The current
outbreak of Ebola in March 2014 began, first announced by the Centers for
Disease Control and Prevention (CDC) on March 25, is the largest history.6, 7,
8 It is associated with a new strain of the species Zaire The deadliest the
five types of Ebola, with a death rate of about 55% reported 0.9 According to
the CDC, dated 30 September 2014 (the most recent information available to the
writing of this article), there were a total of 6574 cases (3626 were confirmed
laboratory) in 5 countries (Guinea, Liberia, Nigeria, Senegal and Sierra Leone)
and 3091 suspected cases deaths.10 Figure 1 shows a map of the West African
countries affected outbreak.11 the World Health Organization (WHO), but in a
statement, reported the numbers "underestimate the extent the epidemic
"in the course of fatalities and undiagnosed cases in communities far from
centers.12 of Health, 13
 |
Figure 1Centers for Disease Control and Prevention map of 2014 Ebola outbreak in West Africa—outbreak distribution map, updated September 17, 2014.11 |
On August 8, 2014, the current Director General of WHO, the current crisis Ebola said "emergency of international concern for public health," a statement released twice before: once in 2009 in response to H1N1 and again this year for polio. 14 This statement forces under Regulation require countries to "develop national preparedness functions, including the obligation to important events all over the world report, monitoring and the pursuit of public health drives the International Health 2005, but at the same human rights and international trade on. "9 at the time of this writing, the first international public health efforts to control the spread of the virus proved to be insufficient. The epidemic is an epidemic phase, with the United Nations request nearly $ 1 billion, enough to help the infection that contain numbers and WHO estimates that up to 20,000 people could be infected in the coming months. September 16, 2014 committed the United States to provide $ 500,000,000 and the use of up to 3,000 military troops in the region in the control effort.15 support
From the perspective of the media, infects the intensive coverage of both the development of the situation in Africa and the disposal and treatment of the current four US citizens in isolation at Emory University Hospital and Nebraska Medical Center16 Ebola first brought to the forefront of national consciousness. This has not only a renewed interest in the virus, but also a growing interest of the American public about the possible spread of the virus in the United Unis.17 18 Added concern public organization that arose Besides being a virulent infectious disease Ebola virus as a Category A bioterrorism bioterrorism classified agent.19 These concerns, however, are likely overstated.20 The possibility of Ebola virus disease with the United States, initially estimated 18%, 21 became a reality 30 September 2014, as the CDC has the first case of confirmed Ebola in the USA in Dallas, TX.22 diagnosis
Given its location at the front of patient care, emergency physicians should about the Ebola fever because it will let more cases with the United States. As the number of US emergency physicians actively involved in global efforts for health in Africa continues to rise, so does the possibility of contact with the Ebola virus disease virus. Even extensive media coverage of the African epidemic continues, doctors may be concerned serve patients and hospital staff in relation to risk factors, transmission important educators, clinical presentation and management of the Ebola virus disease. Professional organizations such as the American College of Emergency Physicians have begun resources for members, including the sharing of materials offer CDC.23 This article aims to emergency physicians with a set of assessment provide essential day clinical information about Ebola virus disease, including the initial assessment, the management and the latest guidelines for personal protection and facilities.
Of the five species of Ebola virus, a 3, a human significance and were also involved in large outbreaks: Zaire, Sudan and Bundibugyo Bundibugyo.9 and Sudan have a rate of about 25% and 50%, respectivement 0.24 A fourth lethality virus Ivory Coast, has been responsible for a single case in 1994 to Côte.4 The fifth species of Reston virus has been found in the Philippines and the United States25, but is not responsible for symptomatic disease in humans is responsible. 26
Even with great effort on the field studies, the identification of the natural reservoir host (s) of Ebola remains elusive.27 A leading suspect in a possible natural reservoir fruit bat.4, 28, 29, 30, however, was in spite of the discovery of the Ebola viral nucleic acid, antigen and antibody in bats, the virus itself not a clear case and without transmission isolated Ebola bat man has never proven.3, 30 In addition, the discovery of the species in Reston pigs emphasizes the importance of considering the existence of other reservoir species, as well as a potential role of reinforcement hosts.4
Since none of the Ebola virus species known to be native to North America, 31, a first estimate of US patient has two clinical symptoms and epidemiological risk factors considered to be a have "suspicious" case Ebola fever. These risk factors to have as published by the CDC, "the contact with blood or other body fluids or human remains of a patient or with Ebola virus disease, residence or travel suspicion indicate where the transmission of a viral disease Ebola Zone Active handling, directly or bats or non-human primates from endemic areas. "32 In addition, risk factors must be present within 21 days of onset of symptoms.
The transmission of Ebola fever occurs by direct contact through the skin or mucous membranes or by objects such as needles. Body fluids, including saliva, blood, vomiting, diarrhea, and sperm seem infectious.33 transfer occurred from Ebola victims died in the family members that are performed ablution of the body burial. Ebola is transmitted through direct contact with infected animals, especially the handling of animal carcasses or consume single physical contact meat.3 bush with an infected person does not seem sufficient to the disease.34 In general contracting the virus, Ebola is not thought through droplet or airborne transmission are distributed, the role of airborne transmission in recent outbreaks not fully excluded.4, 34 thus for comparison, it has not been considered as contagious as measles or flu. Contaminated droplets are briefly released in the air during the operations on the infected patients.35 In addition executed, the people, the aerosol transmission of the virus Ebola virus in non-human primates demonstrated in experimental setting.34 36 Unlike measles or flu, not contagious until symptoms.
The pathogenesis of Ebola fever is immunosuppression, increased vascular permeability and coagulation disorders. Ebola virus in the patient through the mucous membranes and skin lesions and affects many cell types, including cells of the immune response, endothelial cells, hepatocytes, adrenocortical cells and epithelial cells.37 Ebola virus disease causes endothelial injury, which disseminated in vascular permeability and bleeding complications of intravascular coagulation. 38 results are probably due to a combination of liver damage, disseminated intravascular coagulation, and violations of primary marrow megakaryocytes. The Ebola virus infection is also characterized by a congenital severe immunosuppression. The virus attacks the immune response as well as a plurality of channels carrying the rapid proliferation of the virus and to its lethality.38 39
The Ebola virus infection. By an initial non-specific viral syndrome complicated by septic shock and disseminated intravascular coagulation from The incubation time for the people in the range of 2 to 21 days. Most patients are symptomatic after 8-9 days, and when symptoms are present, the infection is contagious.40 41 history provisional Dallas seems to correspond to this time course.22 2 lists the signs and symptoms of Ebola virus disease. Early symptoms include sudden high fever, malaise, sore throat, headache, muscle aches, and vomiting and diarrhea plentiful. Clinical results belonging occur after 3-5 days unexplained bruising or bleeding, renal failure, encephalopathy, multiple organ failure, hypovolemia, and disseminated intravascular
coagulation.
Malaria is another important diagnosis in all febrile patients with flu
symptoms, who lives and comes from Africa to consider. It is difficult to
distinguish between these two diseases early in their presentation. Figure 3
shows a comparison of Ebola fever and malaria
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