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03/08/2016

Ebola, a deadly African virus


dr. M. Adi Firmansyah, SpPD

SMF Ilmu Penyakit Dalam


RSUD Kota Tangerang

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• Ebola virus disease (EVD), formerly known as


Ebola hemorrhagic fever, is a severe, often fatal
illness in humans.
• EVD outbreaks have a case fatality rate of up to
90%.
• EVD outbreaks occur primarily in remote
villages in Central and West Africa, near tropical
rainforests.
• The virus is transmitted to people from wild
animals and spreads in the human population
through human-to-human transmission.
• Fruit bats of the Pteropodidae family are
considered to be the natural host of the Ebola
virus.
• Severely ill patients require intensive supportive
care. No licensed specific treatment or vaccine
is available for use in people or animals.

Ebola – Key Facts

• Close contact with the blood, secretions, organs or other bodily fluids
of infected animals.
• In Africa  the handling of infected chimpanzees, gorillas, fruit bats,
monkeys, forest antelope and porcupines found ill or dead or in the
rainforest.
• It spreads in the community through human-to-human
transmission  direct contact (through broken skin or mucous
membranes) with the blood, secretions, organs or other bodily fluids
of infected people) and indirect contact (environments contaminated
with such fluids)
• Burial ceremonies in which mourners have direct contact with the
body of the deceased person
• Men who have recovered from the disease  still transmit the virus
through their semen for up to 7 weeks after recovery from illness!

Transmission

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Brief History
• First appeared in Africa 1976
• Ebola first appeared in 1976 in 2 simultaneous
outbreaks, in Nzara, Sudan, and in Yambuku,
Democratic Republic of Congo.
• Ebola  taken from Ebola River

• “African Hemorrhagic Fever”


• acute,mostly fatal disease
• causes blood vessel “bursting”
• systemic (all organs/tissues)
• humans and nonhuman primates

• Excluding ‘2000 outbreak


• 1,500 cases
• over 1,000 deaths

Ebola Taxonomy
• Order: Mononegavirales
• Family: Filoviridae
• Genus: Ebola like viruses
• Species: Ebola
• Subtypes:
• Bundibugyo ebolavirus (BDBV)
large EVD
• Zaire ebolavirus (EBOV) outbreaks in
• Sudan ebolavirus (SUDV) Africa
Copyrighted • Reston ebolavirus (RESTV)
Dr. Fre:derick A. Murphy, D.V.M., Ph.D. 1976.
• Taï Forest ebolavirus (TAFV).

RESTV  Philippines and RRC, can infect human


but no death in humans has been reported

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Ebola Epidemiology
• Reservoirs in Nature
• largely unknown
• possibly infected animals (primates?)

• Transmission
• direct contact blood/secretions of infected person
• possible airborne (Reston primate facility)

• Onset of illness abrupt


• incubation period: 2 to 21 days
• infections are acute and mostly deadly

Epidemiology

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Ebola Pathogenesis

• Enters Bloodstream
• skin, membranes,open wounds

• Cell Level
• docks with cell membrane
• Viral RNA
• released into cytoplasm
• production new viral proteins/ genetic material
Copyright: Russell Kightley Media, Australia
• New viral genomes
• rapidly coated in protein
• create cores

Pathogenesis

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Ebola Pathogenesis, cont


• Viral cores
• stack up in cell
• migrate to the cell surface
• produce trans-membrane proteins
• push through cell surface
• become enveloped by cell membrane

• ssRNA- Genome Mutations


• capable of rapid mutation
• very adaptable to evade host defenses and environmental change

• Theory
• virus evolved to occupy special niches in the wild

Signs and Symptoms


• EVD is a severe acute viral illness often characterized by the
sudden onset of fever, intense weakness, muscle pain, headache
and sore throat.
• This is followed by vomiting, diarrhoea, rash, impaired kidney
and liver function, and in some cases, both internal and external
bleeding.
• People are infectious as long as their blood and secretions
contain the virus.
• Ebola virus was isolated from semen 61 days after onset of
illness in a man who was infected in a laboratory.
• The incubation period, that is, the time interval from infection
with the virus to onset of symptoms, is 2 to 21 days.

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Symptoms

Clinical Manifestations

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Day 7-9 Day 10 Day 11 Day 12


• Headache • Sudden high • Bruising • Loss of
• Fatigue fever • Brain damage consciousness
• Fever • Vomiting • Bleeding from • Seizures
• Muscle blood nose, mouth, • Massive
soreness • Passive eyes, and anus internal
behavior bleeding
• Death

Natural of Symptoms

• Early Diagnosis
• very difficult
• signs & symptoms very similar to other infections
• Should be ruled out  malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague,
rickettsiosis, relapsing fever, meningitis, hepatitis and other viral haemorrhagic fevers.
• Laboratory Test
• Low white blood cell and platelet counts and elevated liver enzymes, decreasing
kidney function
• Enzyme-linked immunosorbent assay (ELISA)
• Antigen detection tests
• Serum neutralization test
• Reverse transcriptase polymerase chain reaction (RT-PCR) assay
• Electron microscopy
• Virus isolation by cell culture.

Diagnostic Tests

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• No Standard Treatment available

• Patients receive supportive therapy


• treating complicating infections
• balancing patient’s fluids and electrolytes
• maintaining oxygen status and blood pressure

Treatment

Prevention
• No vaccines!

• Patients are isolated

• Medical Staff Training


• western sanitation practices
• intake
• care during stay
• after patient dies

• Infection-control Measures
• complete equipment and area sterilization

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Prevention

Prevention

After Death
Virus contagious in fluids for days

• Burial use extreme caution


• handling and transport

• cultural practices/ religious belief

• incinerate all waste !!!!

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• Called ZMapp,
• it is a cocktail of specially
engineered antibodies designed to
target and inactivate the Ebola
virus.
• Various antibodies have been
tested in small numbers of
monkeys, but not people. In one
study, 43 percent of treated
monkeys survived when the drug
was given after the animals
showed symptoms.

Zmapp – Promising Drug?

THANK YOU

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