Analytical Essay on Ebola Virus: Symptoms, Diagnosis, Etiology and Pathogenesis

Introduction

Ebola is a haemorrhagic fever that is formally known as Ebola Virus Disease. According to the Wold Health Organization, Ebola causes a severe, serious illness which is often deadly if left untreated.

Stats from WebMD show that Ebola kills up to 90% of infected people. “Ebola is a deadly disease caused by a virus. There are five strains, and four of them can make people sick. After it enters the body, it kills cells, making some of them burst. It wrecks the immune system, causes heavy bleeding inside the body, and damages almost every organ (Ambardekar, 2018).”

Symptoms

Ebola does not spread like other common viruses such as influenza and fever, it spreads through skin contact or bodily fluids of infected human, primates or animals. Other ways to get the virus is by touching Ebola-infected needles or surfaces.

A person cannot get the virus from water, air or food. An Ebola-infected person also cannot spread the virus if there are no symptoms for the virus.

Common symptoms of Ebola can feel like an influenza infection in the first two to 21 days of an infection. Some of the early symptoms are high fever, headaches, joint and muscle aches, weakness, stomach pains and loss of appetite. As the disease worsens, it causes bleeding inside the body as well as from the eyes, ears, and nose. Some people vomit, cough up blood, have a bloody diarrhea, and get a rash (Ambardekar, 2018).

Diagnosis

Diagnosing the virus shortly after infection can be very difficult. It is difficult to diagnose the virus in its early stages because the symptoms are also common with malaria and typhoid fever. “To determine whether Ebola virus infection is a possible diagnosis, there must be a combination of symptoms suggestive of Ebola and a possible exposure to EVD within 21 days before the onset of symptoms. An exposure may include contact with blood or body fluids from a person sick with or who died from Ebola, objects contaminated with blood or body fluids of a person sick with or who died from the virus, infected fruit bats and primates, or semen from a man who has recovered from Ebola (CDC, 2018).”

Etiology

There are six species of Ebola virus, and four of the six species cause diseases in humans. The four species that cause diseases are Zaïre Ebola virus (EBOV), Sudan Ebola virus (SUDV), Tai Forest (TAFV) (formerly known as Ebola Ivory Coast), and Bundibugyo Ebola virus (BDBV). The fifth Ebola virus is Reston Ebola virus (RESTV), which has been proven to cause illnesses in non-human primates but not in humans. The sixth Ebola species is Bombali Ebola virus, it was discovered in bats in Sierra Leone in 2018 therefore it is not yet known if the species is pathogenic for humans (Government Publications, 2019).

Ebola first emerged in 1976, in what were almost simultaneous outbreaks in Sudan and the Democratic Republic of Congo. This disease is caused by the Ebola virus, a member of the filovirus family, which occurs in humans and other primates (Government Publications, 2019). The first outbreak occurred in the Democratic Republic of Congo in a village near the Ebola river and then later in Sudan. Theses outbreaks were thought to have been spread by a single human being who travelled from one area to another, until scientists later confirmed that the outbreaks were caused by two genetically different viruses, Zaire ebolavirus and Sudan ebolavirus. After the discovery, scientists concluded that the virus came from two different sources and spread to people in each of the areas (CDC, 2018). The general cause of this deadly virus is unknown but it has been though to have arose from bats, specifically fruit bats. Slight evidence that support the theory is that in 2005 researchers looked for a possible carrier of the virus and sampled 1 000 small animals in Central Africa. They tested 679 bats, 222 birds and 129 terrestrial vertebrates. The only animal to be found positive of carrying the virus were the bats (Rettner, 2014).

Pathogenesis

Ebola virus enters the patient through mucous membranes, breaks in the skin, or parenterally and infects many cell types, including monocytes, macrophages, dendritic cells, endothelial cells, fibroblasts, hepatocytes, adrenal cortical cells, and epithelial cells. Ebola virus then migrates from the initial infection site to regional lymph nodes and subsequently to the liver, spleen, and adrenal gland. Hepatocellular necrosis occurs and is associated with dysregulation of clotting factors and subsequent coagulopathy. Adrenocortical necrosis also can be found and is associated with hypotension and impaired steroid synthesis. Ebola virus appears to trigger a release of pro-inflammatory cytokines with subsequent vascular leak and impairment of clotting ultimately resulting in multiorgan failure and shock (CDC, Center for Disease Control and Prevention, 2014).

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Pathological and clinical manifestations

After an incubation period of 2–21 days, Ebola virus disease, starts as a non-specific viral syndrome of abrupt onset. The most common symptoms are high fever, malaise, fatigue, and body aches. These symptoms are usually followed after a few days by gastrointestinal symptoms, which include nausea, vomiting, and diarrhea. Although some patients will start recovering at this stage, others will go into shock, possibly due to hypovolaemia and a systemic inflammatory response (Malvy, McElroy, Clerck, Günther, & Griensven, 2019). Neurological events are rare and include confusion, delirium, and convulsions. Late symptoms include dysphagia, throat pain, and oral ulcers and ultimately death due to cardiac arrhythmias. If patients survive the stage of shock, gradual recovery can occur. Several studies have aimed to define clinical prediction tools for Ebola virus disease, integrating discriminatory symptoms or signs (Malvy, McElroy, Clerck, Günther, & Griensven, 2019).

