Ebola

Clemens Gödel is a freelancer for the medical team.

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Ebola is an often severe infection with fever and bleeding (haemorrhagic fever). The disease is caused by the Ebola virus, one of the most dangerous pathogens in the world. So far there are no effective drugs or vaccinations against it. Ebola is fatal in very many cases. Here you can read everything you need to know about Ebola - symptoms, treatment and prognosis.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. A98

Ebola: description

Ebola (Ebola fever) is a serious reportable virus infection that is one of the so-called hemorrhagic fevers. These are infectious diseases that are associated with fever and an increased tendency to bleed (including internal bleeding). The main risk area is Equatorial Africa, where medical care is often inadequate.

The first infection with the Ebola virus was described in the 1970s in Sudan and the Congo. Since then there have been repeated epidemics. A major epidemic last broke out in Guinea in February 2014. In the past, the disease could mostly be contained by strict isolation of the sick, which prevented larger Ebola epidemics. In addition, the high mortality rate limits its spread. Death often occurs after a few days.

To date, there are no uniform standards for treating Ebola. Work has been going on to manufacture a vaccine since an Ebola outbreak in West Africa in 2014 that resulted in more than 11,000 deaths. This vaccine, which was officially approved against Ebola in November 2019, is currently used by healthcare workers and those who have had contact with infected people. A second, not yet approved vaccine against Ebola is currently being tested in a clinical study. Antibody preparations are also currently being used in a study. Two of these have been shown to be effective and can cure about 90 percent of patients.

A pathogen very similar to the Ebola virus is the Marburg virus, also a hemorrhagic fever. Both viruses belong to the filovirus family. They cause diseases that have a similar course and cannot be clearly distinguished from one another.

Due to the great danger of Ebola, the pathogen is being discussed as a possible warfare agent. However, there are no indications for such a use. An attempt by the Japanese Aum sect to use Ebola viruses for terrorist attacks in Japan failed.

Ebola: symptoms

It takes 2 to 21 days (eight to nine days on average) between infection and the outbreak of Ebola. Symptoms are:

• Headache and pain in the limbs
• high fever
• Conjunctivitis
• nausea
• skin rash

In the meantime, the fever can subside with Ebola. In this case, however, the disease often takes a more severe course later. In addition, kidney and liver function can be disturbed.

Severe internal and external bleeding can occur just a few days after the onset of the disease, mainly from the mucous membranes. In addition to the eye and the gastrointestinal tract, other organs can also be affected.

In the further course of Ebola, various organs often fail. Inflammation of the brain can also occur and further worsen the prognosis. The severe cases of illness are similar to septic shock and can be fatal. Heart failure is often the cause of death.

The described course of the disease is not specific to Ebola! Fever, bleeding, and organ damage also occur with other serious infections. This makes it difficult for doctors to make an accurate diagnosis at the beginning.

Ebola: causes and risk factors

The disease is caused by the Ebola virus, of which five strains are known. To date, three of these virus strains have caused major outbreaks of disease in humans.

Contagion from animal to human

The Ebola virus is transmitted to humans through close contact with infected animals or infectious animal products. It is believed that fruit bats form the natural reservoir of the pathogen; However, this is not certain. There is also a risk of infection from other infected animals, especially monkeys and pigs. For this reason, sick animals should be quarantined as soon as possible. The carcasses of dead animals must be carefully disposed of. Raw meat from these animals should not be consumed.

In contrast to many other tropical infections, transmission of the Ebola virus through mosquito bites is not yet known.

Contagion from person to person

The infection from person to person usually only takes place through close contact. In rare cases, the Ebola virus can also be transmitted by coughing (droplet infection).

Sick people are contagious as long as symptoms of the disease persist. Infections during the incubation period (the phase between infection with the pathogen and the onset of the first symptoms) have not yet been reported.

Relatives and caregivers of Ebola patients in particular are at high risk of becoming infected as well. When the disease broke out in Uganda in 2000, 60 percent of the caregivers became infected with the virus. Therefore, Ebola patients must be strictly isolated. All physical contact and the sharing of objects such as cutlery should be avoided. People who have been in very close physical contact with the patient may also be isolated. In any case, the body temperature should be checked regularly with each contact person.

Particular caution is also required when dealing with patients who have died of Ebola and their funerals. The same applies after surviving an Ebola infection: Even 61 days after the disease had subsided, the virus could still be detected in the seminal fluid of male patients.

Risk of infection when traveling to Ebola areas

According to experts, there is usually no increased risk of infection for travelers to areas where Ebola occurs (especially the tropical rainforests of Central Africa). Only those who have had close contact with infected people are at high risk. Nevertheless, all holidaymakers should inform themselves about the current health situation in the region before starting their journey.

Ebola is notifiable

Early warning systems for Ebola are essential to prevent or contain larger outbreaks. In Germany, even the suspicion of an Ebola infection must be reported by the attending physician to the responsible health department (with the name of the patient).

Ebola: examinations and diagnosis

It is particularly difficult to differentiate between Ebola fever and other diseases such as yellow fever, Lassa fever, dengue fever or malaria, especially in the early phase of the disease. In the event of suspicion, patients must be isolated early. Samples are taken and examined for the Ebola virus. The pathogen can be detected primarily in the blood, but also in the skin. Antibodies against the virus usually only develop in the later course of the disease.

Only specialized laboratories of the highest security level are allowed to work with the Ebola virus and examine sample material from patients who are suspected of having Ebola. There are such special laboratories in Munich, Hamburg and Berlin, among others.

If Ebola is suspected, blood values ​​are also closely monitored. In addition, precise checks will be carried out to determine whether bleeding occurs or organ functions are impaired.

Ebola: treatment

So far there is no specific therapy against Ebola, which is why the mortality rate remains very high. There are also no standardized treatment recommendations. Therapy with an antiviral drug can be considered, but in contrast to similar viral diseases, it has so far hardly been successful.

However, current studies with two new antibody preparations against Ebola give hope: According to current results, they can apparently cure up to 90 percent of patients if they are administered early.

Until they are approved as specific drugs against Ebola, Ebola infection can only be treated symptomatically. If possible, the patients receive intensive medical care. Adequate fluid intake with electrolytes is particularly important. In the event of (threatened) organ failure, an organ replacement procedure must be started quickly, such as dialysis for kidney failure.

In some cases, Ebola patients are also given antibiotics to combat secondary infections that can more easily affect the sick body. Sedatives can also be important to relieve the patient of anxiety. In addition, it is essential to control blood clotting.

Ebola: disease course and prognosis

The infection usually begins like a severe flu and then changes to the hemorrhagic fever phase - various types of bleeding occur. In the further course, organ damage can occur, which significantly worsens the prognosis. It is particularly fatal when important organs such as the kidneys fail.

The generally poor prognosis for the disease is also due to the underdeveloped health systems in the areas where the Ebola virus spreads. Symptoms and organ failure often require expensive and modern therapy methods, which are usually not available in such countries.

For these reasons, Ebola leads to death in 25 to 90 percent of cases. Often the infected die just a few days after the onset of the disease. Survivors of an Ebola infection often have to struggle with long-term effects such as psychosis and liver infections.

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