Ebola_LogoDuring SMA’s recent Scientific Assembly in Destin, Dr. G. Richard Holt, Editor-in-Chief of the Southern Medical Journal, provided an update about the Ebola Virus.  

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The Ebola virus is one of approximately 30 viruses which can cause hemorrhagic fever.  The virus derived its name from the Ebola River in African, which was the site of one of the earliest outbreaks in 1976.  The current widespread outbreak is due to the Ebolavirus zaire strain.  The transmission mechanisms have been related to animal vectors, primarily fruit bats and forest non-human primates.

With an incubation period of 2-21 days, the primary manifestations of Ebola infection vary with the stage of the disease at the time of presentation, with fever, sore throat, diffuse constitutional symptoms (aches, nausea and vomiting, diarrhea), maculopapular rash, and conjunctival injection being common.  Late manifestations include bleeding from skin and mucosa, myocarditis and pulmonary edema, dehydration and electrolyte imbalance, hypovolemia, and liver and kidney failure.  Past survivors of the infection appear to have had a robust immune system response.

The virus utilizes two glycoproteins to cause damage—one glycoprotein binds to neutrophil receptors and inhibits neutrophil activity, while another glycoprotein binds to endothelial cells, causing both intravascular coagulation and leaky blood vessels.  Asymptomatic infection does occur, with those individuals exhibiting an early and vigorous immunologic response with production of interleukins and tumor necrosis factor, resulting in enhanced cell-mediated and humoral-mediated immunity.

Management of Ebola infection patients begins with a high index of suspicion, followed by rapid isolation and a rapid ELISA test for Ebola antigens, usually confirmed by the CDC.  A special, reverse flow isolation room is required, with full personal protective equipment (PPE) for all healthcare personnel entering the isolation room.  Special attention to donning and removal of the PPE is extremely important, as is the proper disposal of patient waste products and all items that have come in contact with the patient.  These protocols are still being refined and healthcare personnel education is critical for their protection.

There are many healthcare system challenges still outstanding, including identification of potential victims during the influenza season, safety and protection of other patients in physician’s offices and emergency departments, protection of first responders and healthcare workers, proper disposal of wastes, information technology/electronic medical record keeping, and HIPAA compliance, to name a few.  The process is evolving seemingly daily and all healthcare providers must be as knowledgeable and prepared as possible.

About the Presenter

Richard Holt, MD, MSE, MPH, MABE, D BE
Dr. Holt is a professor emeritus at the University of Texas Health Science Center at San Antonio, on the clinical faculty at the Brooke Army Medical Center, Fort Sam Houston, Texas, and teaches at the UT School of Public Health.  He is also Editor-in-Chief of theSouthern Medical Journal.  His public health interests are in global health and international medicine, including bioterrorism and disaster medicine.  He also teaches bioethics to healthcare professionals.

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