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Ebola haemorrhagic fever: threat from tropical forests

Hemorrhagic fevers relatively recently became known to the general public. However, they have already managed to take their place next to the great epidemics of the past - plague, cholera, typhoid. Of these, the most famous disease is caused by the Ebola virus - an infection locked within the African continent, but potentially able to penetrate anywhere in the world. What threatens us with this disease?

Content

What is Ebola hemorrhagic fever

Ebola haemorrhagic fever, or a disease caused by the Ebola virus (EVD), is a serious illness characterized by an unusually high mortality rate. The name of the fever was at the place of initial detection - the Ebola River Basin in Zaire. The causative agents of the disease are several viruses of the same genus with similar properties.

Until 2010, the disease occurred mainly in villages and small towns. Recent outbreaks occur in densely populated urban areas.

Ebola virus

The different variants of the Ebola virus vary slightly in structure.

Ebola viruses belong to the family of filoviruses. The same group includes pathogens Marburg fever. The close relationship of these pathogens causes similarities in the symptoms of the two diseases.

Ebola viruses are highly aggressive, penetrating into all tissues of the body and remaining there for a long time - up to 9 months after recovery. People with a weakened immune system, pregnant women and children suffer the disease worse than other categories of the population. In their case, the severity of symptoms and the likelihood of death increase. The virus easily passes through the placental barrier, thereby threatening both the expectant mother and the fetus.

Table: Representatives of the genus Ebolavirus

Virus variant Date and place of detection Features of the pathogen
Zaire the city of Yambuku, Zaire, 1976 The first described Ebola virus. It has the highest percentage of mortality - up to 90%.
Sudanese Nzara City, Sudan, 1976 The exact mechanism of transmission from animals to humans is unknown.
Reston Germany, allegedly imported from the Philippines, 1989 Found in the blood of green macaques. Not dangerous for humans.
Ivory Coast Cote d'Ivoire forests, 1994. Later studies showed the presence of the virus in the tissues of people who became ill in 1976.
Bundibugio Bundibughio district, Uganda, 2007 In the WHO reports, it is conventionally referred to as a subtype of the Ebola virus.

Video: Ebola

Causes and factors of development

For a long time, work is underway to elucidate the reservoir of infection — that is, animals in which the virus circulates between noticeable outbreaks. Accumulated data suggest that these are:

  • forest rodents of West and Central Africa;
  • monkey.

When a person comes into contact with infected animals, the virus easily penetrates the mucous membranes and skin. Catching workers, as well as employees of research laboratories, are particularly at risk. Among the indigenous peoples of Africa, outbreaks of the disease predominantly arise from the consumption of insufficiently roasted monkey meat, antelope, and bats.

Wildlife Meat

Eating bushmeat increases the risk of being infected with the Ebola virus.

Once in the human body, the virus quickly reaches a high concentration of its particles in all tissues and secretions. This increases the risk of infection through direct contact with the patient, and through everyday objects. With an insufficient level of development of medicine, there is a chance of infection through non-sterile instruments - that is why it is believed that the first outbreak of fever occurred in Zaire. The risk of infection by airborne droplets is relatively low.

The natural circulation of the virus is limited to several African countries:

  • Gabon;
  • Zaire;
  • Cameroon;
  • Kenya;
  • Liberia;
  • Nigeria;
  • Senegal;
  • Sudan;
  • Central African Republic;
  • Ethiopia.

The appearance of the disease outside this zone occurs either as a result of the removal of infected animals, or during the movement of infected people during the incubation period. In this way, the Ebola fever in 1976 first entered the UK. The first case of infection on the territory of Russia was noted in 1996.

Symptoms of the disease

The duration of the incubation period for Ebola fever ranges from a few days to 3 weeks. During this time, the virus accumulates in the spleen and lymph nodes, but is not released into the environment. The first symptoms resemble the manifestations of angina. The mass release of viral particles into the blood activates a whole cascade of toxic and autoimmune reactions, manifested in the form of:

  • increase in body temperature to +39 ° C;
  • pains:
    • head;
    • intestinal;
    • pulmonary;
    • muscular;
    • articular;
  • general weakness;
  • cortex-like rash;
  • nausea;
  • vomiting.

