Diagnostic Approach to Fulminant Hepatitis in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Ebola, also called Ebola hemorrhagic fever, is a viral hemorrhagic fever of humans caused by the Ebola virus, a member of the Filoviridae family. It is spread by direct contact with body fluids, such as blood, stool, and vomitus of an infected human. Ebola is characterized by fever, fatigue, vomiting, diarrhea, rash, kidney, liver failure, and occasionally bleeding. It is associated with a high case fatality rate of 54.7%, with fatality rates reported to increase with age and high viral load [28]. Patients with Ebola virus disease were found to have AST/ALT levels of more than five times the upper limit of normal and, in severe cases, levels of more than 15 times the upper limit of normal [29]. Diagnosis of Ebola can be made by serum PCR on blood drawn within 3 days of the onset of symptoms. A rapid chromatographic immunoassay (ReEBOV) that detects Ebola virus antigen can provide results within 15 minutes; however, this has been associated with false-positive results in 10% of patients who tested negative by PCR [30]. On postmortem liver biopsy, hepatocellular necrosis with minimal inflammation is the primary histological finding. There is no specific therapy for Ebola, and treatment includes fluids and supportive care.
Public Health and Viruses
Patricia G. Melloy in Viruses and Society, 2023
In 2014, an Ebola outbreak started in Guinea and spread to two neighboring West African countries of Sierra Leone and Liberia. Ebola causes a hemorrhagic fever and is spread by bodily fluids. Once the Ebola outbreak began to move into more populated areas, the WHO declared it a public health emergency of international concern (an alarm sounded before a pandemic), and scientists and physicians from around the world were mobilized to help in the fight against the virus. International efforts on the ground in these countries were able to stop the virus from spreading worldwide. These efforts included healthcare workers and public health support from other countries, and the implementation of public health measures like increasing awareness of how to handle Ebola patients as well as those who died from the disease. Aggressive contact tracing and quarantining also helped put a stop to the virus in 2016, although 11,325 people died (Zimmer 2011; CDC 2022b).
The Black Death and Other Pandemics
Scott M. Jackson in Skin Disease and the History of Dermatology, 2023
Numerous other infectious diseases have been postulated as the cause of the Athenian plague. In 2005, researchers claimed to have extracted Salmonella typhi DNA from the teeth of the ancient remains in a mass grave, leading to the conclusion that typhoid fever was the cause of the plague. However, convincing arguments have come forth that the research was flawed.4 And the constellation of mucosal and skin findings described by Thucydides are not seen in typhoid fever, which has “rose spots” (small red flat spots on the torso), as its only skin finding. Other candidates for the Athenian plague are bubonic plague, epidemic typhus, and meningococcemia. Thucydides neglected to mention glandular swellings (buboes) as a feature of the disease, effectively ruling out bubonic plague. Another interesting hypothesis is that the Athenian plague was caused by Ebola hemorrhagic fever.5 Olson et al. point out that the plague was believed by the Greeks to come from Africa. Ebola is also associated with a sudden onset of fever, headache, and pharyngitis, followed by cough, vomiting, diarrhea, severe weakness, a red rash, and hemorrhage from various orifices. Arboviral (mosquito-borne) diseases, which can lead to encephalitis, should also be considered.
Defibrotide: potential for treating endothelial dysfunction related to viral and post-infectious syndromes
Published in Expert Opinion on Therapeutic Targets, 2021
Edward Richardson, David García-Bernal, Eleonora Calabretta, Rubén Jara, Marta Palomo, Rebecca M. Baron, Gregory Yanik, Jawed Fareed, Israel Vlodavsky, Massimo Iacobelli, Maribel Díaz-Ricart, Paul G. Richardson, Carmelo Carlo-Stella, Jose M. Moraleda
Severe manifestations of the Ebola virus including overt hemorrhage, shock, lymphopenia, and thrombocytopenia. Excessive proinflammatory cytokine production and absence of immune responses are recognized as major factors in the development of these phenomena [69]. As the Ebola virus infects monocytes, macrophages, dendritic cells, and ECs, direct infection may also contribute to disruption of endothelial homeostasis [70]. Widespread endothelial activation and dysfunction are an integral component of pathogenesis, leading to loss of vascular integrity, increased vascular permeability, and activation-dysregulation of the coagulation pathway [66]. This presents the endothelium as an attractive target in therapeutic approaches for Ebola virus infection, a disease with few established therapeutic strategies. Indeed, statins and ARBs have been utilized for their endothelial protective effects in the treatment of Ebola virus infection, with reported improvements in patient mortality [71]. As DF also protects endothelium and may similarly downregulate the Ang-II signaling axis, DF may also achieve therapeutic effects in patients with Ebola virus infection. As cytokine storm is recognized as a critical factor in Ebola virus disease; moreover, DF may stand to modulate the impact of excessive cytokine production on the endothelium. To our knowledge, DF has not been utilized in the treatment of these infections.
Clinical Manifestations and Pathogenesis of Uveitis in Ebola Virus Disease Survivors
Published in Ocular Immunology and Inflammation, 2018
Steven Yeh, Jessica G. Shantha, Brent Hayek, Ian Crozier, Justine R. Smith
Mattia et al.4 described uveitis in 50 (18%) of 277 Sierra Leone EVD survivors, who were evaluated for multiple post-EVD sequelae, including arthralgias (76%) and auditory symptoms (24%). Of patients who developed uveitis, the spectrum by anatomic location included anterior (46%), posterior (26%), intermediate (3%), and panuveitis (25%). The median time of presentation was 3 weeks following discharge from the Ebola Treatment Unit (ETU). Interestingly, presence of ocular symptoms (i.e. blurred vision, light sensitivity, itchy eye) was 88% sensitive for underlying uveitis, but only 51% specific. Within this cohort, 60% of EVD survivors reported ocular symptoms. A higher serum EBOV load (i.e. evidenced by lower cycle thresholds by quantitative real-time polymerase chain reaction after reverse transcription [RT-qPCR]) during acute EVD was associated with an increased risk of uveitis. However, arthralgias or auditory symptoms were not associated with the development of uveitis during convalescence.4
Treatment-focused Ebola trials, supportive care and future of filovirus care
Published in Expert Review of Anti-infective Therapy, 2018
Maryam Keshtkar-Jahromi, Karen A.O Martins, Anthony P. Cardile, Ronald B. Reisler, George W Christopher, Sina Bavari
The basic goals of Ebola supportive care are five-fold: (1) providing replacement fluid (PO and/or IV) and electrolytes (PO and/or IV); (2) maintaining oxygen status and blood pressure; (3) treating coinfections; (4) nutritional support; and (5) symptom control (including pain, nausea, vomiting, anxiety, and psychological support). The latest evidence-based guidelines for supportive care of patients with EVD published by Lamontagne et al. also recommend adequate staffing ratio, availability of biochemical testing, and communication with family and friends to optimize patients’ care [76]. Trad et al. recently argued that while the degree of sophistication of supportive care has not been definitively proven to be associated with improved EBOV survival, the assumption is that supportive care impacts survival [6]. Nonetheless, we know that the range in CFR for this outbreak was ~18.5% [21] in a state-of-the-art hospital/ICU compared to 72% in a CCC with a minimal formulary and a limited capability to medically intervene [74].