Monday, August 11, 2014

CDC Guidance: Ebola Disease Information For Clinicians In U.S.



# 8938


The CDC continues to roll out new guidance and information on Ebola for Health Care and other sectors, with the most recent posted yesterday on their Ebola Information website:


Ebola Virus Disease Information for Clinicians in U.S. Healthcare Settings

The Centers for Disease Control and Prevention is working closely with the World Health Organization and other partners to better understand and manage the public health risks posed by Ebola virus disease (EVD). As of August 10, 2014, no EVD cases have occurred in the United States. The purpose of this document is to provide updated information about EVD to clinicians working in U.S. hospitals and health clinics.

Clinical Presentation and Clinical Course

Patients with EVD generally have abrupt onset of typically 8-10 days after exposure (mean 4-10 days in previous outbreaks, range 2-21 days).  Initial signs and symptoms are nonspecific and may include fever, chills, myalgias, and malaise. Fever, anorexia, asthenia/weakness are the most common signs and symptoms. Patients may develop a diffuse erythematous maculopapular rash by day 5 to 7 (usually involving the face, neck, trunk, and arms) that can desquamate.

Due to these nonspecific symptoms particularly early in the course, EVD can often be confused with other more common infectious diseases such as malaria, typhoid fever, meningococcemia, and other bacterial infections (e.g., pneumonia). 

Patients can progress from the initial non-specific symptoms after about 5 days to develop gastrointestinal symptoms such as severe watery diarrhea, nausea, vomiting and abdominal pain. Other symptoms such as chest pain, shortness of breath, headache or confusion, may also develop.  Patients often have conjunctival injection.  Hiccups have been reported.  Seizures may occur, and cerebral edema has been reported.  Bleeding is not universally present but can manifest later in the course as petechiae, ecchymosis/bruising, or oozing from venipuncture sites and mucosal hemorrhage. Frank hemorrhage is less common.  Pregnant women may experience spontaneous miscarriages.

Patients with fatal disease usually develop more severe clinical signs early during infection and die typically between days 6 and 16 of complications including multi-organ failure and septic shock. In non-fatal cases, patients may have fever for several days and improve, typically around day 6-11. Patients that survive can have a prolonged convalescence. The World Health Organization has estimated the mortality of the current outbreak of EVD in West Africa to be approximately 55%, but appears to be as high as 75% in Guinea.

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