A typical sign of the disease is the development of disseminated intravascular coagulation syndrome (DIC), a pathology in which blood initially forms a large number of clots, and then abruptly loses its ability to coagulate. At the first stage, numerous blood clots clog the vascular lumen, limiting the access of oxygen and nutrients to organs and tissues. Subsequently, these clots are destroyed, they are replaced by bleeding:

  • skin, in the place of damage of integuments;
  • conjunctival;
  • intestinal;
  • stomach;
  • uterine;
  • from gums;
  • from mucous membranes.
Conjunctival bleeding with Ebola

Numerous bleeding occurs in all organs and tissues of the patient.

Hemorrhages in the internal organs provoke symptoms that resemble the development of:

  • hepatitis A;
  • orchitis;
  • pancreatitis;
  • pneumonia;
  • epilepsy;
  • encephalopathy.

Under the influence of pathological processes, connective tissue is destroyed. The strength of vessels, integuments, and mucous membranes is sharply reduced. So, for example, heavy bleeding can occur due to simply pressing on the skin or stretching it. The mucous epithelium lining the gastrointestinal tract and respiratory system is easily separated by large fragments with vomiting, coughing, diarrhea. Foci of necrosis appear in the tissues, emitting highly toxic decomposition products.

The acute form of the disease lasts no more than three weeks. A fatal outcome is likely to begin from the fourth day, but the greatest number of deaths occur on the 10–14 day of the open phase. The cause of death can be:

  • intoxication;
  • extensive blood loss;
  • shock:
    • hypovolemic - developed due to a sharp decrease in the volume of circulating blood;
    • infectious toxic - arising under the influence of decay products.
Late symptoms of Ebola

As the disease progresses, tissue damage becomes severe and irreversible.

With a favorable outcome, the recovery may last for several months. Immunity acquired as a result of postponed Ebola fever is highly resistant. The probability of re-infection does not exceed 5%.

Diagnostics

Diagnosing Ebola is a challenge. First, the absence of specific symptoms that distinguish the disease from a multitude of local infections requires laboratory tests. Secondly, the narrow range of the virus makes it difficult to diagnose outside this zone. Thirdly, any contact with the patient is dangerous for the medical staff. That is why all diagnostic activities are carried out in specialized laboratories of maximum IV level of biological protection.

Working with the Ebola virus

Diagnosing Ebola requires the maximum level of biological protection

For testing, the patient’s blood and saliva are usually used. In addition, nasopharyngeal mucus, skin fragments and urine can be taken. The main areas of specific diagnostics are:

  • Ebola Antibody Detection:
    • indirect immunofluorescence reaction (RNIF);
    • serum neutralization (PCH) reaction;
    • enzyme-linked immunosorbent assay (ELISA);
    • complement fixation reaction (RAC);
  • detection of viral particles and their components:
    • polymerase chain reaction (PCR) and its modification with reverse transcriptase (RT-PCR);
    • isolation of the pathogen in cell cultures;
    • electron microscopy.

Among non-specific diagnostic methods, blood tests are of prime importance:

  • general - reveals a decrease in the number of red blood cells and white blood cells, then - an increase in the level of the latter;
  • biochemical - determines the increased activity of enzymes (amylases and transferases);
  • coagulographic - confirms DIC.

The degree of damage to internal organs is established using non-invasive techniques:

  • radiography;
  • ultrasound (ultrasound);
  • electrocardiography (ECG).

Specific laboratory tests allow us to differentiate Ebola with similar symptomatic diseases.