Complications and sequelae

Many short-term and long-term health problems have been reported. Some of these health problems are leucopenia, Alopecia lasting three months, loss of hearing, loss of vision, weight loss, fatigue and many other problems (Vetter, 2016). However, the clinical findings have been largely uncontrolled, making it difficult to definitively attribute causality to Ebola Virus Disease.

Prognosis

The overall prognosis of Ebola virus is relatively poor due to the virus being having such a high mortality rate of up to 90%. The 90% is without the inclusion of the Reston species of the disease. It is mostly the Zaire species, which is the deadliest of the ebolavirus (Charles, n.d.).

Epidemiology

Ebola transmission can be avoided by taking great care when nursing an infected individual. There needs to be no skin to skin contact or any contact with that person’s bodily fluids. The isolation of a patient is the best way of decreasing chances of spreading the virus and wearing gloves, gown and face masks while treating a patient reduces nurses chances of contracting the viral infection. There are no licensed vaccines at the current moment that prevent the spread of the virus. Virologists though suggest that patients require intensive supportive therapy including intravenous fluid or oral rehydration with solutions including electrolytes, maintaining their oxygen and blood pressure (Government Publications, 2019). The first opportunity that Virologists got to examine infected patients was in 1995. The most important finding was that acutely ill patients are intensely viraemic and that ELISA determination of viral antigens in serum provides a sensitive and specific way to quickly screen large numbers of suspect human samples. Virus isolation and reverse transcriptase-polymerase chain reaction are useful in a few instances as well (peter, 1999).

Conclusion

The Ebola virus first emerged in the Democratic Republic of Congo as the Zaire species then later Emerged in Sudan as the Sudan species. The incidents of the outbreak were first thought to be spread by one individual who contracted the virus in one place and moved to another. It was later discovered that the virus came from two different species with Zaire ebolavirus being the most deadly. Though the main source of the disease is unknown, it is thought to have come from fruit bats, with sample testing evidence backing that theory.

This virus starts off with common influenza and cold virus symptoms but gradually worsens during the two to 21 day inhibition period. Nasty symptoms such as bleeding from the nose and ears then follow, if patient does not get treatment soon, it then leads to death. With a mortality rate of up to 90%, the virus is as deadly as they come.

There have not been any licensed vaccines therefore there is no permanent cure for the virus at the present moment but there are ways to prevent the spread of the disease such as isolation of the infected patient, wearing masks, gloves and gown, and also preventing skin to skin contact or contact with bodily fluids of infected patient.

From a neutral standpoint, one can only hope that with the help of the latest technology and everchanging medical field, a cure for this deadly virus can be found soon to prevent the loss of so many lives in our fellow African countries.

In conclusion all patients seen to have influenza and cold like symptoms need to be tested for the virus if they feel that the symptoms are worsening. This virus is indeed one of the worst viruses an individual could contract due to its ability to spread through skin to skin contact. It is urged that patients who notice abnormal symptoms that could be related to Ebola seek medical attention as soon as possible.

Bibliography

1. Ambardekar, A. (2018, October 17). Web MD. Retrieved from Ebola Fever Virus Infection: https://www.webmd.com/a-to-z-guides/ebola-fever-virus-infection
2. CDC. (2014, March 24). Center for Disease Control and Prevention. Retrieved from CDC 24/7: saving lives, protecting People: https://www.cdc.gov/vhf/ebola/clinicians/evd/clinicians.html#targetText=Pathogenesis,cortical%20cells%2C%20and%20epithelial%20cells.
3. CDC. (2018, March 14). Centers For Disease Control And Prevention. Retrieved from Ebola (Ebola Virus Disease: https://www.cdc.gov/vhf/ebola/diagnosis/index.html#targetText=Ebola%20virus%20can%20be%20detected,that%20Ebola%20infection%20is%20confirmed.
4. Charles, P. D. (n.d.). eMedicine Health. Retrieved from Ebola Virus Disease: https://www.emedicinehealth.com/ebola_virus_disease_ebola_hemorrhagic_fever/article_em.htm#how_contagious_is_ebola_and_how_long_is_someone_with_the_disease_contagious
5. Government Publications. (2019, July 29). Retrieved from https://www.gov.uk/government/publications/ebola-origins-reservoirs-transmission-and-guidelines/ebola-overview-history-origins-and-transmission#targetText=Ebola%20virus%20disease%20(%20EVD%20)%20is,Sudan%20(now%20South%20Sudan).
6. Malvy, D., McElroy, A. K., Clerck, H. d., Günther, S., & Griensven, J. v. (2019). Ebola Virus Disease. Lancet 2019, 238-239.
7. Peter, c. j. (1999). The Journal of Infectious Diseases, Volume 179. An Introduction to Ebola: The Virus and the Disease.
8. Rettner, R. (2014, September 22). Health. Retrieved from Science live: https://www.livescience.com/47946-where-did-ebola-come-from.html
9. Vetter, P. (2016). Sequelae of Ebola virus disease: the emergency within the emergency. The Lencet, Infectious Diseases, 82-91.