Ebola fever A98.4

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 12.11.2024

Synonym(s)

African haemorrhagic fever; EBO-HF; Maridi-hemorrhagic fever

Definition
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Acute hemorrhagic febrile illness caused by the Ebola virus with high lethality, which is transmitted from person to person.

Pathogen
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Ebola virus, family of filo viruses. There are 4 known strains: Zaire, Sudan, Reston (does not cause hemorrhagic fever), Ivory Coast.

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Occurrence/Epidemiology
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Named after the Ebola river.

The first cases occurred in southern Sudan in 1972 and 1976. The towns of Maridi (first named Maridi haemorrhagic fever) and Nzara in Sudan and the town of Yambuka in the Democratic Republic of Congo [formerly Zaire] were affected.

Epidemic outbreaks in Sudan, Democratic Republic of the Congo, Uganda, South Africa, Gabon, Ivory Coast.

Human-to-human transmission; the reservoir is unknown (probably fruit bat species).

Clinical features
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Incubation period 4-10 days (2-21 days). Abrupt fever and uncharacteristic accompanying symptoms. Conjunctivitis (often hemorrhagic), maculo-papular exanthema, petechiae, followed by pharyngitis, severe nausea, vomiting, severe bleeding tendency, delirium.

Laboratory
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Initial lymphocytosis, followed by neutrophilia; thrombocytopenia with abnormal aggregation tendency; only slight increase in bilirubin. Elevated transaminases, high AST/ALT ratio.

Diagnosis
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Virus detection in RT-PCR

Antibody detection (immunofluorescence, Western blot)

Electron microscopic virus detection

Antigen detection in liver scrapings

Cultivation test in guinea pigs or Vero cells.

Differential diagnosis
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Marburg fever; malaria; typhoid fever; bacterial meningo-pepticemia; leptospirosis; anthrax; relapsing fever.

Therapy
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Symptomatic therapy.

In the early stages, reconvalescent serum (no longer recommended due to the possible risk of hepatitis B, C and HI virus infection).

Note: Synthetic self-amplifying RNAs (saRNAs) are safe and potent immunostimulants that can be produced in large quantities at low cost using cell-free systems and good manufacturing practices. Overall, saRNAs expressing viral antigens represent a promising future EBOLA vaccine platform (Krähling V et al. 2023).

Progression/forecast
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Death after 6-9 days (1-21 days).

Severe course during pregnancy.

Reconvalescence possible, but delayed, with weight loss, amnesia.

Prophylaxis
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Immediately isolate people who are ill or suspected of being ill.

Avoid contact with sick people.

Adhere to strict infection control measures.

Vaccination (active immunization): Vaccination of Javan monkeys (long-tailed macaques; Macaca fascicularis) with an attenuated, live, recombinant vesicular stomatitis virus (VSV), which produces a so-called glycoprotein of the Zaire ebolavirus strain "Kikwit" on its surface, has been successful. Vaccination in humans is still being tested.

Note(s)
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Remember! Suspected illness, illness and death must be reported by the doctor to the public health department by name according to §6 IfSG. According to § 7 IfSG there is an obligation to report in case of direct or indirect evidence of the virus.

Literature
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Editorial (1977) "After Marburg, Ebola". Lancet 1: 581-582
Editorial (1977) Ebola virus infection. Br Med J 2: 539-540
Emond RT et al (1977) Br Med J 2: 541-544
Krähling V et al. (2023) Self-amplifying RNA vaccine protects mice against lethal Ebola virus infection. Mol Ther 31:374-386.