Table: Differential Diagnosis of Ebola

Disease Differences with Ebola Diagnostic methods
Flu
  • differentiated from the initial stage of the disease;
  • the nervous and gastrointestinal systems are slightly damaged;
  • antibodies to the influenza virus are present in the blood, but not to Ebola.
  • visual inspection;
  • immunological analysis.
Leptospirosis
  • there are no pulmonary and gastrointestinal symptoms;
  • Bacteria of the genus Leptospira and antibodies to them are detected in the samples, but there are no signs of virus activity.
Hemorrhagic fevers (yellow, Lassa, Marburg)
  • the samples contain the genetic material of the corresponding pathogens;
  • Ebola virus is not detected.
  • PCR;
  • RT-PCR.
Malaria
  • DIC syndrome is not pronounced;
  • in the blood there are cells of malaria plasmodium and antibodies to them.
  • visual inspection;
  • microscopy;
  • immunological analysis.
Sepsis bacterial cells are found in the blood (staphylococci, streptococci, E. coli), but not Ebola virus particles
Typhus in the samples are detected bacteria of the genus Rickettsia.
Cholera
  • throughout the acute phase of the disease intestinal symptoms dominate;
  • in the samples taken, cells of Vibrio cholerae are detected, and antibodies to them are found in the blood.

Ebola treatment

Currently, there are no effective drugs that can immunize a person to Ebola (vaccine) or suppress viral activity in the acute phase of the disease (serum). The treatment is completely symptomatic. Used drugs relieve manifestations of dehydration, intoxication, DIC, thereby allowing the immune system to withstand the immediate threat - a viral infection.

With a significant loss of fluid to the patient provide plenty of drink containing electrolytes. The impossibility of oral administration involves intravenous fluids.

Disseminated coagulation is overcome by injections of various drugs, depending on the stage of the process. At the initial stage, anticoagulants and disaggregants (Heparin, Defibrotide, Curantil, Trental), antishock drugs (Reopoliglukine), corticosteroids (Prednisolone, Methylprednisolone) are shown. In the future, medications that activate blood coagulation (Gordox, Kontrykal, Etamzilat) are used. Intensive blood loss is compensated by injections of albumin, plasma, erythrocyte mass. In infectious foci, the plasma of people with strong immunity, who had previously had Ebola, is often used.

With a successful outcome of treatment, the patient is prescribed bed rest and good nutrition. It is recommended to refrain from stress and physical exertion for the next 3 months.

Gallery: drugs used for symptomatic therapy

Treatment prognosis and possible complications

The prognosis for treating Ebola is unfavorable. The outcome of therapy depends entirely on the properties of the patient’s immunity, as a result of which the probability of recovery is 10–45% . But even in this case, there is a high risk of complications:

  • alopecia (hair loss);
  • anorexia;
  • asthenia (physical and psychological exhaustion);
  • irreversible damage to internal organs:
    • hearts;
    • brain;
    • the liver;
    • lungs;
    • spleen;
    • the kidneys;
    • large vessels;
  • mental disorders.

Prevention

People in the area of ​​the Ebola virus are strongly advised to avoid:

  • eating meat from wild animals, especially raw ones;
  • interactions with animals without protective clothing;
  • contact with others who show obvious symptoms of infection;
  • sexual intercourse with recently recovered Ebola;
  • long stay in public places.

If hemorrhagic fever is suspected, patients are immediately hospitalized in closed departments with the maximum level of biological protection. All their personal items are thoroughly disinfected. Surfaces and patient excretions are treated with solutions of iodoform and phenol. Instruments are subjected to high temperature sterilization.

Work in the infected area

Personnel working in Ebola outbreaks must use protective suits.

All personnel working with patients should be in protective suits. The bodies of the dead are cremated as soon as possible. Recovered patients, as well as healthy people who violate quarantine, are isolated for close observation and laboratory tests for 3 weeks.

Ebola haemorrhagic fever is an extremely dangerous disease with a severe course and an unpredictable outcome of treatment. Reliably protect themselves from its threats allows only the exact observance of preventive and anti-epidemic measures in the foci of infection.

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