• Maintain the oxygen status in the body.
• Monitor blood pressure to prevent it from lowering to dangerous levels.
• Treat other infections in the body to avoid complications.
• Apart from the suggested treatment options, you have other experimental medical treatment options available like:
• Provide immune serum
• Take antiviral drugs
• Blood transfusion (during excessive bleeding)

Complications Associated With Ebola Virus

The disease is deadly and often results in severe complications. The fatality rates of the disease depend on the type of strain affecting you. For example, a person suffering from the Ebola-Zaire strain faces a high fatality rate (up to 90%) while Ebola-Reston never causes any fatality in humans as it affects only animals. After you contract the virus from an infected person, it spread quickly through families and friends. Exposure to infectious body fluids, blood or tissues can increase the risk of infection. So, you need to get immediate assistance when you suffer from symptoms within 2-21 days of contracting the virus.

Complications Without Treatment

When people suffering from the infection fail to get proper treatment, it can result in severe complications. So, the disease progresses, leading to the following:

• Severe bleeding
• Multiple organ failure
• Delirium
• Jaundice
• Seizures
• Shock
• Coma

Why the disease has deadly consequences? It is because it interferes with your immune system. So, your body fails to mount a defense. But, it still remains unclear why some people recover from the problem while others face deadly complications.

Complication After Recovering

Some people survive from Ebola virus disease. But, the recovery is slow and takes longer. So, an infected person can take several months to regain their strength and weight. The virus can remain in the body for several weeks after the symptoms disappear. So, people can experience the following after recovering:

• Hair loss
• Hepatitis (liver inflammation)
• Sensory changes
• Fatigue
• Weakness
• Eye inflammation
• Headaches
• Testicular inflammation

Preventing Ebola Virus Disease

Can you prevent EVD? By maintaining caution, you can avoid the deadly disease from affecting your life. Preventive measures focus on avoiding coming in contact with the virus. But, the disease usually spreads when family or friends come in contact with an infected person. It can also spread at a swift rate within healthcare settings. So, you can follow the precaution guidelines can help prevent as well as spreading of the disease. The steps suggested by the Who and CDC to prevent and control the spread of EVD include:

Avoid Outbreak Areas

Try to avoid areas known for outbreaks. So, before you make a trip, check the CDC (Centers for Disease Control and Prevention) website to check the current situation in the area you wish to travel. It is especially necessary for people who are traveling to African countries that have a high prevalence of the disease.

Wash Your Hands

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Try to wash your hands frequently to prevent the transmission of the virus from your hands to your body through nose, mouth or eyes. Washing your hands with soap and water or sanitizers (60% alcohol-based hand rubs) is one of the important preventive methods to avoid the spread of the virus.

Avoid Bush Meat

Raw meat from wild animals like nonhuman primates or bats can result in the transmission of the virus causing EVD. People living in developing countries eat bush meat. To avoid viral infection, avoid buying or eating bush meat. Try to avoid contact with raw meat that comes from an unknown or unidentified source.

Avoid Contact With Infected People

People who have a high possibility of coming in contact with infected people need to avoid touching the infected person’s clothing, bedding, body fluids (like semen, vagina secretions, or saliva), and tissues. Since people who have contracted the virus can spread the disease at later stages of the disease (highly contagious), you need to avoid contact with the body fluids until the test verifies n virus presence.

Follow Infection-Control Guidelines/Procedures

People who work in healthcare or have high chances of coming in contact with the virus causing EVD have to follow infection control procedures. Without strictly following the guidelines, the virus can spread quickly within people who work in the healthcare setting. So, healthcare workers need to follow safety guidelines like:

• Wear protective clothing like masks, gowns, gloves, and eye shields to prevent coming in direct contact with body fluids or tissue. Following PPE (personal protective equipment) can reduce the risk of catching the Ebola virus disease.
• Healthcare workers need to understand the importance of following PPE. Without realizing its benefits, workers can become complacent in following the protocols.
• It is important to implement equipment sterilization, routine use of disinfectant, and proper disposal of needles. All hospitals and clinics must follow the infection control methods to prevent and halt the spread of an outbreak.
• Healthcare professionals must isolate infected patients from others. It is to prevent the spread of Ebola virus disease to other unsuspecting people.
• People working in the healthcare sector need to follow the suggestion to ensure the virus does not infect while taking care of patients.

Handle Remains With Caution

Since people who have died as a result of EVD are still contagious. So, handling the remains of people with EVD needs caution. A specially organized and trained team can bury the remains without increasing the risk of infection. Such proficient teams use appropriate safety equipment to handle remains with caution.

Get Vaccination

On 19th December 2019, the FDA (Food and Drug Administration) in the USA approved vaccination for EVD. The vaccine with trade name Ervebo (rVSV-ZEBOV) is a single dose vaccination that is safe and protective against the virus causing EVD. But, it is only effective against Zaire ebolavirus species. The vaccine has great significance as it is the first approved vaccination to prevent the disease.

Conclusion

Unfortunately, the prognosis of EVD is often poor. People who face fatal complications, including death ranges from 25-100%. While people who recover from the problem can experience severe complications. Early intervention with proper diagnosis and medical treatment can increase the chance of survival of a patient infected with the Ebola virus disease. But, early intervention becomes impossible as the disease often affects areas in Africa with no medical care. So, the outbreak is common in rural parts of Africa. Until the medical infrastructure of the country changes, you need to maintain caution while traveling to such areas to avoid infection.

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